Question #,Patient Demographic,Mental Status Exam,Presenting Problem,Other Contexts,Question,Choice A,Choice B,Choice C,Choice D,Potential Answers,Correct Answer,Correct Answer (Letter),Explanation For Correct Answer,Competency
1, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.","As a culturally competent counselor, how should you respond to Malik's gift?","I appreciate the sentiment, but I am not allowed to accept gifts.","This is so sweet! But you should keep them, I'm on a diet!","I can't keep them, but let's open them now and share them together.",Mahalo! This is lovely. Thank you for thinking of me.,"(A): I appreciate the sentiment, but I am not allowed to accept gifts.
(B): This is so sweet! But you should keep them, I'm on a diet!
(C): I can't keep them, but let's open them now and share them together.
(D): Mahalo! This is lovely. Thank you for thinking of me.",Mahalo! This is lovely. Thank you for thinking of me.,D,"It is of significance in Hawaiian and many other cultures to bring gifts from one's homeland, sending the message of affection or respect while showcasing and representing the beauty and history of one's culture. Knowing and understanding the meaning behind small gestures and further being able to communicate using common greetings from your client's ethnic culture are ways you can demonstrate cultural competency within clinical boundaries. Answer a may come across as disrespectful or as a rejection of one's heritage, and counselors may accept small, non-monetary gifts of appreciation without crossing ethical boundaries. Answer c would have the same effect, even if it came across as a well-meaning excuse for not accepting a gift. Even if you were on a diet, acceptance of the gift may be more important to your client than the reason why you cannot enjoy it. Answer d is irresponsible as it may convey that you feel like Malik may be infectious and sharing foods would be unsanitary. Therefore, the correct answer is (B)",professional practice and ethics
2,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Taking into consideration what you have learned during the session, what is most important for you to consider when choosing an initial treatment modality for the client?",The client's preference regarding pharmacological intervention,The client's status as a stay-at-home mother,The client's relationship with her husband,The client's therapeutic expectations,"(A): The client's preference regarding pharmacological intervention
(B): The client's status as a stay-at-home mother
(C): The client's relationship with her husband
(D): The client's therapeutic expectations",The client's preference regarding pharmacological intervention,A,"Of these options, the client's preference regarding pharmacological intervention is most important when choosing an initial treatment modality for the client. It is important to ensure that the client is comfortable with any medications prescribed and that the client has an understanding of possible side effects and is given the opportunity to make an informed decision about any medication prescribed. As indicated, the client has stated having a ""bad"" experience with medications in the past, and her preference is to first try counseling without medication. Therefore, the correct answer is (A)",treatment planning
3,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client contacted you to reschedule a session sooner than the one you had originally scheduled. The client reported that he continues to have difficulty getting to work on time and was told that he needs to meet with his supervisor on Friday. The client expresses anxiety surrounding this because he worries about getting fired. The client began to cry during the session when talking about worry regarding being unemployed. The client came to the session in clothes that had stains on them, and his hair was messy and appeared greasy.  Due to increased anxiety and depressive symptoms, you choose to use CBT techniques","Due to increased anxiety and depressive symptoms, you choose to use CBT techniques. Which of the following would be an intervention used in CBT?",Cognitive restructuring or reframing,Assess for readiness for change,Operant conditioning,Reality acceptance,"(A): Cognitive restructuring or reframing
(B): Assess for readiness for change
(C): Operant conditioning
(D): Reality acceptance",Cognitive restructuring or reframing,A,"CBT is based around cognitive restructuring and reframing, which can be a very effective intervention for anxiety or depression. Reality acceptance is part of dialectical behavior therapy and would not be as beneficial for this client because the anxiety is based around an unknown outcome. Assessing readiness for change is part of motivational interviewing, and it is not clear at this point whether the client is willing or able to change. Operant conditioning is a behavior therapy approach that involves positive/negative reinforcement and punishment. Therefore, the correct answer is (A)",counseling skills and interventions
4,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","You are meeting with the client individually and providing parenting training with the client’s PGM. The client’s teacher has implemented a behavioral chart for the classroom, and you ensure the client is receiving appropriate reinforcement for targeted behaviors. The teacher believes the client’s behavior indicates ADHD, and you have agreed to conduct classroom observations. During the observation, you note that the client gets out of her seat multiple times to sharpen her pencil. While doing so, she glares at other students and is observed balling up her fists and threatening others. The teacher yells at the client to sit down and stop disrupting the classroom, which has little effect on the client’s behavior","Which instrument would you select to further assess the client’s social and emotional problems, including DSM-specific disorders such as ADHD, ODD, and other conduct problems?",The Brief Symptoms Inventory-18 (BSI-18),The Woodcock-Johnson IV (WJ IV),The Conners’ Third Edition (Conners 3),The Achenbach Child Behavior Checklist (CBCL),"(A): The Brief Symptoms Inventory-18 (BSI-18)
(B): The Woodcock-Johnson IV (WJ IV)
(C): The Conners’ Third Edition (Conners 3)
(D): The Achenbach Child Behavior Checklist (CBCL)",The Achenbach Child Behavior Checklist (CBCL),D,"The Achenbach Child Behavior Checklist (CBCL) helps detect social and emotional problems, including disorders such as ADHD, ODD, and other conduct problems. The CBCL detects DSM-specific symptoms in the following six categories: affective problems, anxiety problems, somatic problems, ADHD, oppositional defiant problems, and conduct problems. The CBCL also provides information on eight syndrome scales, including aggressive behavior, social issues, and rule-breaking behavior. The Brief Symptoms Inventory-18 (BSI-18) is an 18-item assessment that provides information on three subscales: somatization, depression, and anxiety. The Woodcock-Johnson IV (WJ IV) is an intelligence test that evaluates a wide range of cognitive functions with three batteries: the WJ IV Tests of Cognitive Abilities, the WJ IV Tests of Oral Language, and the WJ IV Tests of Achievement. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
5,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which of the following counseling skills or interventions should be used during this session?,Redirecting John's attention to Jane's distress,Exploring both families of origin patterns and themes,Psychoeducation on relaxation techniques for John and Jane,Summarizing John's fears about infertility and loss,"(A): Redirecting John's attention to Jane's distress
(B): Exploring both families of origin patterns and themes
(C): Psychoeducation on relaxation techniques for John and Jane
(D): Summarizing John's fears about infertility and loss",Summarizing John's fears about infertility and loss,D,"During the individual interview, John openly discussed fears of his own infertility and the loss he would feel if he could not have a child. Because he has not been communicating with Jane, this would be important to summarize with John so that Jane can become more aware of his fears and emotional reaction to their infertility issues. This provides an opportunity for these issues to be discussed by the couple during sessions, while x John has not yet identified his feelings and actions to Jane so this intervention would not be appropriate at this time. Relaxation techniques are helpful when working through strong emotions, however, John is not showing strong emotional engagement at this time. Therefore, the correct answer is (A)",counseling skills and interventions
6,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.",Which of the following referrals will be most helpful in treating the client's hoarding disorder?,Refer client to psychiatry for medication evaluation,Refer client to local government services for evaluation of adequate housing,Refer client to behavioral health to determine client's competency to make decisions,Refer client to a professional organizer who can help organize the client's home,"(A): Refer client to psychiatry for medication evaluation
(B): Refer client to local government services for evaluation of adequate housing
(C): Refer client to behavioral health to determine client's competency to make decisions
(D): Refer client to a professional organizer who can help organize the client's home",Refer client to psychiatry for medication evaluation,A,"Referring the client to psychiatry will be most helpful for treating the client's hoarding disorder due to the components of depression, OCD, and ADHD that are often co-occurring with hoarding disorder. Treatment with SSRIs is helpful in treating those with hoarding disorder. Referring to a professional organizer will not be adequate, although once the client has made gains through therapy, teaming a counselor with a professional organizer who is trained to work with hoarding disorders may be helpful. While hoarding disorders may include difficulty with decision-making, the client does not demonstrate incompetence and referral for evaluation or declaration of incompetence would be inappropriate. Counselors may provide information on local resources for housing but although the client's housing may not be adequate at this time, referring her to resources that may condemn and/or remove her from her home threatens the therapeutic relationship and dishonors the autonomy of the client to choose where she lives. Therefore, the correct answer is (B)",counseling skills and interventions
7,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",You teach Shawn the cognitive strategy of labeling his negative thoughts while they are occurring in his mind in an emotionally detached manner and guide him in applying mindful observations without judging himself. This is an example of?,Thought Responding,Thought defusion,Oral Cognitive Restructuring,Paradoxical Repetition,"(A): Thought Responding
(B): Thought defusion
(C): Oral Cognitive Restructuring
(D): Paradoxical Repetition",Thought defusion,B,"Thought defusion is applying mindful observation of your negative thoughts, then labeling your negative thoughts while they are occurring in your mind and reflecting on them unemotionally and without judgment (""For the moment, I'm having an anxious feeling, but it will pass eventually""). Then, instead of trying to restructure the negative thought, you redirect your attention to an activity or person in the moment as a ""thought interruption"" technique, avoiding self-criticism. This is a gentler approach to helping someone learn how to identify their thoughts and become used to managing them in an un-intimidating and passive way. A person who is constantly being told they must change may be resistant to the criticism. The other methods listed would be useful as brief cognitive strategies for change, but are not thought defusion as described in the question. Therefore, the correct answer is (C)",counseling skills and interventions
8,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",Which treatment objective would provide the client with long-term relief from her stress and anxiety?,Mastering deep breathing techniques during stressful situations,Identifying time-management skills and mindfulness techniques,Learning how to implement positive self-talk in times of stress,Increasing emotional resilience and problem-solving skills,"(A): Mastering deep breathing techniques during stressful situations
(B): Identifying time-management skills and mindfulness techniques
(C): Learning how to implement positive self-talk in times of stress
(D): Increasing emotional resilience and problem-solving skills",Increasing emotional resilience and problem-solving skills,D,"Increasing emotional resilience and problem-solving skills would provide the client with long-term relief from her emotional symptoms. She struggles with anxiety and depression related to taking on the role of caregiver for her mother and having her mother live in the family home. Therefore, the correct answer is (A)",treatment planning
9,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.","Millie admits to abusing pain medication prescribed by her doctor for treating medical issues, as well as getting high on inhalants in her room at her grandparents' house. What is your next step?",Educate Millie on the harmful effects of substance abuse.,Inform her father and grandparents for her own safety.,Prepare Millie for a referral to a higher level of care.,Call 911 to have Millie expedited to detox.,"(A): Educate Millie on the harmful effects of substance abuse.
(B): Inform her father and grandparents for her own safety.
(C): Prepare Millie for a referral to a higher level of care.
(D): Call 911 to have Millie expedited to detox.",Prepare Millie for a referral to a higher level of care.,C,"Unless Millie is experiencing an overdose, incapacitated, or in danger of harming herself or others, calling 911 is not necessary and you can work with Millie on understanding what the next steps would be for entering into a higher level of care should she choose to comply with your recommendations. Education, as in answer b, would present itself as an intervention used during this referral conversation, as well as throughout substance use treatment, but is not enough at this time to ethically address Millie's use. Millie would also be responsible for informing her parents of her plans, as HIPAA does not permit the counselor to report this to an adult's family on their behalf with special exceptions, such as if an individual has a previously indicated mental handicap and is under special guardianship as an adult for such purposes. Therefore, the correct answer is (D)",treatment planning
10,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","Given the nature of your relationship in the school setting, and the time you realistically can allot to the client, as well as her age and maturity level, which approach will you initially use to engage the client in the therapy process?",Person-centered therapy,Solution-focused brief therapy,Reality therapy,Cognitive-behavioral therapy,"(A): Person-centered therapy
(B): Solution-focused brief therapy
(C): Reality therapy
(D): Cognitive-behavioral therapy",Person-centered therapy,A,"The client is in a vulnerable state right now. Using a person-centered approach and practicing unconditional positive regard, genuineness, and empathic understanding will help you establish trust with her. Therefore, the correct answer is (C)",counseling skills and interventions
11,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client comes to the session reporting that he and his girlfriend attempted to have sex the past week, and he wrote down some thoughts he was having on his CBT thought log. The client and the clinician reviewed his thoughts and engaged in cognitive reframing to support him in creating new scripts to use when engaging in sex. The client also wrote down physical responses to anxiety that he was experiencing before and during sex that included muscle tension and increased heart rate. The client identified that one thought he had during sex was “I feel inadequate as a man; therefore, I must be inadequate because I can’t fully satisfy my girlfriend","The client identified that one thought he had during sex was “I feel inadequate as a man; therefore, I must be inadequate because I can’t fully satisfy my girlfriend.” Which of the following cognitive distortions best defines this thought?",Overgeneralization,Fortune-telling,All-or-nothing thinking,Emotional reasoning,"(A): Overgeneralization
(B): Fortune-telling
(C): All-or-nothing thinking
(D): Emotional reasoning",Emotional reasoning,D,"Emotional reasoning is the cognitive distortion displayed here because the client is accepting his emotion as a reality even though just feeling something does not make it true. The client is not experiencing all-or-nothing thinking because he is not experiencing polarized thinking. The client is not fortune-telling because he is not predicting future experiences based on present feelings. The client is not overgeneralizing because he is not applying his current feelings to other situations. Therefore, the correct answer is (A)",counseling skills and interventions
12,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ","Using a cognitive-behavioral approach, what technique could help your client through the thoughts she is dealing with by feeling she is responsible for her friend's death?",Exploration of family constellation,Reattribution,"""Acting as if""",Psychodrama,"(A): Exploration of family constellation
(B): Reattribution
(C): ""Acting as if""
(D): Psychodrama",Reattribution,B,"Reattribution is a CBT technique which takes a situation and examines the automatic thought by considering alternatives for the events under consideration. Therefore, the correct answer is (C)",counseling skills and interventions
13, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.","Despite your possible feelings about Raul's mother's parenting skills, you smile with her as she shares information and offer her kindness and support. What is this practice called?",Fake it 'til you make it,Positive psychology,Emotional restraint,Unconditional positive regard,"(A): Fake it 'til you make it
(B): Positive psychology
(C): Emotional restraint
(D): Unconditional positive regard",Unconditional positive regard,D,"This is a core competency of counselors and demands a non-judgmental stance. Therapy is intended to offer a client a different experience than they have ever had; offering compassion and positive regard makes it easier on the client to communicate their needs, feelings, fears, desires, and concerns. Answer b) is not a clinical term or practice. Answer c) is just suggestive of holding back emotions but does is not a core counseling attribute. Positive psychology is the scientific study of the strengths that enable clients to thrive and is founded on strengths-based interventions. Therefore, the correct answer is (A)",core counseling attributes
14,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.  Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself.    When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress.    Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, ""My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?"" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious.    At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week.  Tenth session You have been working with Michael to develop and practice effective coping skills appropriate to his age. You have been using behavioral modification techniques to decrease his anxiety about being away from his parents. During previous sessions, you suggested that his parents leave your office space for progressively more extended periods. Michael has complied with these requests, although he was initially anxious and agitated. After five weeks, he is now able to tolerate being away from his parents for up to an hour. In today's session, the parents reflect on their son's progress since he started therapy. They believe that he has made a significant improvement. To date, there have only been ""little incidents."" The parents report that two days ago, Michael was reluctant to go to bed without them and had a minor fit. Instead of escalating the situation, they calmly reminded him of the strategies he had learned in therapy such as taking deep breaths when feeling anxious. To their surprise, Michael began using his coping skills and went to bed peacefully. Michael's mother tells you, ""It finally feels like we've turned a corner. I'm so proud of him!"" The parents have also received positive updates from Michael's teachers who say that he is doing much better in school. They report that he has made a new friend and was invited to a sleepover. Michael seems excited about the idea. His parents are not sure how he will handle being away from home overnight, but they are willing to try.    After providing you with an update, the parents leave the room to wait in the waiting room while you talk to Michael. He appears receptive and comfortable with this arrangement. He tells you, ""I kind of feel dumb for being scared. I'm sorry for causing so much trouble."" You respond affirmatively and validate his feelings. Next, you say, ""I remember when you first came to my office with your mom and dad. You were having a lot of trouble being away from them. Do you think that's still a problem for you?"" He shakes his head ""No"" and reports that he is now able to be away from his parents for longer periods of time without feeling scared or upset. You ask him what has been most helpful to him when he starts to feel anxious. He says, ""The counting and breathing stuff you showed me how to do. Also, I think about something fun that I did with my mom and dad, like that time we went to the beach and built a giant sandcastle!"" You tell him how proud you are of his progress and encourage him to keep using the coping strategies he has learned in therapy.    Near the end of the session, you invite Michael's parents back into your office to check in with them about next steps. The parents agree that Michael has made significant progress in tolerating separation and they feel that the treatment has been successful. You offer additional resources for follow-up care and suggest a plan for transitioning out of therapy. Lastly, you thank Michael and his parents for their dedication throughout the course of therapy and let them know that you are available if they have any further questions or concerns.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ",What follow-up recommendation would be most beneficial for the client?,Periodic check-in sessions,Assign a case manager to call him when he is at home,Pediatrician checkup,Involvement in specialized group therapy,"(A): Periodic check-in sessions
(B): Assign a case manager to call him when he is at home
(C): Pediatrician checkup
(D): Involvement in specialized group therapy",Periodic check-in sessions,A,"Although you believe the client is ready for termination, this process can be a difficult adjustment. Being available for periodic check-in sessions following the termination will increase the client's ability to maintain the progress he made in therapy. Therefore, the correct answer is (B)",treatment planning
15,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","The client comes in, sits down, and immediately says that she has been thinking and decided that she is now ready to talk about the physical abuse that she has experienced. She recounts that from age 18 until age 20 she was with a boyfriend who would smack her if she said something he did not like. She believes this is why she is so preoccupied with pleasing others. The client’s second relationship was when she was 25 with a man who would get drunk nightly and punch her in the stomach or in the back when he was upset. You empathize with the client and reflect her emotions regarding these events. The client states, “I didn’t deserve it when the drunk guy hit me, but I do feel I wasn’t the best girlfriend with the first guy. I often didn’t do enough for him and often said the wrong thing.” Throughout the session, the client was tearful and started shaking slightly when speaking several times. The client paused for long periods before sharing more difficult parts of the story. You decide to assess for PTSD during this session, but she does not meet the criteria. When closing the session, the client states that she is not able to pay for today’s session until the end of the week. The client has no history of nonpayment with you thus far.  Your informed consent includes fees for nonpayment and late cancellations of sessions",Your informed consent includes fees for nonpayment and late cancellations of sessions. Which of the following is the most therapeutic response to the client’s inability to pay for the session until the end of the week?,Allow the client until the end of the week to pay for the cost of the session with the added fee.,Waive the session fee and nonpayment fee because the client is experiencing financial hardship.,Allow the client until the end of the week to pay for the session and waive the nonpayment fee.,"Consistency with fees is important in the client–counselor relationship. The fee should still be applied, and payment is still expected on time","(A): Allow the client until the end of the week to pay for the cost of the session with the added fee.
(B): Waive the session fee and nonpayment fee because the client is experiencing financial hardship.
(C): Allow the client until the end of the week to pay for the session and waive the nonpayment fee.
(D): Consistency with fees is important in the client–counselor relationship. The fee should still be applied, and payment is still expected on time",Allow the client until the end of the week to pay for the session and waive the nonpayment fee.,C,"Because this client has no history of nonpayment, it would be the most therapeutic course of action to waive the nonpayment fee and allow the client extra time to pay for the session. Generally speaking, fees for the counseling sessions, for late cancellations, and for nonpayment are beneficial for the counselor and the client. The fees ensure that the counselor is paid, and they develop a level of buy-in and accountability for the client to have regular sessions. A blanket rule to apply the fee every time does not take into consideration special circumstances and can harm the counseling relationship. Waiving the fees for the session and nonpayment would not be a good course of action because you do not know at this point if the client will continue to have issues with payments and the client has already agreed to pay for your services. Therefore, the correct answer is (A)",professional practice and ethics
16, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.",What should you do at this stage of the session?,Align with her empathically and wait for her to be ready to engage undistracted,Inform her the session will be a waste of a Medicaid billing hour and she should reschedule,Explain how her children being present is inappropriate and a violation of HIPAA,Call Department of Family Services to report emotional abuse of children,"(A): Align with her empathically and wait for her to be ready to engage undistracted
(B): Inform her the session will be a waste of a Medicaid billing hour and she should reschedule
(C): Explain how her children being present is inappropriate and a violation of HIPAA
(D): Call Department of Family Services to report emotional abuse of children",Align with her empathically and wait for her to be ready to engage undistracted,A,"In order to build rapport, safety, and trust with this client, especially through a telemedicine platform, it is important to demonstrate concern for her emotional wellbeing and to prioritize your therapeutic relationship. A parent yelling in frustration at her children is not enough evidence to support a claim of emotional abuse. While children in session may not seem appropriate, this is the parent's choice; in many cases clients may not have the ability to secure childcare for sessions. Emotional support for the client should be prioritized over the counselor's idea of how a session should be spent. In this case, the client requested the session to continue. Therefore, the correct answer is (C)",professional practice and ethics
17,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex.  You have provided support for your counseling intern, and he continues to be late for and miss client sessions","You have provided support for your counseling intern, and he continues to be late for and miss client sessions. Which of the following would meet ACA criteria for ethical considerations at this point?",You see this as an opportunity to support the intern in balancing his personal life and his professional life.,You seek consultation and document your decision to terminate your supervisory relationship with the intern.,You encourage the intern to seek counseling in order to work through what he is going through.,You provide a corrective action plan to the intern in order to prevent further issues with his clients.,"(A): You see this as an opportunity to support the intern in balancing his personal life and his professional life.
(B): You seek consultation and document your decision to terminate your supervisory relationship with the intern.
(C): You encourage the intern to seek counseling in order to work through what he is going through.
(D): You provide a corrective action plan to the intern in order to prevent further issues with his clients.",You seek consultation and document your decision to terminate your supervisory relationship with the intern.,B,"At this point, documenting the consultation and terminating the relationship would be indicated because the intern is continuing to harm clients (ACA, 2014, p 13). You have already tried to support the intern, and it was not helpful in preventing client harm or changing his behavior. At this point, a corrective action plan may not be helpful because the intern has not shown that he is willing to change. It may be helpful to encourage the intern to seek counseling; however, this does not address the potential for further client harm. Therefore, the correct answer is (A)",professional practice and ethics
18,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.  Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior.    Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships.",,"After the client shares his revelation, you state, ""It's impressive that you were able to make the connection between your road rage and feeling taken advantage of by your children."" What are you attempting to do with this response?",Empower the client,Provide Unconditional Positive Regard,Demonstrate congruence,Engage the client in therapy,"(A): Empower the client
(B): Provide Unconditional Positive Regard
(C): Demonstrate congruence
(D): Engage the client in therapy",Empower the client,A,"Affirmation is a form of encouragement that is used to affirm behaviors or life choices. Affirmation is important for empowering clients. A few common affirmations include affirming progress that a client has made toward a goal or encouraging a client to do what is important to him. Therefore, the correct answer is (C)",counseling skills and interventions
19,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”","You respond to Davone saying “You are clearly disappointed, and obviously hurt as well! I can't imagine not being able to see my children. It would be so hard.” This is an example of?",reflection,empathy,sympathy,direct correlation,"(A): reflection
(B): empathy
(C): sympathy
(D): direct correlation",empathy,B,"Validating your client's presentation and feelings while attuning to their emotional condition can strengthen your therapeutic bond and help them to feel heard and understood. Offering sympathy shows pity for your client but does not accomplish the congruence that empathy does and maintains an emotional distance from your client, placing them in a position to feel the same sorrow and pity for themselves as opposed to connected. Reflection is part of the active listening process in which the therapist repeats back to the client what was heard. Direct correlation is a mathematical term. Therefore, the correct answer is (B)",counseling skills and interventions
20,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.  Ninth session You have seen the client weekly, and she is progressing. She arrives at today's session on time. She appears calm, alert and focused. She states that she has been actively journaling her thoughts and feelings. This has been helpful for her in identifying themes in her faulty cognitions. She tells you that she is surprised by how much she is learning about herself, including how much her past has influenced her current beliefs.    She showed some psychomotor agitation by pulling on the strings of her blouse. The client expressed that she and her husband have been trying to implement a date night which has helped their relationship and for him to better understand what Panic Disorder is. She said that having meaningful conversations with him and having his support in times of panic has helped reduce the attack's length. However, the client did express that she cannot shake the fear of dying and leaving her children. You discuss with her the potential triggers of these panic attacks and discuss ways to manage them.    As she leaves, you see that she has bruises on her arms as she is getting ready to leave and says she was ""roughhousing"" with her husband. You are unsure if she is telling the truth, making you wonder about everything she has been saying about her husband. You discuss with her the option of attending couples therapy to help them work through any issues they may face. She says she is open to it but worried about bringing up deeper issues surrounding their relationship. You reassure her that she and her husband will have a safe space to discuss any topics and remind her about the counseling.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ",Which of the following would be the least appropriate response to the client's disclosure?,"""It's understandable that you have a fear of dying and leaving your children. It's natural to think about the worst-case scenario. Can you tell me more about this fear?""","""Let's look at some of the pros and cons of your fear. On the one hand, this fear may be a way to protect your children and ensure they are taken care of. But, on the other hand, your fear paralyzes and prevents you from living your life to the fullest. What do you think?""","""It sounds like you have some substantial concerns about dying. Can you tell me more about why your fear around this subject is so strong?""","""I also had a fear of dying for a long time. I think my fear came from a combination of my childhood experiences and denying my mortality. Do any events from your childhood come to mind that might be related to your fears?""","(A): ""It's understandable that you have a fear of dying and leaving your children. It's natural to think about the worst-case scenario. Can you tell me more about this fear?""
(B): ""Let's look at some of the pros and cons of your fear. On the one hand, this fear may be a way to protect your children and ensure they are taken care of. But, on the other hand, your fear paralyzes and prevents you from living your life to the fullest. What do you think?""
(C): ""It sounds like you have some substantial concerns about dying. Can you tell me more about why your fear around this subject is so strong?""
(D): ""I also had a fear of dying for a long time. I think my fear came from a combination of my childhood experiences and denying my mortality. Do any events from your childhood come to mind that might be related to your fears?""","""Let's look at some of the pros and cons of your fear. On the one hand, this fear may be a way to protect your children and ensure they are taken care of. But, on the other hand, your fear paralyzes and prevents you from living your life to the fullest. What do you think?""",B,"This is not the best way to respond to a client's fear of dying as it does not provide any strategies to help the client cope with their fear. It also does not acknowledge the client's feelings or provide any support or reassurance. Therefore, the correct answer is (C)",professional practice and ethics
21,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",Would it be appropriate for you to provide counseling for both Shania and Malia?,"Yes, because you can always provide therapy for both parent and child.","No, because you need a child psychology degree to work with a child.","No, since you can never be the counselor for both a parent and child.","Yes, because this is the nature of your job at this company.","(A): Yes, because you can always provide therapy for both parent and child.
(B): No, because you need a child psychology degree to work with a child.
(C): No, since you can never be the counselor for both a parent and child.
(D): Yes, because this is the nature of your job at this company.","Yes, because this is the nature of your job at this company.",D,"In this scenario your counseling position is to provide services to individuals and their family members. General counseling ethics will guide your boundary making decisions with every case, however in this unique circumstance you are the case worker for the entire family which makes seeing them together appropriate. It is not advised that you are the same provider for more than one family member in other circumstances, but the agency you work for, job description, and case specifics will help inform your boundaries and guide your decision. For reasons of confidentiality, appropriateness, or clinical considerations, you may have difficulty being the advocate of a child while also providing individual services for a parent. While there are specialists in child therapy training and child psychologists, you do not need a child psychology degree or specialized training with children to provide mental health counseling support to them and their families (unless it is against your agency rules or your job description. Therefore, the correct answer is (C)",professional practice and ethics
22,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.  10th session During your last session with the client, she discussed the anxiety that she was feeling about going home for winter break in a few weeks. She told you that her mom and stepdad always prepare a large meal for the holidays, and the extended family members get together to eat. She expressed a desire to participate in the family festivities but concern about her mom and stepdad's lack of understanding about her illness. She told you, ""I don't want to make anyone feel bad, but I just can't eat like everyone else. It's not only the food - it's the conversations and comments about my body that really bother me."" You listened as she expressed her fear of disappointing her family and reassured her that is was okay to set boundaries and have conversations about food. Together, you brainstormed coping strategies to manage her anxiety. You also suggested that she bring a dish of food that she would be comfortable eating to the winter break gathering. At the end of the session, she asked if she could bring her parents to the next session in an effort to gain their support and to help them understand what she is going through. You agreed to her request and scheduled an appointment to meet with the client and her parents.    At the start of today's session, you introduce yourself to her parents and explain your role in helping their daughter. The client's mother tearfully shares that she had no idea her daughter was struggling so much and that she wishes she had picked up on the signs sooner. The stepfather appears quiet and reserved. You help guide a conversation between the client and her parents about her eating disorder and symptoms that she is experiencing. The client shares her fears, triggers, and struggles around food. Her stepfather speaks up and says, ""I've heard enough. This is just ridiculous. You should just be able to eat, like everyone else. Your generation has gone 'soft' and started making up problems. There are people out there who don't have any food. When I was growing up, we had nothing. Your behavior is disrespectful."" As he is talking, the client's mother is quiet and visibly uncomfortable. The client interjects, ""Are you kidding? I'm the one who's being disrespectful?"" She looks toward you and says, ""When I'm home, he cooks these extravagant meals and refuses to let me leave the table until I've eaten what he's served me because it's 'wasteful to throw away food.' It's abuse! I feel like a captive when I'm at home."" She looks back at her stepfather and says, ""All I'm asking is that you understand what I'm going through and try to be a little more supportive."" The stepfather's face turns red with anger, and he gets up to leave the room. You intervene and ask him to stay, offering a suggestion that you all take a few moments to reflect on what each person has shared before continuing the conversation. While the stepfather takes a break, you encourage the mother to open up and express her feelings. She reveals that she is scared of not being able to help her daughter and feels helpless in understanding how to come together as a family. You discuss ways that she can be supportive and provide an empathetic environment for her daughter.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","Based on best practices for family therapy, how would you recommend structuring future sessions with the client and her parents?",Propose bringing in a co-therapist to take the stepfather for individual work while you continue with the client and mother.,Decline any further joint sessions to avoid exposing the client to further harm and conflict. Only meet with her individually.,Hold joint sessions to resolve conflicts and teach communication skills together.,"Suggest individual sessions for each, then small joint sessions with the client and mother before full family sessions.","(A): Propose bringing in a co-therapist to take the stepfather for individual work while you continue with the client and mother.
(B): Decline any further joint sessions to avoid exposing the client to further harm and conflict. Only meet with her individually.
(C): Hold joint sessions to resolve conflicts and teach communication skills together.
(D): Suggest individual sessions for each, then small joint sessions with the client and mother before full family sessions.","Suggest individual sessions for each, then small joint sessions with the client and mother before full family sessions.",D,"Starting with individual sessions allows each family member to work on their concerns separately, optimizing progress. Small joint sessions for the client and mother can nurture their relationship before engaging the stepfather. This staged approach minimizes the risks of re-traumatization. Therefore, the correct answer is (C)",professional practice and ethics
23,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter.  The client discloses that he has recently taken up boxing to release pent-up energy",The client discloses that he has recently taken up boxing to release pent-up energy. This is an example of which one of the following?,Sublimation,Regression,Rationalization,Reaction formation,"(A): Sublimation
(B): Regression
(C): Rationalization
(D): Reaction formation",Sublimation,A,"Taking up boxing to release pent-up energy is an example of sublimation. Sublimation, rationalization, reaction formation, and regression are all defense mechanisms. Defense mechanisms are unconscious means for protecting a person from overwhelming feelings of anxiety. Sublimation occurs when a person redirects unacceptable urges in a socially acceptable way (eg, boxing). Rationalization is when a person provides a logical reason for behaving or thinking instead of the actual reason or motive. Reaction formation occurs when a person expresses the opposite opinion, feeling, or action because their true belief causes great anxiety. Regression is the process of returning to an earlier stage of development when encountering overwhelming feelings of fear, anger, anxiety, or resentment. Therefore, the correct answer is (D)",counseling skills and interventions
24,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.  Sixth session The wife presents for today's session without her husband. She reports that two nights ago, he was taken to the emergency room for pain. He had been drinking, and test results at the hospital liver indicated that his liver functioning was impaired. He continues to deny that he is drinking, but she knows this is untrue as she has been finding half-full liquor containers hidden around the house. She starts to cry, ""I don't know what I will do without him. I had to call a babysitter and get a cab to come here. I'm worried about how I'll pay for the mortgage if my husband can't work. We'll end up losing the house and our health insurance! I'm going to have to sell off everything to make ends meet!"" You respond to her fears with empathy and understanding. You are respectful of the client's thoughts and feelings and seek to understand her experience. You also explore the cognitive error that your client has made and how this is affecting her emotions.    You continue the session by asking her what her most immediate concerns are at the moment and what she needs help with. She pauses for a moment and then starts to explain how she is feeling overwhelmed by the situation and feeling helpless in being able to help her husband. She expresses a lot of fear and anxiety about her family's financial security and the potential loss of the house and health insurance if her husband's drinking continues. She expresses a need for support and understanding and worries about how she will cope without her husband. She feels isolated and alone, stating, ""I feel like my worst nightmare has come true. I've been worrying about my husband's drinking for a long time. I've heard horror stories about how addiction can ruin people's marriages, and I don't want that for us. I know it's hard for him, but it's hard for me, too."" You offer her some resources that could help her with her financial situation and ask her to put together a list of a few people she feels she can talk to for emotional support.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",The wife's reaction to the loss of her husband's income is an example of which cognitive error?,Catastrophizing,Mental Filtering,Overgeneralization,Polarization,"(A): Catastrophizing
(B): Mental Filtering
(C): Overgeneralization
(D): Polarization",Catastrophizing,A,"Catastrophizing is the cognitive error of automatically expecting the worst-case scenario to occur. In this case, the client is jumping to the conclusion that she will lose her mortgage and health insurance and have to sell everything without considering other potential solutions or outcomes. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
25,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.  Fifth session This is your fifth weekly session with the client, and she states that she likes the ""structure"" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, ""I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal.""    You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, ""I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships."" You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family.    During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she ""had other stuff going on.""  Seventh session During today's session, the client tells you that she read a few of the chapters in the book you recommended on human sexuality, and she is starting to feel more comfortable with herself. At your suggestion, she started keeping a journal to organize her thoughts and feelings about her sexuality. She says that she has ""pretty much decided to end my engagement and take some time to explore who I am and what it means to be in a relationship with another woman."" She relates that she still feels homesick at times, but her roommate has been supportive and understanding. She smiles and says, ""My roommate surprised me the other day by cooking a traditional dish that I told her about that my mom used to cook for us growing up. It was so comforting to have a reminder of home like that."" You continue to explore the client's thoughts on telling her parents about her newfound identity, and she says that although the idea of coming out to them and breaking off her engagement is frightening, she knows it is ""the right thing to do."" You provide guidance on how to approach this sensitive subject in a way that may be best received by her family. You also provide additional resources that may help her learn more about navigating conversations around sexuality and sexual orientation with family and friends. The client notes that if all goes well, she'd like to take her roommate back home with her for a visit during a school break so they can spend time together away from school.",,What is the best way to demonstrate empathic attunement in response to the client's fear of her family's disapproval?,"""What would you advise another person in your situation to do?""","""It's understandable that you are worried about how your family will react. It can be very difficult to balance the expectations of your family with your own needs.""","""How would you feel about role playing a conversation with your family about your relationship? This might help alleviate some of the anxiety that you're feeling.""","""You're not alone in this experience and what you're feeling is valid.""","(A): ""What would you advise another person in your situation to do?""
(B): ""It's understandable that you are worried about how your family will react. It can be very difficult to balance the expectations of your family with your own needs.""
(C): ""How would you feel about role playing a conversation with your family about your relationship? This might help alleviate some of the anxiety that you're feeling.""
(D): ""You're not alone in this experience and what you're feeling is valid.""","""It's understandable that you are worried about how your family will react. It can be very difficult to balance the expectations of your family with your own needs.""",B,"This is an example of empathic understanding because it acknowledges the client's feelings and validates her concerns without passing judgment. It shows that the therapist understands the difficulty of navigating family expectations, while also affirming the client's autonomy to make decisions about her own life. This response allows the client to feel heard and understood in a non-judgmental environment. Therefore, the correct answer is (C)",core counseling attributes
26,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","   ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.”  You use a biopsychosocial assessment during the client’s initial intake appointment",You use a biopsychosocial assessment during the client’s initial intake appointment. Which one of the following uses a holistic approach to address a client’s biopsychosocial and spiritual dimensions?,Humanistic,Behavioral,Cognitive-behavioral,Psychoanalytic,"(A): Humanistic
(B): Behavioral
(C): Cognitive-behavioral
(D): Psychoanalytic",Humanistic,A,"A humanistic style uses a holistic approach to address a client’s biopsychosocial and spiritual dimensions. Humanistic theories include person-centered therapy, gestalt therapy, and existential therapy. CBT’s primary focus is to help clients change thought patterns characterized by erroneous, irrational, or negative beliefs. There are several examples of CBT, including REBT, dialectic behavior therapy, and cognitive therapy. Psychoanalytic theory addresses the effects of early childhood experiences on the unconscious mind. Behavioral therapy is based on the assumption that a person’s behaviors can be changed through rewards, punishments, reinforcement, and desensitization. Therefore, the correct answer is (B)",counseling skills and interventions
27, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,"Theodore decides that he would like to tell Nate about his decision to not move in with him. A Gestalt technique in which Theodore can practice, by playing both sides of the conversation, would be?",Role playing,Empty chair technique,Rehearsal technique,Drama therapy,"(A): Role playing
(B): Empty chair technique
(C): Rehearsal technique
(D): Drama therapy",Empty chair technique,B,"The empty chair technique is a Gestalt technique in which Theodore practices the conversation between him and Nate. This can show the counselor the expectations that Theodore has of Nate. This technique is also used in counseling for internal conflicts where an individual may have a conversation with a part of themselves, or a younger self. Role playing would be the client playing himself or Nate and the counselor playing the other. Drama therapy describes many techniques, not specific to Gestalt. The rehearsal technique is used to enhance memory and is a way to practice a speech or dialogue. It is not a two-way conversation. Therefore, the correct answer is (B)",counseling skills and interventions
28,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""  Eighth session The client has been coming to therapy consistently for seven weeks. During today's session, he states that he has been able to have sex once to full term and has been practicing his relaxation skills before initiating sexual activity with his wife. The client tells you, ""My wife just doesn't do it for me anymore. With the other two women I am currently seeing, I can go two, even three times. I don't feel guilty, and it feels great to feel like a man now."" This is the first time your client has admitted his infidelity to you.    The client expresses feelings of relief to speak honestly about his infidelities and the dual benefit of ""feeling like a man again"" and being able to perform sexually. He reports that he feels more confident and his anxiety levels have decreased since engaging in extra sexual activity with the other two women and his wife.","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","Using an Adlerian approach, what technique might be most appropriate for this client in light of the client's most recent revelations regarding his extra affairs?",Push button technique,Guided imagery,"""Spitting in the client's soup""",Empty chair,"(A): Push button technique
(B): Guided imagery
(C): ""Spitting in the client's soup""
(D): Empty chair","""Spitting in the client's soup""",C,"The Adlerian technique ""spitting in the client's soup"" can be used to bring awareness to a persistent pattern of negative behavior (ex. the client having affairs while saying he wants to enjoy a sexual relationship with his wife). Therefore, the correct answer is (B)",counseling skills and interventions
29,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.  Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is ""officially sleeping in the spare bedroom"" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, ""We don't talk anymore. He just berates me all the time, and that hurts a lot."" As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, ""She's a mess. I don't know what to say.""    You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed.    Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship.  Seventh session You met previously with each partner separately. They shared their perspectives with you about their relationship. The husband told you that he was reluctant to stay with his wife. The wife described feelings of worthlessness and loneliness. Today, the husband arrives for their couples session ten minutes after the wife, as they are driving in separate cars. The husband states that he is bored at home and is tired of his wife ""nagging"" him. The wife rolls her eyes and expresses that she will never be a priority, and the husband blames her for everything that goes wrong. The wife is now staying at her friend's house, and the husband is relieved that she is gone. You talk to the couple about their perceived outcomes in therapy and what they hope to accomplish going forward.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ","When talking to the wife, you tell her that sometimes you take a break from your own marriage by taking a ""mini-vacation"" for a weekend. What are you doing here?",Using self-disclosure,Summarizing the client's statements,Empowering the client,Demonstrating respect for the client's autonomy,"(A): Using self-disclosure
(B): Summarizing the client's statements
(C): Empowering the client
(D): Demonstrating respect for the client's autonomy",Using self-disclosure,A,"You are disclosing personal information to the client. As a therapist, you can self-disclose as long as you do not take away from the client and as long as your self-disclosure is appropriate to the client's situation. Therefore, the correct answer is (A)",professional practice and ethics
30,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client",Which of the following indicates that this client is ready for termination?,"The client reports that no symptoms of the eating disorder or trauma are present, and you also observe no symptoms.","The client states that she is not restricting, bingeing, or purging and that she and her husband are going to start couples counseling.",The client has nothing to talk about in sessions and reports that she does not have anything she needs to work on.,"Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur.","(A): The client reports that no symptoms of the eating disorder or trauma are present, and you also observe no symptoms.
(B): The client states that she is not restricting, bingeing, or purging and that she and her husband are going to start couples counseling.
(C): The client has nothing to talk about in sessions and reports that she does not have anything she needs to work on.
(D): Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur.","Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur.",D,"It is not always realistic to expect all symptoms to be abated. When minimal symptoms are present and the client is able to manage them and maintain progress, termination is appropriate. Although no symptoms being present is the ideal, this may never be attainable in some clients; therefore, it is appropriate to terminate when the client is able to be autonomous and manage her symptoms by herself. The client having nothing to talk about is not ideal for termination because this may indicate that she is not reporting or not being forthcoming with what she is experiencing. The client’s report regarding eating habits and a plan for couples counseling is good progress, but it does not focus on the client’s autonomy regarding her ability to manage symptoms on her own. Symptoms may be present long after therapy, but one of the most important aspects of counseling is that the client is able to self-regulate and manage what life sends to her. Therefore, the correct answer is (B)",professional practice and ethics
31, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.",Which response would help Leah regulate her emotions while accepting her situation?,Explain that feeling anxious is unhelpful if she cannot change anything.,Remind her of her counseling skills and challenge her to use them.,Validate her feelings and acknowledge her virtues as a mother.,Deliver a list of possible solutions to her problems.,"(A): Explain that feeling anxious is unhelpful if she cannot change anything.
(B): Remind her of her counseling skills and challenge her to use them.
(C): Validate her feelings and acknowledge her virtues as a mother.
(D): Deliver a list of possible solutions to her problems.",Validate her feelings and acknowledge her virtues as a mother.,C,"Regardless of Leah's knowledge and competency as a clinician, she is in the vulnerable position of needing to feel supported just like any other clients in your caseload. Therefore, using the same strategies as you would with a client who does not already possess prior knowledge of anxiety reduction skills will offer the most effective delivery of emotional comfort. Normalizing or validating her distressing thoughts has been proven in behavioral therapy techniques to actively reduce a person's momentary suffering because it allows them to feel the way they do without challenging them to fight against it which can often be more anxiety-provoking. Using strengths-based and positive psychology strategies of reflecting her virtues as a mother who prioritizes her child is a way of motivating her out of her own value system and hopefully leading her into a discussion about accepting her temporary, unchangeable position. Reminding her of coping skills, offering her solutions, or even attempting to have her rationalize, are all secondary supportive techniques to helping Leah feel heard, understood, valued, and accepted. If she were momentarily able to use her coping skills, she would have. Reviewing them and challenging her at this moment could increase her feelings of shame she has already expressed that she is not able to put into practice things she knows she should do. Trying to solve her problems for her will not help her as much as regulating her disposition in session for her to be able to find solutions to her own problems. Therefore, the correct answer is (D)",counseling skills and interventions
32,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","At the start of the session, the foster parents ask the client if she would mind meeting alone with you; she agrees and asks to have access to the toy bin in your office. You and the client begin to play together, and you ask her if she talked to her birth parents. The client says “yeah, Mommy talked about coming home in a few years.” You ask how she feels about living with her mother again, and she says she does not want to be with her because her mother does not want to be with her. You try to process this with the client, and she says that she likes her house and her school and does not want to leave. You meet with the foster parents and the client at the end of the session, and they report that spending quality time with the client on a daily basis has been helpful in improving their relationship. They state that they think they had been too afraid to overwhelm her and that at times they were trying to give her space, but they realize that the intentional time together has been helpful. You empathize with the foster parents and encourage them to continue to spend quality family time with her.  The court provides a subpoena for an update on the counseling process",The court provides a subpoena for an update on the counseling process. All of the following are appropriate considerations EXCEPT:,Providing all progress notes and assessments,Only sending information in an encrypted and secure manner,Providing only relevant material,Obtaining legal counsel,"(A): Providing all progress notes and assessments
(B): Only sending information in an encrypted and secure manner
(C): Providing only relevant material
(D): Obtaining legal counsel",Providing all progress notes and assessments,A,"Even when information is subpoenaed, it is important to only provide relevant information, which means that you may not provide the client’s entire file. The ACA Code of Ethics encourages only sharing information that is relevant to the entity receiving the information (ACA Governing Council, 2014). It may be helpful to obtain legal counsel to navigate this situation because you want to ensure that you are providing what is legally appropriate. It is always important that information is sent in a manner that is compliant with HIPAA standards. Therefore, the correct answer is (B)",professional practice and ethics
33,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","The husband and wife come into the session and sit as far as they can from each other on the couch, and their individual body positions are oriented away from each other. You ask for any updates in the couple’s relationship, and the husband states that they have not been talking about the affair and continue to only communicate regarding the kids. You attempt to process with the couple what the affair means for their relationship and what events led up to the affair. During the session, the husband stops talking and looks away from his wife when she talks about how she became frustrated that her husband did not spend quality time with her prior to the affair. She thinks that this led to her seeking attention from a man outside of the couple’s relationship","Based on John and Julie Gottman’s concept of the four horsemen of the apocalypse, which include criticism, defensiveness, contempt, and stonewalling, which one of the following terms describes the husband’s communication style when he disengages from the session?",Criticism,Contempt,Defensiveness,Stonewalling,"(A): Criticism
(B): Contempt
(C): Defensiveness
(D): Stonewalling",Stonewalling,D,"The husband’s response is an example of stonewalling. Stonewalling occurs when a partner stops engaging in communication. Criticism involves attacking the partner for who they are and what they do. Contempt involves treating the partner with disrespect and ridicule. Finally, defensiveness involves making excuses for behavior and often deflects from addressing the partner’s feelings. These often are sequential, going from criticism to contempt and subsequently from defensiveness to stonewalling (Lisitsa, 2021). Therefore, the correct answer is (C)",counseling skills and interventions
34,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","During the previous session, the client committed to controlled drinking and agreed on a limit of two drinks per night. She admits to having limited success with this goal and concedes to over-indulging when feeling “stressed out.” You learn she ran into a woman from her church who she discovered was a recovering alcoholic. She agreed to meet the woman at an AA meeting, and the client was surprised she could relate to other alcoholics. The client’s affect brightened as she reported that she has had seven days of continuous sobriety. She continues to have a strained relationship with her now ex-husband. Her youngest child is home on spring break, which has helped improve her mood and kept her accountable for staying sober. She is able to use relaxation and mindfulness techniques for insomnia, which have been effective at times at improving her sleep pattern","According to the Transtheoretical Stages of Change model, in which stage would you classify this client?",Precontemplation,Action,Preparation,Contemplation,"(A): Precontemplation
(B): Action
(C): Preparation
(D): Contemplation",Preparation,C,"The Transtheoretical Stages of Change (SOC) Model, developed by Miller & Rollnick (2013), outlines the following SOC: precontemplation, contemplation, preparation, action, and maintenance. This client has just entered the preparation stage. Individuals in the preparation stage consider making a change but are unsure exactly how to do so. Like others in this stage, this client has taken significant steps towards sobriety, but there is still unresolved ambivalenceShe has explored AA and is in early sobriety but will need specific behavioral goals and a more solid commitment to reach the action stage. Individuals in the precontemplation stage are not considering a change, while those in the contemplation stage are beginning to consider making a change. Those in the contemplation stage are still drinking but are weighing the pros and cons of cutting back or abstaining. This client was in the contemplation stage when she attempted to cut back to two drinks per night. Individuals in the action stage have a specific behavioral plan and are committed to the process of change. When individuals become more stable in their sobriety, they have reached the maintenance stage. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
35,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",What approach should you recommend Shania use with Malia for discipline?,"Use preventative, supportive, and corrective discipline.",Set strict boundaries with consequences.,Use positive parenting approach.,You should learn more about and meet Malia prior to making suggestions.,"(A): Use preventative, supportive, and corrective discipline.
(B): Set strict boundaries with consequences.
(C): Use positive parenting approach.
(D): You should learn more about and meet Malia prior to making suggestions.",You should learn more about and meet Malia prior to making suggestions.,D,"It is best practice whenever possible to obtain as much information about a client's parenting experience and their children before offering suggestions of methods to apply. Conducting skills tests, hearing family history, understanding the child's medical or psychological conditions, observing the parent-child interaction are some of the many ways to obtain information prior to making recommendations. A well-informed evaluation could lead to different interventions that could be more directly targeted towards the problem rather than attempting to treat the patient, using basic parenting skills, such as possible psychiatric medications for the child, distress tolerance training for the parent, or even clinical assessments that discover autism spectrum disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
36,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations.”  After your discussion with the client about her social media use, she sends you a Facebook friend request","After your discussion with the client about her social media use, she sends you a Facebook friend request. What is your ethical obligation regarding the use of social media, distance counseling, and other related technology?",To have written procedures in place and reviewed before or during the client’s initial session,"To recognize the potential harm and benefits of developing an informal virtual relationship with clients, former clients, and their families and personal friends","To disclose that you maintain a professional and personal online presence, and it may be difficult for the client to distinguish between the two","To include in the client’s record all electronic communication, except clerical information (e.g., appointment scheduling)","(A): To have written procedures in place and reviewed before or during the client’s initial session
(B): To recognize the potential harm and benefits of developing an informal virtual relationship with clients, former clients, and their families and personal friends
(C): To disclose that you maintain a professional and personal online presence, and it may be difficult for the client to distinguish between the two
(D): To include in the client’s record all electronic communication, except clerical information (e.g., appointment scheduling)",To have written procedures in place and reviewed before or during the client’s initial session,A,"Your ethical obligation is to have written procedures in place and reviewed before or during the client’s initial session. Answer B is incorrect. According to the NBCC Code of Ethics (2016), “NCCs shall include all electronic communications exchanged with clients and supervisees, including those through digital technology and social media methods, as a part of the record, even when strictly related to clerical issues such as change of contact information or scheduling appointments” Answer C is incorrect because it includes benefits and harms rather than only specifying harms. The NBCC Code of Ethics states, “NCCs shall recognize the potential harm of informal uses of social media and other related technology with clients, former clients and their families and personal friends” Lastly, the ethical guideline for an online virtual presence included in the ACA Code of Ethics (2014) states, “separate professional and personal web pages and profiles are created to clearly distinguish between the two kinds of virtual presence (ACA, 2014)”. Therefore, the correct answer is (A)",professional practice and ethics
37,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”","When assessing this client's cultural identity, which of the following will provide the most information?",Influence of client's cancer on her mental health,"Influence of client's race, ethnicity, and sexuality on her mental health",All of the above,Influence of parent's divorce on her mental health,"(A): Influence of client's cancer on her mental health
(B): Influence of client's race, ethnicity, and sexuality on her mental health
(C): All of the above
(D): Influence of parent's divorce on her mental health",All of the above,C,"Culture encompasses all groups which an individual has membership in, including race, ethnicity, socioeconomics, sexuality, religion, biological disease or emotional disorder, and family of origin. For example, research shows that people who grow up in divorced households have different experiences than those in non-divorced households. Just as people from different ethnic cultures have differing experiences based on their cultural norms, so do people who have experienced chronic disease, such as cancer. Cultural identity is not restricted to race and includes assessing for all influences on a client's identity. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
38,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.","You discuss with Shania how trauma is a psychological injury that continues to harm one's cognitive and emotional state, often rendering them helpless to recurrent patterns of maladaptive behaviors. She agrees to begin trauma work. In what order would you attempt the following interventions?","coping skills, TF-cognitive therapy, order for EMDR and/or neurofeedback","cognitive therapy, teach coping skills, EMDR","neurofeedback, prolonged exposure therapy, cognitive therapy, teach coping skills","EMDR, teach self-soothing techniques, TF-cognitive therapy","(A): coping skills, TF-cognitive therapy, order for EMDR and/or neurofeedback
(B): cognitive therapy, teach coping skills, EMDR
(C): neurofeedback, prolonged exposure therapy, cognitive therapy, teach coping skills
(D): EMDR, teach self-soothing techniques, TF-cognitive therapy","coping skills, TF-cognitive therapy, order for EMDR and/or neurofeedback",A,"It is crucial that prior to having a client address their trauma they learn to master coping skills, both during exercises in session as well as at home in real life situations. Concurrent to teaching coping (self-soothing techniques included) you should engage your client in cognitive interventions, such as Cognitive Processing Therapy approach and trauma-focused Cognitive Behavioral therapy. Once they have thoroughly discussed their traumas and become comfortable managing their reactions and emotions in counseling sessions, they should continue interventions such as neurofeedback operations or EMDR (eye-movement desensitization reprocessing) techniques. Neurofeedback machines are not commonly found on most agency sites and technicians must be specialty trained to administer the resource; but they have been found to drastically reduce emotional complications from trauma, anxiety, and depression often in a single session. EMDR is a specialty intervention requiring licensure and/or certification and training. As a counseling intern in a state-run facility, you would have to order a referral for this service. EMDR interventions may seem like the first line of defense in treating trauma, however without first feeling comfortable with approaching traumatic content in therapy and having confidence in one's ability to self-soothe resultant anxiety, it is possible for EMDR to be too challenging. Prolonged exposure therapy is effective if relatable to certain traumas where one can control the reduction of fear response associated with the trauma (ie, driving over the bridge where they had a car accident, or taking a shower after being attacked in water). It would not be appropriate for Shania who has a history of physical and verbal abuse by her parents. Therefore, the correct answer is (D)",treatment planning
39,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","You learn that the client withheld information during the intake interview because of a negative experience with psychiatric treatment. Two years previously, the client presented at the emergency room with symptoms of depression and suicidal ideation. The emergency department clinician recommended hospitalization, and the client complied. During his hospital stay, he was placed on an antipsychotic medication for paranoia and was diagnosed with schizoaffective disorder. Although the client admits to suicidal ideation, he denies ever experiencing paranoia. He reports having side effects from the medication and immediately discontinued it after discharge. The client states that he has been very depressed since the breakup with his girlfriend and was willing to give counseling another try before his depression “hit rock bottom.”  After disclosing his experience with hospitalization, the client asks questions about your credentials, counseling approach, and experience","After disclosing his experience with hospitalization, the client asks questions about your credentials, counseling approach, and experience. What would be your first response?",Understand and validate the client’s experience with hospitalization and consider contextualized factors.,Shift the focus back to the client and emphasize the importance of honest communication regarding suicidality.,Obtain a signed release of information to communicate with the hospital and request the client’s records.,"Provide a written copy of informed consent, which includes your credentials and related information.","(A): Understand and validate the client’s experience with hospitalization and consider contextualized factors.
(B): Shift the focus back to the client and emphasize the importance of honest communication regarding suicidality.
(C): Obtain a signed release of information to communicate with the hospital and request the client’s records.
(D): Provide a written copy of informed consent, which includes your credentials and related information.",Understand and validate the client’s experience with hospitalization and consider contextualized factors.,A,"You would first seek to better understand and validate the client’s experiences with psychiatric care and consider contextualized factors (eg, race, gender, ethnicity). For example, researchers suggest that African Americans are more likely to be diagnosed with schizophrenia or psychosis than non-Hispanic whites presenting with the same symptoms. Your client’s misdiagnosis likely contributes to medical mistrust and influences his help-seeking behaviors. Establishing a therapeutic alliance at this juncture is critical. Empathetic listening and validation communicate warmth, positive regard, and affirmation. Emphasizing the importance of honest communication regarding suicidality is more likely to occur within the context of a trusting counselor-client relationship. Providing the client with a written copy of informed consent is appropriate but should not be the first consideration. Lastly, obtaining a signed release of information to communicate with the hospital may be helpful. However, using this as an initial response may communicate to the client that you doubt his experiences. Therefore, the correct answer is (C)",counseling skills and interventions
40,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Shawn expresses his frustrations over his parents' pressure on him to do something with his life. Which response is the most effective use of motivational interviewing?,"""I think their pressure is what is causing your social anxiety. Does that make sense?""","""I would be frustrated, too! What do you think is the best way to get them to stop?""","""You have quite the inner strength to manage that and still stay sober. How are you doing it?""","""Tell me about how your family's strong Indian culture affects you and your stress.""","(A): ""I think their pressure is what is causing your social anxiety. Does that make sense?""
(B): ""I would be frustrated, too! What do you think is the best way to get them to stop?""
(C): ""You have quite the inner strength to manage that and still stay sober. How are you doing it?""
(D): ""Tell me about how your family's strong Indian culture affects you and your stress.""","""You have quite the inner strength to manage that and still stay sober. How are you doing it?""",C,"Bringing up culture when the client did not address his culture as a stressor is not culturally sensitive, so it does not yet apply here unless Shawn chooses to discuss it. If Shawn knew the best way to ""get his parents to stop pressuring him"" he would not be in counseling asking you about it, nor would he feel frustrated. Diagnosing his anxiety with your own theories about where it comes from is not helpful to your client in developing his own insight into his problems. Only answer d utilizes core MI skills of affirming your client's strengths and asking open-ended questions to increase or review your client's motivation. Therefore, the correct answer is (D)",counseling skills and interventions
41,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.",,What therapeutic approach would be most beneficial for this client at this time?,Adlerian therapy,Cognitive-behavioral therapy,Person-centered therapy,Emotion-focused therapy,"(A): Adlerian therapy
(B): Cognitive-behavioral therapy
(C): Person-centered therapy
(D): Emotion-focused therapy",Emotion-focused therapy,D,"Emotion-focused therapy (EFT) is a therapeutic approach based on the premise that emotions are key to identity. According to EFT, emotions are also a guide for individual choice and decision making. This type of therapy assumes that lacking emotional awareness or avoiding unpleasant emotions can cause harm. Therefore, the correct answer is (A)",counseling skills and interventions
42,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.","Knowing this client's history and symptomology, it would be important to assess for which disorder in the intake session?",Substance/medication-induced Obsessive-Compulsive Disorder,Attention-Deficit/Hyperactive Disorder,Somatic Symptom Disorder,Post-traumatic stress disorder (PTSD),"(A): Substance/medication-induced Obsessive-Compulsive Disorder
(B): Attention-Deficit/Hyperactive Disorder
(C): Somatic Symptom Disorder
(D): Post-traumatic stress disorder (PTSD)",Post-traumatic stress disorder (PTSD),D,"This client's combat experience and symptomology would require a PTSD rule-out to ensure that this diagnosis is not warranted. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
43,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. You address her ambivalence to change, as well as obstacles she has experienced in the past. When discussing exercise, the client states, “You don’t understand! I’ve tried exercise, and it never works.” You provide the client with self-monitoring sheets to record the following in real-time: daily food intake, maladaptive eating patterns, and thoughts and feelings that accompany binge eating. She is hesitant but agrees to give it a try for one week.  You are using self-monitoring to obtain baseline data and wish to use the SMART framework for constructing treatment plan goals and objectives",You are using self-monitoring to obtain baseline data and wish to use the SMART framework for constructing treatment plan goals and objectives. Which of the following accurately depicts the five SMART criteria?,"Strengths-based, measurable, appropriate, rational, timeless","Strengths-based, measurable, appropriate, rational, and timely","Specific, measurable, achievable, realistic, and timeless","Specific, measurable, achievable, realistic, and timely","(A): Strengths-based, measurable, appropriate, rational, timeless
(B): Strengths-based, measurable, appropriate, rational, and timely
(C): Specific, measurable, achievable, realistic, and timeless
(D): Specific, measurable, achievable, realistic, and timely","Specific, measurable, achievable, realistic, and timely",D,"SMART goals and objectives are specific, measurable, achievable, realistic, and timely. The counselor and the client construct specific goals and objectives by determining, in detail, what they would like to accomplish. Measurable goals consist of changes that are observable or quantifiable in terms of progress made within a pre-selected timeframe. Goals and objectives must be achievable. The client and counselor set achievable goals by examining the client’s internal and external resources, such as personal characteristics and social support. Goals must be realistic or relevant to the client’s diagnosis and overall plan for overcoming the presenting problem. Timely goals and objectives are an accurate reflection of the timeframe in which they can realistically be accomplished. Therefore, the correct answer is (B)",treatment planning
44,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",What cognitive error is the client making when she talks about being judged at work?,Catastrophizing,Mind reading,All-or-nothing thinking,Magnification of negative thoughts/minimizing positive ones,"(A): Catastrophizing
(B): Mind reading
(C): All-or-nothing thinking
(D): Magnification of negative thoughts/minimizing positive ones",Mind reading,B,"The client is demonstrating the cognitive distortion of mind reading in this session, where she assumes that others are judging her and thinking negatively about her weight without any evidence or confirmation from them. Therefore, the correct answer is (A)",counseling skills and interventions
45,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ","The client asks you if you can ""fix"" her. What is the best response to this statement?","Acknowledge her comment, then redirect her concern",Explain the benefits of psychotherapy,Explain your role as a therapist,"Convey that it may take some time, but you will work on fixing her","(A): Acknowledge her comment, then redirect her concern
(B): Explain the benefits of psychotherapy
(C): Explain your role as a therapist
(D): Convey that it may take some time, but you will work on fixing her",Explain your role as a therapist,C,"Therapists, or psychotherapists, are licensed mental health professionals who specialize in helping clients develop better cognitive and emotional skills, reduce symptoms of mental illness, and cope with various challenges to improve their lives. Therefore, the correct answer is (A)",professional practice and ethics
46, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,"Later in the day, the counselor realized what had occurred in his office and went to find Autumn in class. The counselor explained that the other school counselor had left some of her files on her desk of graduated students college essays. The counselor stated that regardless of this, all files should have been put away and she made a serious mistake. Autumn considers this for a few moments and agreed to return. The counselor demonstrated?",Non-judgement,Genuineness,Congruence,Positive regard,"(A): Non-judgement
(B): Genuineness
(C): Congruence
(D): Positive regard",Genuineness,B,"In this situation, the counselor is displaying the attribute of genuineness as she is speaking honestly and apologizing for her mistake without being defensive or pretentious. Congruence is when a counselor gives feedback on the client's progress in a genuine manner. Positive regard describes when a counselor can focus on the positive and demonstrated the belief that everyone can make positive changes in their lives. Non-judgement is the acceptance of the client and their actions. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
47,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","    History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork","To accurately diagnose social anxiety disorder, individuals must experience marked fear or anxiety in social situations and which of the following?",Fear of acting in ways that other people will scrutinize,Fear of social situations because of perceived appearance-related flaws,Fear of not being able to escape certain situations in the presence of profound anxiety,Fear of being incapacitated by an unforeseen panic attack in public,"(A): Fear of acting in ways that other people will scrutinize
(B): Fear of social situations because of perceived appearance-related flaws
(C): Fear of not being able to escape certain situations in the presence of profound anxiety
(D): Fear of being incapacitated by an unforeseen panic attack in public",Fear of acting in ways that other people will scrutinize,A,"According to the DSM-5-TR, social anxiety disorder is characterized by a marked and persistent fear of social situations or occasions in which the individual may be called upon to perform. Typically, the individual fears criticism and evaluation by others. This aspect of social anxiety disorder differentiates it from other anxiety disorders. Fear of being incapacitated by an unforeseen panic attack in public is a manifestation of panic disorder. The fear or avoidance of social situations because of perceived appearance-related flaws characterizes body dysmorphic disorder. Individuals with agoraphobia fear not being able to escape certain conditions in the presence of profound anxiety. Therefore, the correct answer is (C)",counseling skills and interventions
48,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.  Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.",The client expresses concern about his daughter's difficulties at school and inquires about the possibility of you becoming her therapist. Which of the following responses would be most appropriate to the client's request?,Explain the potential for a conflict of interest and offer to provide a referral for his daughter.,Clarify that offering therapy to adolescents falls outside the scope of your clinical practice.,Consent to become the therapist for his daughter and elucidate that she will receive exceptional care.,Explain that you cannot work with both of them in your practice as it would be a violation of ethical principles.,"(A): Explain the potential for a conflict of interest and offer to provide a referral for his daughter.
(B): Clarify that offering therapy to adolescents falls outside the scope of your clinical practice.
(C): Consent to become the therapist for his daughter and elucidate that she will receive exceptional care.
(D): Explain that you cannot work with both of them in your practice as it would be a violation of ethical principles.",Explain the potential for a conflict of interest and offer to provide a referral for his daughter.,A,"This response acknowledges the potential conflicts of interest and suggests that it would be best for the client's daughter to receive treatment from another counselor. Therefore, the correct answer is (C)",counseling skills and interventions
49,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,"The severity of Mark's symptoms can be assessed by administering all of the following, except?",Calgary Depression Scale for Schizophrenia,Brief Psychiatric Rating Scale (BPRS),The scale of assessment for Positive symptoms (SAPS),The scale for the assessment of Negative symptoms (SANS),"(A): Calgary Depression Scale for Schizophrenia
(B): Brief Psychiatric Rating Scale (BPRS)
(C): The scale of assessment for Positive symptoms (SAPS)
(D): The scale for the assessment of Negative symptoms (SANS)",Calgary Depression Scale for Schizophrenia,A,"The Calgary depression scale for schizophrenia should not be used as Mark did not mention any symptoms of depression. The SANS measures 25 negative symptoms of schizophrenia including lack of facial expressions, social inattentiveness, lack of interests and relationships. SAPS checks for 34 positive symptoms including hallucinations and delusions. The SANS and SAPS can be administered together. The BPRS is the most common test that psychiatrists use when they want to check how severe someone's symptoms of schizophrenia are. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
50,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.",The client reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him. The client says he has attended Metropolitan Community Church (MCC) with his boyfriend and was surprised to hear their messages of acceptance and inclusion. He has stopped going to bars and nightclubs since dating and reports less substance and alcohol misuse. The client states it has been quite some time since he felt like he had no purpose in life,You have selected acceptance and commitment therapy (ACT) and mindfulness to best address which of the following?,Shame and guilt,Sexual desire,Social isolation,Negative self-talk,"(A): Shame and guilt
(B): Sexual desire
(C): Social isolation
(D): Negative self-talk",Shame and guilt,A,"Acceptance and commitment therapy and mindfulness are evidence-based mental health interventions for various mental health disorders, including depression. The premise of ACT is that moving individuals toward acknowledging and accepting (rather than fighting) their thoughts and feelings in the present moment influence behavioral changes. The fact that the client is fighting against feelings of guilt and shame makes ACT and mindfulness an effective means for helping the client learn to gradually accept these feelings, as well as the thoughts that accompany them. Although some consider ACT a form of cognitive-behavioral therapy (CBT), ACT seeks to accept (rather than change) thoughts and feelings, whereas CBT aims to change thoughts so one’s feelings can change. Sexual desire is a physiological concept rather than a thought or feeling. When appropriate, behavioral therapy best addresses sexual desire. Social isolation is a behavior. There are thoughts and feelings underlying social isolation, but social isolation as a behavior is better addressed through behavioral modification or other behavioral therapy techniques. Therefore, the correct answer is (C)",counseling skills and interventions
51,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.  Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a ""new chance at living."" She further discloses that she recently met a ""wonderful man."" They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that ""he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me."" She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different.    From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. ""He's always around when I need him,"" she explains, ""And he listens to me and takes what I say seriously."" The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, ""If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared.""    You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",How would you use dialectical behavior therapy to validate the client's positive experiences in this relationship and help her manage any potential risks?,Acknowledge her feelings and encourage the client to continue her current treatment plan and discuss her new relationship during her next session.,"Acknowledge her feelings, and challenge the client's perception of her new relationship, focusing on the potential negative consequences of her impulsive actions.",Acknowledge her feelings and encourage her to take the relationship slowly while continuing to get to know her partner.,Acknowledge her feelings and encourage her to recognize and act on the positive effects of the relationship.,"(A): Acknowledge her feelings and encourage the client to continue her current treatment plan and discuss her new relationship during her next session.
(B): Acknowledge her feelings, and challenge the client's perception of her new relationship, focusing on the potential negative consequences of her impulsive actions.
(C): Acknowledge her feelings and encourage her to take the relationship slowly while continuing to get to know her partner.
(D): Acknowledge her feelings and encourage her to recognize and act on the positive effects of the relationship.",Acknowledge her feelings and encourage her to take the relationship slowly while continuing to get to know her partner.,C,"Validation is an important part of creating a supportive and safe therapeutic environment. By validating her positive experiences in this relationship, it can help to reinforce and build the client's feelings of self worth and trust in herself. Additionally, by encouraging her to take things slowly while continuing to get to know her partner better, it allows her to make informed decisions and reduces any potential risks. Therefore, the correct answer is (A)",counseling skills and interventions
52,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What is a common reason that couples therapy fails?,Couples' communication styles are overtly ambiguous.,The couple lacks the willingness to deal with uncomfortable feelings.,The couple lacks the ability to see their relationship and themselves objectively.,The couple does not seek therapy until problems are severe.,"(A): Couples' communication styles are overtly ambiguous.
(B): The couple lacks the willingness to deal with uncomfortable feelings.
(C): The couple lacks the ability to see their relationship and themselves objectively.
(D): The couple does not seek therapy until problems are severe.",The couple does not seek therapy until problems are severe.,D,"Most couples do not go to therapy until their problems have escalated out of control, which often results in unsuccessful therapy. Therefore, the correct answer is (C)",counseling skills and interventions
53,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.","Before wrapping up your latest session, you suggest John attend a support group. Which of the following is not the best recommendation?",Celebrate Recovery,Emotions Anonymous,A support group for single professionals,A men's divorce support group,"(A): Celebrate Recovery
(B): Emotions Anonymous
(C): A support group for single professionals
(D): A men's divorce support group",A support group for single professionals,C,"This type of group may trigger John and not adequately address his emotional needs. Emotions Anonymous is a 12-step group for dealing with any emotional condition. Celebrate Recovery is also a 12-step group that is faith-based and addresses recovery from any addiction, ""hurt, habit or hang-up"" and can be a new outlet for John to reconnect with his spirituality as he mentioned in the family history portion of the initial assessment. Men's groups that focus on divorce are also great for divorcees to find common ground among others in the same situations and can learn from one another in a safe environment. Therefore, the correct answer is (A)",counseling skills and interventions
54,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","   ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation",What information gathered during the assessment is most indicative of the diagnosis of Major Depressive Disorder (MDD)?,Poor coping skills,Strained relationships with family members,Emotional dysregulation,Excessive guilt,"(A): Poor coping skills
(B): Strained relationships with family members
(C): Emotional dysregulation
(D): Excessive guilt",Excessive guilt,D,"The client’s diagnosis of Major Depressive disorder is confirmed by the following symptoms: excessive guilt, suicidal ideation, insomnia, persistent negative mood, and feelings of worthlessness. These symptoms must be present during a sustained period of 2 weeks, which is also confirmed in the assessment. Strained relationships with family members have exacerbated the client’s symptoms, but this is not a clinical manifestation of MDD. Poor copings skills are not required for a diagnosis of MDD. Emotional dysregulation occurs when individuals exhibit emotional reactions that are disproportional to the actual event. Individuals diagnosed with Disruptive Mood Dysregulation Disorder, PTSD, and bipolar disorder, rather than MDD, tend to exhibit emotional dysregulation. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
55,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",Which instrument would allow you to screen for Autism Spectrum Disorder?,Behavior Assessment Rating Scale,The Behaviors and Experiences Inventory,The Behavior Assessment System for Children,The Behavioral Summarized Evaluation,"(A): Behavior Assessment Rating Scale
(B): The Behaviors and Experiences Inventory
(C): The Behavior Assessment System for Children
(D): The Behavioral Summarized Evaluation",The Behavioral Summarized Evaluation,D,"The Behavioral Summarized Evaluation assesses Autism Spectrum Disorders. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
56,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”","Before hanging up with Shawn's parents over the phone, you tell them ""I am very impressed with and grateful for your concern and involvement in Shawn's healing process, so I thank you for understanding that he is not yet ready to share in front of his parents!"" This statement best demonstrates which attribute?",Sensitivity to multicultural issues,Respect for client confidentiality,Awareness of self and impact on clients,Empathic attunement,"(A): Sensitivity to multicultural issues
(B): Respect for client confidentiality
(C): Awareness of self and impact on clients
(D): Empathic attunement",Respect for client confidentiality,B,"Using this positive voice in an uncomfortable situation where the payors of your client's counseling are demanding to sit in your sessions is an effective method for demonstrating respect of your client's HIPAA rights. Answers a, c and d do not seem to apply here; although it is important to be aware of self and the impact you have on your clients, as well as to be sensitive to multicultural issues. Empathic attunement is when one tries to respond to the client's perception of reality at that moment as opposed to their objective view of reality. Therefore, the correct answer is (B)",counseling skills and interventions
57, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",Jonny responds to your outburst by grabbing his books and leaving your office. You feel powerfully obliged to run after him and apologize. What should you do?,Go apologize right away and ask him if he will come back in and talk.,Let the dust settle and process with Jonny at your next scheduled session.,Call his cell phone and leave a voicemail asking about his safety.,Allow him to go and then consult with a supervisor prior to engaging Jonny again.,"(A): Go apologize right away and ask him if he will come back in and talk.
(B): Let the dust settle and process with Jonny at your next scheduled session.
(C): Call his cell phone and leave a voicemail asking about his safety.
(D): Allow him to go and then consult with a supervisor prior to engaging Jonny again.",Allow him to go and then consult with a supervisor prior to engaging Jonny again.,D,"There has clearly been a breach of trust in your therapeutic relationship with Jonny considering his reaction. Seeking supervision to process your thoughts and feelings, choices you have made, and underlying reasons why is the best choice for you. It is vital that counselors have good self-awareness and understand how to avoid future instances of countertransference, unhealthy projection, or lack of restraint. This session with your supervisor will protect you professionally as well as Jonny clinically in the future if you are afforded another opportunity to counsel with him again. Antagonizing him while he is upset before you have had the chance to process the event is not advised, as in answers a) or b); however, neglecting to address this issue with supervision could result in repeat mistakes. Therefore, the correct answer is (C)",counseling skills and interventions
58,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies.  The client recognizes gains that she has made but fears that she will fail after discharge",The client recognizes gains that she has made but fears that she will fail after discharge. Which humanistic technique would you use to best respond to this discrepancy?,Self-disclosure,Constructive confrontation,Amplified reflection,Attending,"(A): Self-disclosure
(B): Constructive confrontation
(C): Amplified reflection
(D): Attending",Constructive confrontation,B,"Constructive confrontation is designed to help clients achieve congruence. Humanistic therapists assert that incongruence occurs when there is a discrepancy between clients’ perceptions of themselves and reality. Therapists use constructive confrontation when pointing out discrepancies among the client’s actions, thoughts, behaviors, perception, or nonverbal communication. An amplified reflection is a motivational interviewing skill used to state the client’s original statement and overemphasize their point or intent. Amplified reflections address ambivalence to change, making this answer option incorrect. Attending is the counselor’s way of showing interest. The interest can be verbal (eg, by saying “Go on”) or nonverbal (eg, nodding the head). Finally, counselors use self-disclosure when sharing personal aspects of themselves. Self-disclosure can take many forms and may be appropriate or inappropriate, depending on the counselor’s motives (ie, self-serving versus benefiting the client and/or the therapeutic relationship). Therefore, the correct answer is (A)",counseling skills and interventions
59,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.  Ninth session Alexei appeared anxious during his weekly session today. He tells you that he constantly thinks about how good his life was in Germany and is afraid he will never feel comfortable in America. On a positive note, Alexei shares that he and his wife talked about their relationship and want to take steps to repair their marriage. He now admits to you that his drinking is a problem, but he struggles with the physical aspects of trying to quit. Whenever he tries to stop drinking, he gets sweaty and fears that he will have a seizure, so he begins drinking again. He explains that he cannot get past these symptoms. You discuss with Alexei the option of entering a rehabilitation center to assist him medically with the detox process. Alexei admits that he is unsure about the idea of going into treatment. He acknowledges that it might be beneficial but worries about leaving his family for a prolonged period. He expresses concern that his wife will not be able to handle everything on her own and wonders what will happen with their marriage while he is in treatment. You explore his concerns using motivational interviewing techniques and ask him to discuss this information with his wife.    During the session, you commend Alexei for recognizing the impact of his drinking on his life and his willingness to discuss these concerns openly. You acknowledge the challenges he faces in trying to quit and the physical symptoms he experiences. You explain that seeking professional help at a rehabilitation center could provide the medical support he needs to manage withdrawal symptoms safely and effectively. You emphasize that by addressing his alcohol dependence, he will likely find it easier to adapt to his new life in America and repair his marriage.    Regarding his concerns about his wife managing things while he is in treatment, you explore potential solutions and support systems that could be implemented during his absence. You encourage Alexei to discuss these concerns with his wife and involve her in decision-making. Together, they can identify family members, friends, or community resources that could offer assistance. Finally, you reassure Alexei that taking the time for treatment is an investment in his long-term well-being and that of his family. By addressing his alcohol dependence, he will be better equipped to support his wife and family emotionally and practically in the long run.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",The client is in the early stages of recovery and has stated that he and his wife want to work on their relationship. How would you incorporate this request into his treatment plan?,Consider allowing the rehab center to manage couples therapy work at a more clinically appropriate time.,Provide the client the option to start couples therapy now or after his recovery.,"Recognize that couples' therapy is appropriate only after his rehabilitation is complete, and advise against it.",Let the client determine what he wants to do about the couples therapy.,"(A): Consider allowing the rehab center to manage couples therapy work at a more clinically appropriate time.
(B): Provide the client the option to start couples therapy now or after his recovery.
(C): Recognize that couples' therapy is appropriate only after his rehabilitation is complete, and advise against it.
(D): Let the client determine what he wants to do about the couples therapy.",Consider allowing the rehab center to manage couples therapy work at a more clinically appropriate time.,A,"As early on as the client's recovery appears to be, beginning couples therapy at this time would be premature. Allowing him to get stabilized initially will be essential before diving into the relationship dynamics. It would be okay to convey that you could be available for follow-up couples work if necessary when the time comes after he returns from rehab. Therefore, the correct answer is (B)",treatment planning
60,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",Which of the following assessments would you use during the diagnostic interview to identify mental health domains which may have a significant impact on the client?,Personal History Questionnaire,Cultural Formulation Interview,Family genogram,Level 1 Cross-Cutting Symptom Measure,"(A): Personal History Questionnaire
(B): Cultural Formulation Interview
(C): Family genogram
(D): Level 1 Cross-Cutting Symptom Measure",Level 1 Cross-Cutting Symptom Measure,D,"The DSM-5-TR Level 1 Cross-Cutting Symptom Measure is a self- or informant-rated measure which assesses mental health domains important across psychiatric diagnoses. It is intended to help clinicians identify additional areas of inquiry which may significantly impact the individual's treatment and prognosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
61,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ",Which tool would provide the most comprehensive information about Rick before entering group therapy?,Thematic Apperception Test (TAT),Millon Clinical Multiaxial Inventory (MCMI-III),Columbia Impairment Scale (CIS),BRIGANCE Comprehensive Inventory of Basic Skills (CIBS),"(A): Thematic Apperception Test (TAT)
(B): Millon Clinical Multiaxial Inventory (MCMI-III)
(C): Columbia Impairment Scale (CIS)
(D): BRIGANCE Comprehensive Inventory of Basic Skills (CIBS)",Millon Clinical Multiaxial Inventory (MCMI-III),B,"The MCMI-III is used to assess for a wide range of psychological disorders and syndromes, including anxiety, depression, bipolar disorder, substance abuse, and other personality disorders. The MCMI-III consists of 175 multiple-choice questions that assess a person's current psychological functioning. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
62,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","This session is occurring in the client’s home in order to observe behaviors in his natural environment. The client’s parents and 8-year-old brother are present. You are observing during this session in order to gather information and then to provide psychoeducation at the end of the session to the parents. The client and his brother are sitting on the floor playing with a building toy, which the client’s parents report is often a toy that causes him frustration because he plays very specifically with it and his brother does not want to play how he does. After about 5 minutes, the client becomes visibly frustrated as he is telling his brother to put a brick in a certain place because it is the same color and his brother says he is not going to and goes to build on his own. The client continues to build and asks for the piece repeatedly over a few minutes. The client then picks up what he is building and throws it against the wall and leaves the room.  After the session, you provide psychoeducation to the parents regarding how to support their son in coping with the denial of his request to have a block put in a certain place","After the session, you provide psychoeducation to the parents regarding how to support their son in coping with the denial of his request to have a block put in a certain place. Based on your short-term goals with the client, all of the following would be appropriate interventions, EXCEPT:",Instruct the client on anger management skills.,Remind the client that others have different ways of playing and that is okay.,Prompt the client to practice deep breathing.,Support the client to learn progressive muscle relaxation.,"(A): Instruct the client on anger management skills.
(B): Remind the client that others have different ways of playing and that is okay.
(C): Prompt the client to practice deep breathing.
(D): Support the client to learn progressive muscle relaxation.",Remind the client that others have different ways of playing and that is okay.,B,"You compiled goals for the client in the first session based on the ASD diagnosis, and you identified the client’s difficulty with imaginative play. This barrier would make understanding that others have different ways of playing difficult for the client and would be the least appropriate intervention in this scenario. Deep breathing, progressive muscle relaxation, and other anger management skills would be helpful for this client because, although he will have trouble identifying with others, he can learn to manage his own strong emotions. Therefore, the correct answer is (C)",treatment planning
63,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",How would you proceed with the client as he presents for this therapy session in his current state?,"Empathize with the client, and utilize the situation to attempt to establish rapport.",Be direct and reschedule the appointment.,"Consider this session a 'non-event', since the client was too impaired for him to have been competent to give consent.",Explore with the client what was happening before the session that led to his coming to the session intoxicated.,"(A): Empathize with the client, and utilize the situation to attempt to establish rapport.
(B): Be direct and reschedule the appointment.
(C): Consider this session a 'non-event', since the client was too impaired for him to have been competent to give consent.
(D): Explore with the client what was happening before the session that led to his coming to the session intoxicated.",Be direct and reschedule the appointment.,B,"It is critical to set limits with clients in general, especially in setting standards for managing substance use issues. Being under the influence while attending therapy is not clinically appropriate nor professionally acceptable. Therefore, the correct answer is (A)",counseling skills and interventions
64,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ","Based on your observations of the client in session, what might you do to build a therapeutic alliance with him?",Bring a two-person video game to play with the client.,Speak in a clear and authoritative voice to the child and request that he respond,Use therapeutic silence until the client responds,Ask the child if he would like to examine the clock on your desk,"(A): Bring a two-person video game to play with the client.
(B): Speak in a clear and authoritative voice to the child and request that he respond
(C): Use therapeutic silence until the client responds
(D): Ask the child if he would like to examine the clock on your desk",Ask the child if he would like to examine the clock on your desk,D,"This may help the child gain trust and form a therapeutic alliance with you. Recall that while he was hiding behind his mother during the session, he appeared to be interested in the clock on your desk. Therefore, the correct answer is (D)",counseling skills and interventions
65,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","Since the start of counseling and services with the local government mental health agency, the client has maintained sobriety from fentanyl and has been moved into stable housing via assistance from the agency. The client reports that the management of his anxiety has been better, but that he often feels lonely and unengaged. The client states that he is not sleeping well and thinks it is because he does not do much during the day. He continues to participate in Narcotics Anonymous daily in order to have interactions with other people. The client says that he tried to reach out to his children but they would not answer his phone call. You empathize with the client regarding his difficulty reaching out to his children. You and the client use this session in order to review progress and identify new goals",Which of the following would be a helpful career aptitude tool for a client with limited resources?,O*Net Interest Profiler,Motivational Appraisal Personal Potential,Criteria Cognitive Aptitude Test,Career Assessment Inventory,"(A): O*Net Interest Profiler
(B): Motivational Appraisal Personal Potential
(C): Criteria Cognitive Aptitude Test
(D): Career Assessment Inventory",O*Net Interest Profiler,A,"The O*Net Interest Profiler is a free online tool that is used to determine what abilities can lead to careers that match an individual’s existing skills and abilities. The Motivational Appraisal Personal Potential, Career Assessment Inventory, and Criteria Cognitive Aptitude Test are all clinical counseling assessments that cost money. Although they would be helpful career assessments, they would not be accessible to the client with his current level of resources because he is currently financially reliant on the government. The O*Net Interest Profiler would give a good direction for the client to consider potential fields of work. Therefore, the correct answer is (A)",professional practice and ethics
66,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues.  Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand.    When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have ""one drink."" He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""","Given the client's physical condition, what should you do first?",Determine the client's blood alcohol content (BAC) for proper notation.,Establish boundaries regarding therapy and being intoxicated,Reschedule the session and address your concerns at that time,Refer the client to a residential program,"(A): Determine the client's blood alcohol content (BAC) for proper notation.
(B): Establish boundaries regarding therapy and being intoxicated
(C): Reschedule the session and address your concerns at that time
(D): Refer the client to a residential program",Establish boundaries regarding therapy and being intoxicated,B,"Taking advantage of a difficult situation could facilitate possible changes needed in the client by implementing motivational interviewing techniques while at the same time being able to be firm with the client to reinforce what is minimally expected as part of the therapeutic experience would be helpful. Therefore, the correct answer is (B)",professional practice and ethics
67, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,Symptoms indicate the possibility of?,Post-Traumatic Stress Disorder and Major Depressive Disorder,Post-traumatic Stress Disorder and Dissociative Amnesia,Adjustment Disorder and Dissociative Amnesia,Post-Traumatic Stress Disorder and Traumatic Brain Injury,"(A): Post-Traumatic Stress Disorder and Major Depressive Disorder
(B): Post-traumatic Stress Disorder and Dissociative Amnesia
(C): Adjustment Disorder and Dissociative Amnesia
(D): Post-Traumatic Stress Disorder and Traumatic Brain Injury",Post-Traumatic Stress Disorder and Traumatic Brain Injury,D,"Carl's symptoms -- avoidance, guilt, distressing dreams, reckless and self-destructive behaviors -- have caused significant distress and impairment, indicate Post Traumatic Stress Disorder. He lost consciousness for half a day after the blast and could not remember who he was for two days. According to his medical records, he suffered from disorientation and confusion for about 11 days. Since he has been home, Carl has suffered from light sensitivity and seizures. Other symptoms included irritability, aggression, and apathy. In adjustment disorder, the severity of the stressor does not meet Criteria A of PTSD. Dissociative amnesia may or may not include exposure to a traumatic event and does not include light sensitivity, physical injury to the brain. Major Depressive Disorder also does not have to include a traumatic event and may not include any PTSD Criterion B or C symptoms (intrusion symptoms and avoidance of stimuli). Therefore, the correct answer is (D)",counseling skills and interventions
68,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.  Sixth session The client has not been following through with her mood journal. She says that she ""got bored and didn't feel like writing in it anymore."" During this session, a month and a half into therapy, she relays an incident that happened with the friend she went to visit out-of-state. They argued due to political differences and are currently not talking to each other. The client now considers her friend ""a drunk who doesn't know what she's talking about."" You suggest that the client's anger and judgment may be a defense that she uses to avoid feeling rejected as she did with her father. You state, ""It seems that in an attempt to avoid feeling hurt and rejected, you use anger and alcohol to push people away."" The client responds with reflective silence and begins to tear up.    You guide the client to examine her defensive behavior and understand why she relies on it when faced with difficult emotions. You emphasize that her feelings of hurt, rejection, and anger are valid, however, they can be managed in healthier ways. You suggest that part of processing these feelings is to recognize them and make attempts at reconnecting with her friend. Additionally, you recommend cultivating self-care practices. The client acknowledges the importance of looking after herself during this difficult time, understanding that if she is able to take care of herself first she will be in a better position to address her relationships.    You remind the client that it is important to take steps to move forward, even if those steps are small. You highlight her willingness to talk through her emotions and gain insight into her reactions as an opportunity to grow in self-awareness. You explain that having knowledge of one’s own feelings helps them to make better decisions and boundaries, which can lead to healthier relationships with others and ultimately, more peace within oneself. With this understanding, you create a plan of action together for how she will move forward between now and your next session. You close the session by telling the client that she has made progress today by having gained insight into her feelings, and that will lead to exploration of how to respond to them more productively. You conclude by encouraging her to keep exploring new methods of self-care and to bring up any additional topics she wants to discuss in the next session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",Which of the following is not a benefit of reviewing the client's progress in treatment?,It helps you determine whether treatment goals are being met.,It allows you to assess your therapy effectiveness.,It helps you to uncover the client's motivation for seeking therapy.,It enables you to reevaluate the client's needs.,"(A): It helps you determine whether treatment goals are being met.
(B): It allows you to assess your therapy effectiveness.
(C): It helps you to uncover the client's motivation for seeking therapy.
(D): It enables you to reevaluate the client's needs.",It helps you to uncover the client's motivation for seeking therapy.,C,"Uncovering a client's motivation for seeking therapy happens at intake when she expresses her concerns. Assessing mental health is a process, not a one-time event. It is important, therefore, to monitor a person's mental health symptoms throughout treatment as they may change over time. Therefore, the correct answer is (B)",treatment planning
69,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.",Which of the following assessments would be used next in most effectively understanding your client's substance use?,Drug and Alcohol Screening (DAS),Drug Abuse Screening Test (DAST),Alcohol Use Disorders Identification Test (AUDIT),Minnesota Multiphasic Personality Inventory - 2 (MMPI-2),"(A): Drug and Alcohol Screening (DAS)
(B): Drug Abuse Screening Test (DAST)
(C): Alcohol Use Disorders Identification Test (AUDIT)
(D): Minnesota Multiphasic Personality Inventory - 2 (MMPI-2)",Drug Abuse Screening Test (DAST),B,"The DAST is a drug screening tool that does not include screening for alcohol. Since the MAST has already screened for alcohol use, it is important to screen for other substances. The MMPI-2 is a good instrument but is broader and more expensive than needed for substance screening. The AUDIT assesses alcohol use so duplicates what was learned from the MAST and does not screen for other substances. The DAS is not an actual instrument. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
70,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ","""Gender identity"" refers to which of the following?","An individual's identification as male, female, or another category",A broad spectrum of individuals who transiently or persistently identify as a gender different than their natal gender.,"The identification of a person based on physical characteristics, such as reproductive organs.",The initial assignment as male or female which occurs at birth,"(A): An individual's identification as male, female, or another category
(B): A broad spectrum of individuals who transiently or persistently identify as a gender different than their natal gender.
(C): The identification of a person based on physical characteristics, such as reproductive organs.
(D): The initial assignment as male or female which occurs at birth","An individual's identification as male, female, or another category",A,"Gender is used to denote the publicly lived roles of an individual, and identity is how an individual lives. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
71,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",What intervention would be most beneficial for the parents and client to address his behavior disturbances?,The family is not your client; interventions should be client-specific.,A behavior contract between the clients and the parents paired with the client keeping a self-reflective journal,"Setting up a positive reward system in the house for good behavior (an ""if/then"" chart for the client) and giving a list to the parents of appropriate restrictions for the client","Discuss various disciplinary actions and their effectiveness with the parents, and instruct them on what is going to work best for the client","(A): The family is not your client; interventions should be client-specific.
(B): A behavior contract between the clients and the parents paired with the client keeping a self-reflective journal
(C): Setting up a positive reward system in the house for good behavior (an ""if/then"" chart for the client) and giving a list to the parents of appropriate restrictions for the client
(D): Discuss various disciplinary actions and their effectiveness with the parents, and instruct them on what is going to work best for the client",A behavior contract between the clients and the parents paired with the client keeping a self-reflective journal,B,"These options are age-appropriate and are helpful to the client to engage in self-awareness and self-confidence building. Therefore, the correct answer is (D)",counseling skills and interventions
72,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","As the group leader, which technique would you use to build cohesion and encourage group members to work together?",Modeling,Linking,Active listening,Unconditional Positive Regard,"(A): Modeling
(B): Linking
(C): Active listening
(D): Unconditional Positive Regard",Linking,B,"In group therapy, linking involves the group leader compares members to each other based on what is shared. Finding commonalities encourages group members to work together. Therefore, the correct answer is (C)",counseling skills and interventions
73,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family.  You are a certified counselor who has never worked with a client diagnosed with MND. You assess your ability to work with this client based on your credentials and the information provided thus far","You are a certified counselor who has never worked with a client diagnosed with MND. You assess your ability to work with this client based on your credentials and the information provided thus far. At this point in treatment, which of the following statements is the most accurate?",You should refer the client to a counselor who specializes in neurocognitive disorders.,You should proceed with the client only after obtaining specialized training and consultation.,You should proceed with the client unless the results of the PET scan indicate advanced memory impairment.,Your background and training should permit you to work with this client.,"(A): You should refer the client to a counselor who specializes in neurocognitive disorders.
(B): You should proceed with the client only after obtaining specialized training and consultation.
(C): You should proceed with the client unless the results of the PET scan indicate advanced memory impairment.
(D): Your background and training should permit you to work with this client.",Your background and training should permit you to work with this client.,D,"Despite never working with a client diagnosed with MND, your education, experience, and training should provide you with the skills to treat the client’s anxiety, apathy, and depression. You can provide supportive counseling, address psychosocial symptoms, teach coping skills, and suggest compensatory memory strategies. Section C2 of the ACA Code of Ethics states that counselors must only practice within the boundaries of their competence, which is specifically based on “their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” Counselors have an ongoing ethical responsibility to remain current and increase their knowledge base by obtaining continuing education, but this would not be a prerequisite for working with this client. The counselor would not necessarily need the PET scan results to proceed because a mental status exam and neuropsychological report both show MND and associated behavioral disturbances. Therefore, the correct answer is (A)",professional practice and ethics
74,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.","Given the client is resistant to actively participating in therapy and primarily seeks validation that she has attended sessions, how would you navigate this situation to foster genuine engagement while addressing her underlying motives and considering ethical implications?",Indicate that you will only report to her probation officer if she actively engages in the therapeutic process.,"Begin the session, ignoring her resistance, and proceed with the therapy",Explain that treatment goals are predefined for mandated clients and are determined by the court jurisdiction,Engage in motivational interviewing,"(A): Indicate that you will only report to her probation officer if she actively engages in the therapeutic process.
(B): Begin the session, ignoring her resistance, and proceed with the therapy
(C): Explain that treatment goals are predefined for mandated clients and are determined by the court jurisdiction
(D): Engage in motivational interviewing",Engage in motivational interviewing,D,"Motivational interviewing would be a good way to engage the client in the therapeutic process given that she has been court-ordered and is not happy about being in therapy. Therefore, the correct answer is (B)",counseling skills and interventions
75,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.  Ninth session Logan arrives at the session a few minutes late and apologizes. He says that he was outside playing kickball with his class. He reports that he has been feeling better about being in school lately. His classmates are friendlier to him, or at the very least, ""they don't bother me so much,"" He is now eating lunch back in the lunchroom. He is learning to play soccer and plans to ask his parents if he can join the summer league. Next, you call Logan's mother and share his progress in counseling with her. Finally, you examine Logan's care plan and assess for any changes needed.    Logan's progress in counseling has been notable as he has demonstrated increased social engagement and involvement in extracurricular activities. It appears that the therapeutic interventions implemented have successfully addressed his initial concerns regarding social anxiety and peer relationships. In addition, Logan's newfound interest in soccer and desire to join a summer league further demonstrates his willingness to engage with peers and develop new skills.    In conversation with Logan's mother, you emphasize the importance of fostering a supportive home environment to encourage Logan's growth and self-confidence. The mother expresses gratitude for the improvements in her son's well-being and commits to facilitating Logan's involvement in the summer soccer league. Additionally, she agrees to maintain open communication with the counselor to address any potential concerns that may arise in the future.    Upon reviewing Logan's care plan, the counselor determines that the current therapeutic goals and interventions remain appropriate and relevant to Logan's ongoing progress. However, it may be beneficial to introduce supplementary strategies to further enhance his self-esteem and resilience and promote effective communication and problem-solving skills. By doing so, Logan will be better equipped to navigate any challenges that may emerge as he develops and maintains positive relationships with his peers.    After the session, you receive a phone call that your wife has passed away. In the midst of the sudden loss of your beloved wife, you find yourself struggling to maintain your usual level of composure, which is understandable, feeling overwhelmed and emotionally drained during this difficult time. Being a therapist, you recognize the weight of your emotional burden and decide to reach out to your supervisor to discuss your struggles. After a heartfelt conversation, you feel a sense of relief and connection with your supervisor, who has provided you with support and understanding.    As the conversation draws to a close, you make an unexpected request of your supervisor: that she attend your wife's memorial and wake so that she can meet your family and share in the memories of your loved ones. This request may seem a lot to ask, but you feel comforted by the thought of having someone close to you share in this challenging time. You also ask if she can take over your caseload as you deal with your wife's passing.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",Which would be most beneficial to communicate in your last session with the client?,"""You have succeeded at overcoming a major setback and it is the foundation for much greater success moving forward.""","""Are there any other specific questions or concerns you would like to address at this moment?""","""It is important to prioritize self-care and not feel pressured to prioritize forming friendships, as you can be content and fulfilled on your own.""","""You did an incredible job and I wish you the best going forward.""","(A): ""You have succeeded at overcoming a major setback and it is the foundation for much greater success moving forward.""
(B): ""Are there any other specific questions or concerns you would like to address at this moment?""
(C): ""It is important to prioritize self-care and not feel pressured to prioritize forming friendships, as you can be content and fulfilled on your own.""
(D): ""You did an incredible job and I wish you the best going forward.""","""You have succeeded at overcoming a major setback and it is the foundation for much greater success moving forward.""",A,"The idea is to put both the past and the future into a positive perspective moving ahead for this client. You are also reinforcing his capacity to discover new ways of responding to difficulties in life and preparing at the same time for the future. Therefore, the correct answer is (B)",counseling skills and interventions
76,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client comes into your office and says hello in a quiet voice and then sits down, slumps his shoulders, and does not make eye contact. You inquire about what you see, and the client says that he has been feeling more depressed over the past week. The client says that he is experiencing low appetite, a down mood, fatigue, and irritability. You empathize with the client and discuss coping skills for depressive symptoms. The client expresses frustration with his church because he worked part-time in the church office until recently when they encouraged him to resign because he is divorced and he is now unable to work in the church because of this. You empathize with the client regarding his situation at church.  You do not share the same religious views as the client",You do not share the same religious views as the client. Which of the following would be the most helpful approach when considering the impact of your own beliefs in counseling?,You support the client’s beliefs and do not impose your own values,You encourage the client to assess his own beliefs and if he really does believe them because he is currently feeling that they are incongruent with those of the church,You continuously assess how your beliefs may affect the counseling process,"You explain to your client that you do not share his beliefs; therefore, you may not be very helpful in supporting him","(A): You support the client’s beliefs and do not impose your own values
(B): You encourage the client to assess his own beliefs and if he really does believe them because he is currently feeling that they are incongruent with those of the church
(C): You continuously assess how your beliefs may affect the counseling process
(D): You explain to your client that you do not share his beliefs; therefore, you may not be very helpful in supporting him",You continuously assess how your beliefs may affect the counseling process,C,"It would be most helpful to continuously assess how your own values and beliefs affect the counseling process. Although it is important to support your client’s beliefs and not impose your own, there is a level of self-reflection that is important in the process of counseling to ensure that you are not unintentionally imposing your own beliefs. Although it might be helpful to explain that you do not share beliefs with the client, it also undermines your own ability to help him because it invalidates your ability to connect with him. It may also be helpful to support the client in assessing his own beliefs because it appears that he is feeling the conflict; however, your goal is to support his beliefs and values. Therefore, the correct answer is (C)",core counseling attributes
77,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”","Lottie uses play to show how her father was killed. She notices you have let a tear out of your eye while observing her and says, ""Why are you crying? Please don't!"" What is the best clinical response?","""Why not, don't you cry when you think about your dad?""","""Lottie, what you shared was sad. I cried. But I am okay.""","""I just have irritated eyes, nothing to do with you.""","""I'm so sorry you saw that; I couldn't hold it back.""","(A): ""Why not, don't you cry when you think about your dad?""
(B): ""Lottie, what you shared was sad. I cried. But I am okay.""
(C): ""I just have irritated eyes, nothing to do with you.""
(D): ""I'm so sorry you saw that; I couldn't hold it back.""","""Lottie, what you shared was sad. I cried. But I am okay.""",B,"Demonstrating to a child that a person can cry when something is sad, but that they can also be okay right afterwards, is a very powerful clinical lesson. Helping model for Lottie a healthy grief response and recovery is a great way for her to learn that she can do the same thing. Turning the response back onto her can be confrontational in a sensitive grief situation which may trigger a stronger response from her. This can be okay to ask, as in answer a), but do not miss the opportunity to first give a clinical response such as in answer d). It builds a more genuine therapeutic bond and offers sincere empathy, something Lottie desperately needs. Apologizing is setting the example that it is ""not okay to cry when something is sad"". Denying your feelings to her using excuses like in answer c) is in direct conflict with the skills you are working to show Lottie how to use, therefore it is not the best choice. Therefore, the correct answer is (D)",counseling skills and interventions
78,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","Considering the information gained in this session, which attachment style seems most appropriate for this client's history and current presentation?",Ambivalent attachment,Disorganized attachment,Avoidant attachment,Secure attachment,"(A): Ambivalent attachment
(B): Disorganized attachment
(C): Avoidant attachment
(D): Secure attachment",Ambivalent attachment,A,"Adults with parental figures who were inconsistently available and rejecting, or violated normal boundaries tend to be anxious and insecure, ruminate about relationships and may be dependent or needy. Adults with secure attachments create meaningful relationships and set healthy boundaries, those with avoidant attachment styles tend to avoid closeness or connection and may be perceived as rigid, critical, and intolerant. Individuals with a disorganized attachment style often are chronically vulnerable and tend to dissociate when triggered by perceived threats. Therefore, the correct answer is (D)",counseling skills and interventions
79,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.  Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms.  Ninth session Rober arrives elated at the session, appearing happy, talkative, and smiling. He states that he has felt this way for four days now, which has not been the typical length of time or the intensity of his positive mood episodes. He reports that his family relationships are satisfactory, and he has been somewhat successful at his part-time job at the local lumberyard. However, he is angry with his manager, who says he has been too distracted this past week and spends more time talking with customers than working. He is still drinking three beers at night to sleep but reports that he has not had to sleep much this past week and feels ""wide awake."" He says he is ready to open his own business but isn't sure what he wants to do yet.  Roger reports feeling energized, creative, and motivated over the past several days. He has come up with many new business ideas that he is eager to pursue, including opening a restaurant, starting a landscaping company, and developing a crypto blockchain. Roger stays up late into the night brainstorming ideas and making extensive plans. He feels compelled to act on his ideas immediately and has already taken steps to register business names and research loans. However, the next day, Roger often changes course, dropping previous ideas for new ones that seem even more exciting. His friends notice his frenzied pace in bouncing from idea to idea, worrying he has taken on too much. But Roger reassures them this surge of creativity allows him to see endless possibilities for his future business success. Though well-intended, their skepticism only pushes him to work harder to bring his visions to life.  Roger also mentions experiencing increased sociability and talkativeness lately. He says he has frequently called and texted friends and family to share his business ideas and other excited thoughts. Roger speaks rapidly, his thoughts racing as he tries to get loved ones as enthused as he feels. Though some gently try to interject realistic concerns, he remains unchecked in his ambitious optimism. A few close friends have expressed concern over Roger's intensified pace and plans, but he brushes them off, feeling very optimistic and self-assured about his ideas. Roger's confidence borders on grandiose as he envisions an incredibly successful entrepreneurial future. Attempts by caring friends and family to restrain his inflated self-assurance are met with irritation, as Roger feels unable to focus on anything but chasing his next big idea. He's optimistic that his new crypto blockchain will rival and surpass Bitcoin in a matter of months.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.",What is the primary step a therapist should take if a client is presenting in a manic state that impairs their capacity for autonomous decision-making or indicates a potential risk to others?,Respect the client's autonomy and ask how they would like to proceed.,Sit with the client until they are stable.,Call the client's spouse and arrange pickup.,Coordination of inpatient care.,"(A): Respect the client's autonomy and ask how they would like to proceed.
(B): Sit with the client until they are stable.
(C): Call the client's spouse and arrange pickup.
(D): Coordination of inpatient care.",Coordination of inpatient care.,D,"The therapist has an ethical duty to protect the client and community. Therefore, the correct answer is (D)",professional practice and ethics
80, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,"To understand Theodore in the context of his family, a systemic counselor would?","Use tools, such as a genogram, to show relationships",Teach Theodore coping mechanisms when he is frustrated with Nate,Focus on a diagnosis,Focus on Theodore's experiences since his wife's passing,"(A): Use tools, such as a genogram, to show relationships
(B): Teach Theodore coping mechanisms when he is frustrated with Nate
(C): Focus on a diagnosis
(D): Focus on Theodore's experiences since his wife's passing","Use tools, such as a genogram, to show relationships",A,"A systemic counselor tries to look at a client within his/her system and not just individually. One way to do this, is by using a genogram. A genogram would be particularly helpful in this situation to understand the dynamic between Theodore and Nate. A systemic counselor would not just focus on obtaining information to come up with diagnosis. As opposed to teaching Theodore coping mechanisms when frustrated with Nate, they may bring Nate into a session. And instead of focusing on Theodore's experience with his wife passing, a systemic counselor may look at how the death affected the system. Therefore, the correct answer is (D)",counseling skills and interventions
81,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.",Which of the following interventions would be the most effective in helping the client learn how his traits impact his relationships with himself and others?,Invite client to join a long-term process group,Invite client to bring spouse to sessions,All of the above,Invite client to read a book about narcissism,"(A): Invite client to join a long-term process group
(B): Invite client to bring spouse to sessions
(C): All of the above
(D): Invite client to read a book about narcissism",All of the above,C,"All of the above interventions are appropriate for a client with narcissistic traits and partial insight. Because the client recognizes his personality characteristics and wants to create changes, reading about the personality style will help him understand his defenses better and may allow him to view these as defense strategies rather than character flaws. Process groups, unlike psychoeducational groups, help clients work on personality change by recreating one's relationships in the group through transference. Inviting the client to bring his spouse to sessions will be helpful as he has described a good relationship, which is supportive to him. Including her in sessions is likely to help her be more supportive as she understands his personality better. Therefore, the correct answer is (D)",treatment planning
82,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",Which statement shows your support of the client in dealing with her feelings?,"""What I hear you saying is that you feel like drawing helps your mood.""","""What I hear you saying is that you feel better when you skip school.""","""Your mother reports that you are difficult at home.""","""What I hear you saying is you are feeling powerless, and you are not in control of your own life.""","(A): ""What I hear you saying is that you feel like drawing helps your mood.""
(B): ""What I hear you saying is that you feel better when you skip school.""
(C): ""Your mother reports that you are difficult at home.""
(D): ""What I hear you saying is you are feeling powerless, and you are not in control of your own life.""","""What I hear you saying is you are feeling powerless, and you are not in control of your own life.""",D,"Mirroring the client's feelings can help the client experience a sense of understanding and rapport. Therefore, the correct answer is (D)",counseling skills and interventions
83,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.  Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, ""I can't do this. You tell them."" Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents.    You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, ""We know that something is going on."" He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, ""We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl."" You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her.    The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that ""did this to our daughter."" The initial conversation is difficult, but you provide support as the family talks through their feelings.  Fifth session You have been seeing the client weekly during her lunch break. After their initial shock, her parents have accepted the news and are now focused on helping their daughter. The client told you that they have been discussing the options available to them, such as adoption or parenting the baby. When you met with the client last week, she opened up about how she was feeling physically and emotionally. She told you that although her parents have been supportive, she was still feeling overwhelmed and uncertain about the future. She told her boyfriend about the baby, but he has been distant and unsupportive. Her parents met with the boyfriend's parents and tried to talk about options, but his parents said they did not want to be involved. They said they ""already had too many mouths to feed"" and could not help with the baby.    Today, the client and her mother come to see you for a scheduled appointment. The mother smiles as she pulls out a picture of the baby's sonogram to show you. She says, ""We met with our minister, and the three of us have been praying for guidance as we have been trying to cope with this situation."" They decided that the best option for their daughter and the unborn baby was to find a loving family who would be willing to adopt. The mother explains, ""We want our daughter to focus on her education and not worry about the responsibilities of raising a child right now. We are hoping that by finding a good home, we can provide this baby with a bright future."" As the mother talks, you notice that the client is more relaxed and looks alert and focused. You ask her about how she feels about the decision. She admits that although she still feels overwhelmed, she is also starting to feel more at peace with the idea of adoption. You nod your head in understanding and offer some words of support. Finally, the mother states, ""What we need at this point is for you to reschedule our daughter's classes so that she can continue with schoolwork virtually and also ensure that she gets the rest she needs during her pregnancy."" You assure them that you will work with the school administration to facilitate the client's needs. You end the session with a plan for the client's continued care. You will continue to meet with her as needed and provide additional support.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","The client and her mother have made it clear that they as a family have decided that bringing the client's baby to term and seeking adoption is the best choice for them; a direction that the client seems comfortable with. In acknowledgment of the client's intentions, but also being mindful of the difficulties that she may face, how can you best assist the client in finding support to help her with the physical as well as psychological burdens she will face during this time?","Considering that the client has now decided firmly to seek adoption for her child, you should suggest that the boyfriend might now be amenable to providing emotional support.","In light of the client's situation of improved outlook and willingness to accept help, you should recommend a teen pregnancy support group.","Given the client's age, lack of maturity, and still tenuous psychological condition, you should provide psychoeducation on teen pregnancy.","You should advise that the client continue to meet with her minister, since his involvement was key to gaining the parents' positive involvement, and could still be helpful in providing spiritual comfort.","(A): Considering that the client has now decided firmly to seek adoption for her child, you should suggest that the boyfriend might now be amenable to providing emotional support.
(B): In light of the client's situation of improved outlook and willingness to accept help, you should recommend a teen pregnancy support group.
(C): Given the client's age, lack of maturity, and still tenuous psychological condition, you should provide psychoeducation on teen pregnancy.
(D): You should advise that the client continue to meet with her minister, since his involvement was key to gaining the parents' positive involvement, and could still be helpful in providing spiritual comfort.","In light of the client's situation of improved outlook and willingness to accept help, you should recommend a teen pregnancy support group.",B,"Attending a teen pregnancy support group would be helpful. Therefore, the correct answer is (A)",core counseling attributes
84, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.","Having assessed the client as ISA type, which of the following will provide the client with the best occupational information that match her type?",The Occupation Finders Handbook,The Occupational Outlook Handbook,Occupational Network Encyclopedia of Titles,The Career Options Handbook of Occupational Titles,"(A): The Occupation Finders Handbook
(B): The Occupational Outlook Handbook
(C): Occupational Network Encyclopedia of Titles
(D): The Career Options Handbook of Occupational Titles",The Occupational Outlook Handbook,B,"The Occupational Outlook Handbook (OOH) is published by the Bureau of Labor Statistics in the U S Department of Labor. It contains thousands of occupations and information about each that include work environment, job tasks, required training, salary and growth projections, and advancement opportunities. It is updated every two years and is the most popular source used by career counselors. The OOH is matched to Holland's RIASEC personality types and each occupation is coded with a type. Responses b, c, and d are not occupational resources. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
85,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",Which might you use to provide additional information about this couple?,16 Personality Factor Questionnaire (16PF),Myers-Briggs Type Indicator (MBTI),Marital Satisfaction Inventory (MSI),Sexual Interaction Inventory (SII),"(A): 16 Personality Factor Questionnaire (16PF)
(B): Myers-Briggs Type Indicator (MBTI)
(C): Marital Satisfaction Inventory (MSI)
(D): Sexual Interaction Inventory (SII)",Marital Satisfaction Inventory (MSI),C,"This is a 150-item inventory to help determine the nature and intensity of the couple's distress. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
86,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","   tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her","Based on the client’s past relationships, which of the following would be helpful in understanding the client’s relationship patterns?",Clinician Administered PTSD Scale for DSM-5-TR,Relationship Assessment Scale,A genogram,Adult Attachment Interview,"(A): Clinician Administered PTSD Scale for DSM-5-TR
(B): Relationship Assessment Scale
(C): A genogram
(D): Adult Attachment Interview",A genogram,C,"Creating a genogram could be very helpful with this client because it examines relationships with family members and is a visual representation of these relationships including the psychological factors that affect the family and the client. This can be helpful in understanding where this client came from and how it shaped her current functioning. Creating a genogram can also help open up a conversation regarding her history. The Clinician-Administered PTSD Scale might be helpful in understanding the client’s level of PTSD symptomatology, but it would not give insight into the client’s relationship patterns. The Relationship Assessment Scale identifies general satisfaction levels in a current relationship and would not be helpful for this client. The Adult Attachment Interview might be helpful in understanding the client’s attachment with her parents, but the genogram would provide a more global understanding of the client’s family history and the client’s relationships with others in her family. Therefore, the correct answer is (A)",counseling skills and interventions
87,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",What is the primary purpose of parental skills training?,To create a sense of trust between parent and child,To help parents understand their children's emotional needs,To help parents learn how to control their children's behavior,To provide parents with tools for engaging in positive parenting practices,"(A): To create a sense of trust between parent and child
(B): To help parents understand their children's emotional needs
(C): To help parents learn how to control their children's behavior
(D): To provide parents with tools for engaging in positive parenting practices",To provide parents with tools for engaging in positive parenting practices,D,"The primary goal of parental skills training is to provide parents with evidence-based tools and techniques for fostering healthy relationships with their children. Therefore, the correct answer is (B)",counseling skills and interventions
88,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","   iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents",Which of the following would be a clinically appropriate short-term goal at this point in therapy once rapport is built?,Improve the client’s ability to follow directions from his parents.,Improve social interactions with peers and his sister.,Improve grades and functioning in school.,Improve the client’s awareness of the consequences of his actions.,"(A): Improve the client’s ability to follow directions from his parents.
(B): Improve social interactions with peers and his sister.
(C): Improve grades and functioning in school.
(D): Improve the client’s awareness of the consequences of his actions.",Improve the client’s awareness of the consequences of his actions.,D,"The client becoming more aware of the consequences of his actions would be an appropriate short-term goal at this point in the therapeutic relationship. This would be appropriate because it is prioritizing creating awareness more than a significant change in behavior and would assist the client in knowing what he is doing and how it affects himself and others. Assisting the client with awareness of his behavior can also help because if the client can find more effective ways of meeting his needs, he may be more motivated to make changes. Grades, functioning in school, social interactions, and ability to take directions are more long-term goals of therapy because they require incremental change and will take time to achieve. Therefore, the correct answer is (C)",treatment planning
89,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.  Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, ""I can't do this. You tell them."" Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents.    You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, ""We know that something is going on."" He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, ""We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl."" You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her.    The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that ""did this to our daughter."" The initial conversation is difficult, but you provide support as the family talks through their feelings.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","Based on the client's home life, the realities of her pregnancy, and her relationship with her parents, which would be the most beneficial short-term goal to include in a treatment plan?",The client will learn an array of emotion regulation strategies to assist her in effectively functioning with her parents in conflictual situations.,The family will learn and understand triggers and negative patterns contributing to their family problems.,The client and her parents will engage in a psychoeducational unit regarding the physiological and psychological implications of teen pregnancy.,The client and her parents will learn effective communication and conflict-resolution skills to overcome barriers to meaningful conversations.,"(A): The client will learn an array of emotion regulation strategies to assist her in effectively functioning with her parents in conflictual situations.
(B): The family will learn and understand triggers and negative patterns contributing to their family problems.
(C): The client and her parents will engage in a psychoeducational unit regarding the physiological and psychological implications of teen pregnancy.
(D): The client and her parents will learn effective communication and conflict-resolution skills to overcome barriers to meaningful conversations.",The client and her parents will learn effective communication and conflict-resolution skills to overcome barriers to meaningful conversations.,D,"This is the most beneficial short-term goal to include in her treatment plan because it highlights their presenting problems. Therefore, the correct answer is (D)",treatment planning
90, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.",Which of the following is the most helpful response for the client when she reported experiencing panic out in public?,"""You did the right thing by calling your friend to help you calm down, great job!""","""There's nothing to be afraid of right now, it's likely a reaction to your past trauma.""","""Always ensure you know where the nearest police officer is, your safety is paramount.""","""Next time you have anxiety, remind yourself of everything you are grateful for!""","(A): ""You did the right thing by calling your friend to help you calm down, great job!""
(B): ""There's nothing to be afraid of right now, it's likely a reaction to your past trauma.""
(C): ""Always ensure you know where the nearest police officer is, your safety is paramount.""
(D): ""Next time you have anxiety, remind yourself of everything you are grateful for!""","""You did the right thing by calling your friend to help you calm down, great job!""",A,"Using a strengths-based approach, affirming the client of what she did well is the best response. The client reached out to a safe contact requesting support in soothing her nerves; this is the next best thing to being able to soothe herself. Invalidating her experience of fear, assuring her safety where it is not felt, offering irrelevant interventions, or increasing her anxiety by elevating the severity of her fears are all things to be avoided when helping an anxious client overcome panic. Therefore, the correct answer is (A)",counseling skills and interventions
91,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Which of the following does not need immediate assessment in Nadia's case?,Mental status,Where Nadia goes when she is away,Cognitive and adaptive functioning,Parent/child relationship,"(A): Mental status
(B): Where Nadia goes when she is away
(C): Cognitive and adaptive functioning
(D): Parent/child relationship",Parent/child relationship,D,"Although it is important to explore Nadia's relationship with her parents, there are more immediate concerns. These include knowing where Nadia goes when she runs away, to assess for safety. It is also important to assess Nadia's cognitive and adaptive functioning since her cognitive functioning seems low. This is not uncommon for those who have experience extensive abuse and trauma. A mental status exam would also assess for risk and current mental capacity. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
92,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps.  Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, ""I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?"" You remain calm and acknowledge the client's frustration. You reply, ""You're angry with me because you feel that I'm not listening. Am I hearing you right?"" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety.    The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but ""she just doesn't get how hard it is for me."" He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, ""It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?"" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ",You feel the client may benefit from concurrent treatment. Who would you refer the client to based on symptoms?,Involuntary hospitalization,Psychiatrist,Marriage Family Therapist,Family Therapy,"(A): Involuntary hospitalization
(B): Psychiatrist
(C): Marriage Family Therapist
(D): Family Therapy",Psychiatrist,B,"A psychiatrist would be beneficial for treatment of the client's anxiety, especially as medication may be needed at this time. Therefore, the correct answer is (D)",treatment planning
93,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated.  You want the client to know that you are listening because he is expressing strong emotions and you want to support him","You want the client to know that you are listening because he is expressing strong emotions and you want to support him. All of the following demonstrate therapeutic listening, EXCEPT:",Refraining from the use of “mm-hmm” and similar responses,Identifying and discussing verbal/nonverbal inconsistencies,Attentive silence,Mirroring,"(A): Refraining from the use of “mm-hmm” and similar responses
(B): Identifying and discussing verbal/nonverbal inconsistencies
(C): Attentive silence
(D): Mirroring",Refraining from the use of “mm-hmm” and similar responses,A,"A balanced use of affirmative sounds (“mhmm,” “yeah,” etc). lets the client know that you are listening to him. Be conscientious about how often you use these responses because they can be distracting, may appear as though you are rushing the client, or may appear as though you are disinterested. Silence generally does not provide the client with the feedback that you are listening to him. However, attentive silence with body language that demonstrates you are listening can allow the client the space to speak freely. Mirroring involves repeating key words or phrases that the client uses to demonstrate that you heard the important pieces of what was said. Identifying and expressing that you notice inconsistencies in verbal and nonverbal communication is important but needs to be done carefully. This demonstrates to the client that you hear him and recognize how he feels. Therefore, the correct answer is (C)",counseling skills and interventions
94,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.  Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, ""On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life."" The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, ""Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!""    You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now.    At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her.",,Why would the psychiatrist you referred the client to prescribe a low dosage of Paxil?,Address her panic attacks,Address her anxiety,Address her insomnia,Address her forgetfulness,"(A): Address her panic attacks
(B): Address her anxiety
(C): Address her insomnia
(D): Address her forgetfulness",Address her anxiety,B,"Paroxetine (Paxil) is an antidepressant used to treat various mental health conditions in adults, including depression, anxiety, and panic disorder. Therefore, the correct answer is (B)",counseling skills and interventions
95,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.","In assessing for Social Phobia, which is the best description of Mary's presentation?",Avoidance causes clinically significant impairment in social functioning,Persistent concern or worry about people noticing her anxiety,Mary is afraid of getting sick by others in public,Complex grief has developed into severe social phobia,"(A): Avoidance causes clinically significant impairment in social functioning
(B): Persistent concern or worry about people noticing her anxiety
(C): Mary is afraid of getting sick by others in public
(D): Complex grief has developed into severe social phobia",Avoidance causes clinically significant impairment in social functioning,A,"Mary's contributing factors to her social anxiety are numerous, however her response to her fears is the same in that all are subject to her avoidance. Therefore, summarizing her symptoms because of specific factors (such as in answers a, b, or d) is not the best choice. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
96,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks","All of the following are helpful cognitive behavioral therapy (CBT) techniques to manage the anxious thoughts that lead to a panic attack, EXCEPT:",Reframing,Progressive muscle relaxation,Radical acceptance,Thought stopping,"(A): Reframing
(B): Progressive muscle relaxation
(C): Radical acceptance
(D): Thought stopping",Radical acceptance,C,"Radical acceptance is a DBT technique that does help with anxiety because it is about seeing the world how it is and accepting your reality, but it is not a CBT technique. Although acknowledging that a panic attack is occurring is helpful, it takes away the individual’s power to change her situation if she simply accepts it. Thought stopping and reframing are helpful cognitive techniques to manage the spiraling anxious thoughts that build into panic attacks. Progressive muscle relaxation is a helpful technique to use in the moment to calm her body down physically and to calm her mind. Therefore, the correct answer is (D)",counseling skills and interventions
97,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.",ntly. Family History: The client has an older brother who transports the client to appointments and periodically checks in with the client. Hospital records indicate that the client becomes increasingly agitated during visits with his parents. The hospital social worker noted that his father was critical and dismissive toward the client during family therapy. The client’s mother is diagnosed with generalized anxiety disorder and had to quit her job due to the overwhelming burden of the client’s care. The father blames the client for the excessive toll his illness has placed on the family,Which of the following medication side effects is the client experiencing?,Akathisia,Dystonia,Tardive dyskinesia,Parkinsonism,"(A): Akathisia
(B): Dystonia
(C): Tardive dyskinesia
(D): Parkinsonism",Akathisia,A,"The client is experiencing akathisia. Akathisia manifests as nervousness, restlessness, tension, and creates the need for individuals to feel like they constantly need to move. First-generation antipsychotics, such as haloperidol (Haldol), are commonly associated with extrapyramidal side effects (EPS). There are several EPS associated with antipsychotic medications, such as phenothiazine neuroleptics and haloperidol, and many are painful and can be serious if not treated. Dystonia, tardive dyskinesia, and Parkinsonism are all examples of EPS. Dystonia involves involuntary muscle contractions and can occur in various body parts, including the neck, jaw, head, and back. Tardive dyskinesia affects individuals by causing involuntary movements of the tongue and may impede eating and swallowing. Parkinsonism is commonly expressed as unsteadiness and is characterized by a slow, shuffling gait. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
98,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",What is the value of recommending the client keep a mood journal at this stage of therapy?,It assists her in becoming more introspective rather than too externally focused.,It allows her to identify triggers for different emotional states.,It enables her to practice becoming more aware of her feelings.,It helps her to identify the frequency of the moods she is experiencing.,"(A): It assists her in becoming more introspective rather than too externally focused.
(B): It allows her to identify triggers for different emotional states.
(C): It enables her to practice becoming more aware of her feelings.
(D): It helps her to identify the frequency of the moods she is experiencing.",It allows her to identify triggers for different emotional states.,B,"Identifying triggers is essential to helping the client curb her mood dysregulation. This is particularly the case for those on the bipolar spectrum. Journaling helps control symptoms and improve mood by assisting with prioritized problems, fears, and concerns. Tracking symptoms on a day-to-day basis both helps the client to recognize triggers as well as to learn techniques to control them better. Therefore, the correct answer is (C)",counseling skills and interventions
99, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,An important area to gain more information on at this point is?,Source of anxiety,Cultural factors,Financial situation,Social support,"(A): Source of anxiety
(B): Cultural factors
(C): Financial situation
(D): Social support",Source of anxiety,A,"It is evident that Li is distressed enough to come to counseling even though she believes she is putting herself at risk and maybe cannot afford it. Starting with the source of her anxiety is important. This may lead to discussion about the other areas which would all be discussed during a comprehensive intake. However, the source of Li's anxiety should be addressed first. Therefore, the correct answer is (B)",counseling skills and interventions
100,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ","When developing a treatment plan for this client, what approach has the most likelihood of success given her diagnosis?",Creating a treatment plan that is focused on decreasing anxiety,Creating a treatment plan that prioritizes postponing gratification,Creating a treatment plan that seeks to address social deficits,Creating a treatment plan based on the skill-building and identifying strengths,"(A): Creating a treatment plan that is focused on decreasing anxiety
(B): Creating a treatment plan that prioritizes postponing gratification
(C): Creating a treatment plan that seeks to address social deficits
(D): Creating a treatment plan based on the skill-building and identifying strengths",Creating a treatment plan based on the skill-building and identifying strengths,D,"There is no ""cure"" for Specific Learning Disorder, but clients who are struggling with a learning disorder can improve their skills and explore alternate methods of learning that are based on their unique strengths. Therefore, the correct answer is (C)",treatment planning
101,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Which of the following is a nonprojective test that can be administered to Nadia?,Achenbach tests,Thematic apperception test,Rorschach,Sentence completion test,"(A): Achenbach tests
(B): Thematic apperception test
(C): Rorschach
(D): Sentence completion test",Achenbach tests,A,"The Achenbach tests are a collection of question-based assessments for ages 1 ½ to 90, and are not projective. Achenbach tests look at several areas of functioning. Projective tests use ambiguous stimuli which are identified or completed by an individual and are said to bring forth unconscious feelings or desires. The thematic apperception test uses ambiguous scenes in which the individual tells a story of what they think is happening. The Rorschach uses inkblots in which the individual identifies what the object is. In the sentence completion test, a sentence stem is given which the individual completes. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
102,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”",Which objective is most efficient for addressing Lottie's behavior issues?,Discuss feelings about having ADHD and learn acceptance and coping.,Identify behaviors causing difficulty and list consequences of problem behaviors.,Teach replacement behaviors and practice using them.,Learn how ADHD affects behavior and verbalize understanding of symptoms.,"(A): Discuss feelings about having ADHD and learn acceptance and coping.
(B): Identify behaviors causing difficulty and list consequences of problem behaviors.
(C): Teach replacement behaviors and practice using them.
(D): Learn how ADHD affects behavior and verbalize understanding of symptoms.",Identify behaviors causing difficulty and list consequences of problem behaviors.,B,"With co-occurring ADHD and ODD, Lottie is going to have a hard time taking suggestions in treatment of her conditions. Cognitively she is impaired and behaviorally she is resistant to suggestions. Without an understanding of how or why some of her behaviors are problematic, Lottie may not develop the desire or motivation to modify her behaviors. With little insight into what is causing her difficulty, Lottie will also not be willing to make changes. Discussing feelings about her conditions, learning acceptance, and coping strategies, and better comprehending the clinical issues underlying her symptoms, are all healthy objectives in counseling with Lottie; however, the most efficient method to directly help affect positive change for her is to target what Lottie endorses she is struggling with and help her see the effect of her choices. She may then be more willing to work on interventions aimed towards modifying inappropriate actions or improving skills needed to compensate for deficits. Therefore, the correct answer is (D)",counseling skills and interventions
103,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","Fourth Session, 3 Weeks After the Initial Intake The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions",What kind of cognitive distortion is the client experiencing?,All-or-nothing thinking,Personalization,Labeling,Jumping to conclusions,"(A): All-or-nothing thinking
(B): Personalization
(C): Labeling
(D): Jumping to conclusions",Jumping to conclusions,D,"The client is experiencing the cognitive distortion of jumping to conclusions. The client is using past experiences regarding her trauma to infer that this present situation will end in the same way. Labeling is about assigning value or labels to ourselves or others. Personalization is about taking blame or responsibility for the situation and would not relate to this client’s thoughts during this session. All-or-nothing, or black-or-white, thinking implies that a situation is either one way or the complete opposite. This would not apply because the client is assuming results based on prior experiences rather than assigning an all-or-nothing quality to the situation. Therefore, the correct answer is (D)",counseling skills and interventions
104,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with client 3 for his individual therapy session. The client continues to be resistant, stating that he does not need to meet with you. You spend the session trying to build rapport with the client and are successful in taking down some of his walls. The client says he knew client 2 from back when he was in high school and began telling you that she slept with a bunch of guys and did a lot of drugs. You redirect the client back to focusing on himself. The client starts to open up about his relationship with his parents growing up and how he thinks they did not really try to show him affection and this made him sad talking about it. The client concludes by saying “I feel overwhelmed sharing all of this because I’ve never talked about it before.” You thank the client for sharing and you empathize with him.  Due to resistance, you choose to use motivational interviewing techniques with client 3","Due to resistance, you choose to use motivational interviewing techniques with client 3. Which of the following would be an approach in engaging the client in treatment planning that uses motivational interviewing?","You realize that you are imposing your goals for engagement, so you support the client in identifying what is important to him.",You decide to support the client in reframing thoughts about counseling and its ability to improve his life.,You assess the client’s personality by discussing birth order and its effects on functioning.,"You realize that the purpose of the client’s behavior is to escape counseling, so you continue to engage the client in order to prevent escape.","(A): You realize that you are imposing your goals for engagement, so you support the client in identifying what is important to him.
(B): You decide to support the client in reframing thoughts about counseling and its ability to improve his life.
(C): You assess the client’s personality by discussing birth order and its effects on functioning.
(D): You realize that the purpose of the client’s behavior is to escape counseling, so you continue to engage the client in order to prevent escape.","You realize that you are imposing your goals for engagement, so you support the client in identifying what is important to him.",A,"Using the client’s motivation and focusing on what they want to work on may help in building rapport and would be using motivational interviewing techniques. Reframing thoughts uses CBT techniques. Focusing on addressing escape behaviors would be an example of a behavior therapy technique. Discussing birth order is related to Adlerian therapy. Therefore, the correct answer is (A)",counseling skills and interventions
105,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",Who is the identified client in this case?,The father as he is the established cause for the son's treatment,The son because his maladaptive behavior is compromising his wellbeing,The mother because she is the client seeking help for her son,The mother and the son,"(A): The father as he is the established cause for the son's treatment
(B): The son because his maladaptive behavior is compromising his wellbeing
(C): The mother because she is the client seeking help for her son
(D): The mother and the son",The son because his maladaptive behavior is compromising his wellbeing,B,"In this case, all treatment is tailored toward the son's wellbeing. All other parties would be considered support systems for this client. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
106,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client has made steady progress toward reducing maladaptive eating. After several weeks of collecting self-monitoring data, you and the client successfully identify patterns that maintain the problem of binge eating. The client’s depressive symptoms have improved, and she is seeking interpersonal connections. She has set appropriate boundaries with her family and distanced herself from their church. The client briefly attended a more liberal church, experienced biphobia, and did not return. She explains, “In my parent’s church, I’m not straight enough. In the LGBTQ community, I’m not gay enough.” You have introduced her to dialectical behavioral therapy, and she attributes mindfulness to improved depressive symptoms","Using the Transtheoretical Model (TTM) of the Stages of Change Model (SOC), which technique helps move the client from the contemplation stage to the preparation stage?",Tipping the decisional balance,Flexible pacing,Commitment and activation,Rolling with resistance,"(A): Tipping the decisional balance
(B): Flexible pacing
(C): Commitment and activation
(D): Rolling with resistance",Tipping the decisional balance,A,"Tipping the decisional balance (DB) is essential for moving the client from the contemplation stage to the preparation stage of change. Prochaska and DiClemente (1984) developed the Transtheoretical Model (TTM) of the Stages of Change Model (SOC) that serves as the foundation for enhanced motivational interviewing (MI). The stages of change are precontemplation, contemplation, preparation, action, and maintenance. Tipping the decisional balance is used to move clients from ambivalence toward commitment and change. DB exercises include examining ambivalence and advocating for change talk. Commitment, activation, and taking steps (CAT) help move clients from preparation to action. Rolling with resistance is used to decrease sustain talk (ie, what is keeping them in the problem) and is mainly used in the earlier SOC. Flexible pacing is an MI strategy used to help the counselor stay with the client and resist the urge to jump ahead or push the client forward rather than move at their own pace. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
107,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,The counselor should respond?,"""I have a colleague here, if you want to just see them?""","""All therapists abide by the same confidentiality laws and principals, but we can find you someplace where you feel most comfortable.""","""I don't know if that is a good idea as we already started talking about goals, I can definitely help you.""","""If that is what you want, I will gladly do that.""","(A): ""I have a colleague here, if you want to just see them?""
(B): ""All therapists abide by the same confidentiality laws and principals, but we can find you someplace where you feel most comfortable.""
(C): ""I don't know if that is a good idea as we already started talking about goals, I can definitely help you.""
(D): ""If that is what you want, I will gladly do that.""","""All therapists abide by the same confidentiality laws and principals, but we can find you someplace where you feel most comfortable.""",B,"Sometimes clients will ask for a referral out, for diverse reasons. Clients must be able to assert their freedom of choice of who conducts their treatment. Choice d respects Harold's autonomy but lets Harold know he should expect the same standards of confidentiality with whomever he sees. Although the counselor and Harold did start the work, this statement seems more about the counselor and his/her feelings about the rejection. Choice b seems a little cold, as if the counselor is relieved that Harold suggested this. Choice c dismisses why Harold is requesting a referral out. The counselor is obligated to make an appropriate referral. Therefore, the correct answer is (D)",professional practice and ethics
108,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.",The client presents as an outwardly successful professional who has a family history of substance abuse and emotional repression who has just experienced the end of a long-term relationship as result of her alcohol use. Which short-term objective is most appropriate to address at this time?,Participate in a medical evaluation to assess effects of long-term alcohol use,Attend a 12-step program for group support,Verbalize an understanding of alcoholism and the recovery process,Learn and implement coping strategies focused on loss,"(A): Participate in a medical evaluation to assess effects of long-term alcohol use
(B): Attend a 12-step program for group support
(C): Verbalize an understanding of alcoholism and the recovery process
(D): Learn and implement coping strategies focused on loss",Participate in a medical evaluation to assess effects of long-term alcohol use,A,"A full physical examination can help determine if there are any underlying medical conditions that are contributing to the client's mental health issues. It is important to rule out any potential physiological causes before beginning therapy. Additionally, a physical exam may also reveal effects of long-term alcohol abuse, such as jaundice or liver damage. Therefore, the correct answer is (C)",treatment planning
109,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",How would you best reflect the client's feelings at the beginning of the session?,"""It's okay to feel frustrated about coming here today. Can you tell what happened today that has caused you to feel this way?""","""I can see that you're feeling frustrated and angry right now. And maybe like you don't have any control over what's happening. Does that sound right?""","""It makes sense to me why you don't want to be here. You believe that no matter what you say or do, nothing changes.""","""I hear what you're saying and I understand how it might feel like I don't care. Can you tell me more about why you think that?""","(A): ""It's okay to feel frustrated about coming here today. Can you tell what happened today that has caused you to feel this way?""
(B): ""I can see that you're feeling frustrated and angry right now. And maybe like you don't have any control over what's happening. Does that sound right?""
(C): ""It makes sense to me why you don't want to be here. You believe that no matter what you say or do, nothing changes.""
(D): ""I hear what you're saying and I understand how it might feel like I don't care. Can you tell me more about why you think that?""","""I can see that you're feeling frustrated and angry right now. And maybe like you don't have any control over what's happening. Does that sound right?""",B,"At the beginning of the session, the client is feeling angry and frustrated. He is tired of talking about his problems and doesn't think it will make any difference. He is also feeling a sense of hopelessness, thinking that no matter what he does, nothing changes. Ultimately, he feels like he has no control over his life or his emotions. Therefore, the correct answer is (C)",counseling skills and interventions
110,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",What assessment tool is most applicable to the client based on his presentation?,Connors Comprehensive Behavior Rating Scales (Conners CBRS),Beck Anxiety Inventory (BAI),CAGE Questionnaire,Columbia Mental Maturity Scale (CMMS),"(A): Connors Comprehensive Behavior Rating Scales (Conners CBRS)
(B): Beck Anxiety Inventory (BAI)
(C): CAGE Questionnaire
(D): Columbia Mental Maturity Scale (CMMS)",Beck Anxiety Inventory (BAI),B,"The Beck Anxiety Inventory gauges severity and distinguishes between anxiety and depression. This would be helpful for the client who experiences anxiety and tries to distract himself by such actions as punching mirrors. The first priority is to ascertain the severity of the anxiety. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
111,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations","Counselors practicing the ethical use of distance counseling, technology, and social media disclose to clients all of the following EXCEPT:",The lack of visual cues and voice intonations used with electronic communication may affect the counseling process.,"The need to identify alternative methods of service delivery may occur, because of the possibility of technology failure.","Informed consent for distance counseling, technology, and social media is no different than the protocol used with face-to-face counseling.",There are some individuals who may have unauthorized access to their electronic health records.,"(A): The lack of visual cues and voice intonations used with electronic communication may affect the counseling process.
(B): The need to identify alternative methods of service delivery may occur, because of the possibility of technology failure.
(C): Informed consent for distance counseling, technology, and social media is no different than the protocol used with face-to-face counseling.
(D): There are some individuals who may have unauthorized access to their electronic health records.","Informed consent for distance counseling, technology, and social media is no different than the protocol used with face-to-face counseling.",C,"According to the ACA Code of Ethics (2014), “In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, [there are] issues, unique to the use of distance counseling, technology, and/or social media, [that] are addressed in the informed consent process” Specifically, counselors must explain that “individuals might have authorized or unauthorized access to such records or transmissions (eg, colleagues, supervisors, employees, information technologists)” (ACA, 2014). Counselors acknowledge that the lack of visual cues and voice intonations used with electronic communication may affect the counseling process. Finally, counselors inform clients that there is a need to identify alternative methods of service delivery because of the possibility of technology failure. Therefore, the correct answer is (C)",professional practice and ethics
112, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,A necessary factor for Sandy to overcome alcohol abuse is?,Support from family,A sponsor,Medication to alleviate withdrawal symptoms,Motivation to change,"(A): Support from family
(B): A sponsor
(C): Medication to alleviate withdrawal symptoms
(D): Motivation to change",Motivation to change,D,"Sandy can have all the resources above available to her, but if she does not have the motivation to change, she will not be successful. Once she has the motivation to change, support from others will be important to prevent relapse. One example of support is a sponsor, someone who has been through the stages of recovery. Medication to relieve the symptoms of withdrawal also makes this process more bearable. Therefore, the correct answer is (B)",treatment planning
113,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client talks about when he went to see his daughter at a dance recital and how, afterward when he went to say hello to her, she ignored him. He called his ex-wife later that day, and she denied knowing what was wrong, but when he talked to his son, the boy said, “Mommy told us you didn’t want to live with us anymore and that is why you left.” The client expresses frustration and anger with his ex-wife because she chose to leave him, and he thinks that it is not fair that she is telling the children a lie and also that it is affecting his relationship with them. The client states that he wanted to talk to you before he confronted his wife about this. You and the client discuss conflict resolution skills.  The client provides you with a gas gift card, and he expresses that he is appreciative of your support","The client provides you with a gas gift card, and he expresses that he is appreciative of your support. Which of the following would demonstrate the most appropriate response considering what you know about the client?",You deny the gift because you do not want to cause economic hardship.,You consider what the client wants in return for the gift.,You consider why you want to accept the gift.,You consider accepting the gift due to cultural considerations.,"(A): You deny the gift because you do not want to cause economic hardship.
(B): You consider what the client wants in return for the gift.
(C): You consider why you want to accept the gift.
(D): You consider accepting the gift due to cultural considerations.",You consider accepting the gift due to cultural considerations.,D,"Based on what you know about this client, you consider the cultural reasons for the gift because it could be considered offensive in Hispanic cultures to decline a gift. It is also important to consider economic hardship, what the client may want or expect in exchange for the gift, and why you want the gift; however, with what you know thus far about the client, the most important aspect to consider is his culture. Therefore, the correct answer is (A)",professional practice and ethics
114,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”",Which of the following interventions would be the most effective for helping the client and her partner develop better communication skills at home?,Role play having the client's partner clarify whether the client is asking for help,Have the client and her partner develop a list of practice topics for asking for help,Provide a list of ideas that the client and her partner can use to ask for help from each other,Identify which areas the client has the most difficulty asking for help,"(A): Role play having the client's partner clarify whether the client is asking for help
(B): Have the client and her partner develop a list of practice topics for asking for help
(C): Provide a list of ideas that the client and her partner can use to ask for help from each other
(D): Identify which areas the client has the most difficulty asking for help",Identify which areas the client has the most difficulty asking for help,D,"Identifying which areas the client struggles with in asking for help will guide the counselor and client to focus on the emotions that surround these specific situations. This allows the client and her partner to be aware that these trouble spots are important and need more attention when communicating. The counselor and client then can practice role-playing examples of these situations. Having the counselor provide, or the client and her partner develop, a list for practice topics is likely to include more superficial topics since these are seen as practice opportunities. No evidence has been shown that the client struggles to ask for help except with her cancer journey and its impact on the couple's intimacy. Having the counselor roleplay with the client's partner puts the partner in the position to have to ""pull out"" what the client is really asking for, rather than helping the client communicate her needs more openly. Therefore, the correct answer is (C)",counseling skills and interventions
115,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,What assessment would be best to assess Molly's current functioning?,Beck Depression Inventory,Child and Adolescent Functional Assessment Scale,Conners Rating Scale,Vineland Adaptive Behavior Scales,"(A): Beck Depression Inventory
(B): Child and Adolescent Functional Assessment Scale
(C): Conners Rating Scale
(D): Vineland Adaptive Behavior Scales",Beck Depression Inventory,A,"The Beck Depression Inventory is a 21 question, self-scoring questionnaire to determine the severity of depression. This would be beneficial to use at this time to assess the presence and severity of depressive symptoms. The Child and Adolescent Functional Assessment Scale is an assessment that measures functioning in various domains such as cognitive functioning and issues at school, home and the community. Molly has not had difficulties prior to the death of her father and her school issues are the result of attendance issues. If she was having difficulty in other areas of her life, this assessment may be beneficial to help drive goals and treatment. The Vineland Adaptive Behavior Scales is a guided questionnaire used to identify developmental disabilities. This would not be appropriate to use with Molly as there is no indication of developmental issues. The Conners Rating Scale is used to measure the severity of symptoms of Attention Deficit Hyperactivity Disorder (ADHD). In addition, various domains are examined. This would not be an appropriate assessment to use with Molly as she is not exhibiting any symptoms of ADHD. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
116,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.",tion. Family History: The husband and wife have been married for 13 years. They report that they met when friends introduced them and that they dated for about 2 years before getting married. The couple have two children: two daughters (ages 7 and 10). The couple reports that they have been in “parent mode” for the past few years and have not been emotionally connected to each other because their attention has been predominantly focused on their children.  You supervise an intern in your clinic who is working with a couple that is in counseling for coparenting but is also in a legal battle for custody,You supervise an intern in your clinic who is working with a couple that is in counseling for coparenting but is also in a legal battle for custody. Which of the following is the most ethically sound indication to release information for legal purposes?,"The husband’s lawyer requests records of sessions, so you provide them to the lawyer because they are a legal representative and you have written consent to release the information.","The court subpoenas the records, so you provide them without written consent from either individual.","The wife’s lawyer requests you to appear in court, so you attend and testify without written consent from either the wife or husband.","Both individuals can request and receive records because they are both the identified client, and you must provide records when they are subpoenaed.","(A): The husband’s lawyer requests records of sessions, so you provide them to the lawyer because they are a legal representative and you have written consent to release the information.
(B): The court subpoenas the records, so you provide them without written consent from either individual.
(C): The wife’s lawyer requests you to appear in court, so you attend and testify without written consent from either the wife or husband.
(D): Both individuals can request and receive records because they are both the identified client, and you must provide records when they are subpoenaed.","The court subpoenas the records, so you provide them without written consent from either individual.",B,"You can release information to the court if the court provides an official subpoena for recordsThis is a situation in which you can release information without any ethical conflicts because it is a legal requirement. The husband’s lawyer may be his legal representative, but you do not have written consent from the wife to release records. The wife’s lawyer can request that you appear in court, but you still would not have the husband’s consent to do so. Although both individuals are the identified client, you can withhold records if it causes potential harm to the other client. In this case, harm may be likely if information is released to one of the individual clients because it may affect the couple’s relationships with their children. For that reason, ethically, it would not be sound judgment to release the requested records to the individuals at this time. Therefore, the correct answer is (B)",professional practice and ethics
117,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","    plan. Family History: The client’s parents are divorced and he lives with his mother and two younger siblings. There is a history of child protective services (CPS) involvement due to reports of domestic violence between his parents. The client witnessed these incidents between that ages of 10 and 12. His parents subsequently divorced and the client has had minimal contact with this father since. The client’s maternal aunt is diagnosed with obsessive-compulsive disorder. His mother previously attended therapy for anxiety and other trauma-related symptoms. The client began experiencing symptoms of body dysmorphic disorder at age 13, with symptoms worsening after starting high school.  The client states, “When I leave the house, everyone is staring at my ears and laughing at my deformity","The client states, “When I leave the house, everyone is staring at my ears and laughing at my deformity.” This is an example of which one of the following?",Black-and-white thinking,All-or-nothing thinking,Emotional reasoning,Personalization,"(A): Black-and-white thinking
(B): All-or-nothing thinking
(C): Emotional reasoning
(D): Personalization",Personalization,D,"This is an example of personalization. Personalization is a cognitive distortion that involves a person believing that they are being targeted by someone else’s behavior (eg, laughing) when it has nothing to do with that person. All-or-nothing thinking is synonymous with black-and-white thinking and polarized thinking (eg, “If I’m not perfect, then I’m nothing”). Emotional reasoning results from believing that one’s feelings are facts, despite contradictory evidence (eg, “I feel deformed and worthless, so I must be that way”). Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
118,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",You would like to collaborate with other providers for the treatment of the client. Who would be the most important person to discuss progress and monitoring with?,The school principal,The school psychologist,The school resource officer.,The client's teacher,"(A): The school principal
(B): The school psychologist
(C): The school resource officer.
(D): The client's teacher",The school psychologist,B,"School psychologists bridge the gap between teacher and parent. They assess children's needs and report to the principal to make final decisions. This is the most important professional with whom to collaborate. Therefore, the correct answer is (C)",treatment planning
119,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","   e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services.  You discuss the case with your supervisor, who encourages you to use a structural family therapy approach to examine the relationship between the client and his mother","You discuss the case with your supervisor, who encourages you to use a structural family therapy approach to examine the relationship between the client and his mother. Which statement best reflects this approach?",The client and the mother’s maladaptive behavior is the result of misunderstandings and a lack of loyalty and trust.,The client and the mother belong to an enmeshed family subsystem.,The client and the mother’s dysfunctional communication is the result of a reinforced circular feedback loop.,The client and the mother are highly emotionally fused and undifferentiated.,"(A): The client and the mother’s maladaptive behavior is the result of misunderstandings and a lack of loyalty and trust.
(B): The client and the mother belong to an enmeshed family subsystem.
(C): The client and the mother’s dysfunctional communication is the result of a reinforced circular feedback loop.
(D): The client and the mother are highly emotionally fused and undifferentiated.",The client and the mother belong to an enmeshed family subsystem.,B,"Developed by Salvador Minuchin, structural family therapy is based on the premise that family subsystems and boundaries are either disengaged or enmeshed. The mother and the client are an enmeshed subsystem due to being overly dependent and close. Multigenerational (Extended) Family Systems therapists use the termundifferentiated family ego massto describe individuals in families with high levels of emotional fusion and low levels of differentiation. Contextual family therapists view maladaptive behavior as an imbalance in loyalty, trust, and mutual understanding. Strategic family therapists view maladaptive behavior as the result of circular communication. Circular communication occurs when a behaviorally reinforced feedback loop maintains the family’s homeostasis and dysfunction. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
120,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",What is the most noteworthy reason you would need to break confidentiality with this client?,The client is engaging in behavior where he is at risk of harming himself,The client poses an imminent and violent threat to others,The client reports a history of emotional abuse from his father,The client is destroying property,"(A): The client is engaging in behavior where he is at risk of harming himself
(B): The client poses an imminent and violent threat to others
(C): The client reports a history of emotional abuse from his father
(D): The client is destroying property",The client is engaging in behavior where he is at risk of harming himself,A,"The client punches bathroom mirrors when he cannot distract from the anxious thoughts. He is not cutting or harming himself badly, but this is something to monitor. You need to reiterate to the client that you must break confidentiality if he is a danger to himself or others. Therefore, the correct answer is (D)",professional practice and ethics
121, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,"Based on the first session notes, what should the counselor do next?",Refer client to inpatient treatment,Definitively state that trust and therapeutic alliance is established,Identify client driven goals and objectives,Discuss transferring to someone who specializes in eating disorders,"(A): Refer client to inpatient treatment
(B): Definitively state that trust and therapeutic alliance is established
(C): Identify client driven goals and objectives
(D): Discuss transferring to someone who specializes in eating disorders",Identify client driven goals and objectives,C,"Now that the diagnosis has been established, it is important to formulate a treatment plan that focuses on the needs and priorities of the client. Autumn is not currently a safety risk to herself or others, so hospitalization is not warranted. Throughout the counseling process, the quality of the therapeutic alliance should be monitored and addressed if any issues arise. There is no indication that the counselor cannot properly treat the client. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
122,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client talks about when he went to see his daughter at a dance recital and how, afterward when he went to say hello to her, she ignored him. He called his ex-wife later that day, and she denied knowing what was wrong, but when he talked to his son, the boy said, “Mommy told us you didn’t want to live with us anymore and that is why you left.” The client expresses frustration and anger with his ex-wife because she chose to leave him, and he thinks that it is not fair that she is telling the children a lie and also that it is affecting his relationship with them. The client states that he wanted to talk to you before he confronted his wife about this. You and the client discuss conflict resolution skills.  The client asks if his ex-wife can come into the next session so they could work on co-parenting skills",The client asks if his ex-wife can come into the next session so they could work on co-parenting skills. Which one of the following is the most ethical course of action?,Explain your role with the client and provide a family therapy or couples counseling referral.,"Explain that if you are going to work with the client and his wife, then you would not be able to revert back to individual counseling because you can only work with him in one modality to avoid a conflict of interest.",Explain guidelines for how you can provide individual therapy for him and his family or couples therapy for him and his ex-wife.,Explain that you are unable to meet with both of them because you are his individual counselor.,"(A): Explain your role with the client and provide a family therapy or couples counseling referral.
(B): Explain that if you are going to work with the client and his wife, then you would not be able to revert back to individual counseling because you can only work with him in one modality to avoid a conflict of interest.
(C): Explain guidelines for how you can provide individual therapy for him and his family or couples therapy for him and his ex-wife.
(D): Explain that you are unable to meet with both of them because you are his individual counselor.",Explain your role with the client and provide a family therapy or couples counseling referral.,A,"You have had four sessions with this client and would likely already be too engaged, and therefore biased, to provide appropriate therapy to your client and his ex-wife at this point. It would be most ethical to refer the couple to another therapist if they would like to work on coparenting skills. Simply stating your inability to work with the couple without providing proper direction via a referral would not be the most ethical course of action because it does not support your client in seeking the additional help that he is requesting. If you provided individual and couples/family therapy, you would be risking bias toward this client because you work more directly with him and his needs. Therefore, the correct answer is (A)",professional practice and ethics
123,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",While conducting a suicide assessment you learn Shania has a history of attempts using prescription medications. What precautions should you advise for her safety plan?,Dispose of all old Rx and lock up any active Rx for partner to administer as needed.,There's nothing she can reasonably do to prevent this from happening again.,File a caution alert on her medical records and mental health charts.,Have her sign a safety plan agreeing to call for help if she feels suicidal.,"(A): Dispose of all old Rx and lock up any active Rx for partner to administer as needed.
(B): There's nothing she can reasonably do to prevent this from happening again.
(C): File a caution alert on her medical records and mental health charts.
(D): Have her sign a safety plan agreeing to call for help if she feels suicidal.",Dispose of all old Rx and lock up any active Rx for partner to administer as needed.,A,"Signing a safety plan does not adequately support a client's high-risk behaviors if there is something that can be done to improve her physical safety. Alerts on her EMRs will not improve her safety when she's at home with access to harmful content. While there is no guarantee of a client's safety, making no advisements is irresponsible if there is something that can at least support her in the interim while you are providing her with services and can monitor her condition and progress. A reasonable suggestion would be to eliminate any inventory of prescription medications that are in her home that she no longer needs, and if she is on current medication, she can discuss safety precautions with her partner who can assist in administering medications daily while the remaining medications are kept in a locked safe. Therefore, the correct answer is (B)",professional practice and ethics
124,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","   e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination.”  Which of the following suggests that gender dysphoria is caused not only by external (distal) stressors (e\. g","Which of the following suggests that gender dysphoria is caused not only by external (distal) stressors (e.g., prejudice, discrimination) but also by internalized (proximal) stressors (transphobia, stigma)?",Social identity theory,Minority stress theory,Escape theory,Cognitive dissonance theory,"(A): Social identity theory
(B): Minority stress theory
(C): Escape theory
(D): Cognitive dissonance theory",Minority stress theory,B,"Minority stress theory posits that gender dysphoria is caused not only by external (distal) stressors (eg, prejudice, discrimination) but also by negatively internalized (proximal) stressors, including internalized transphobia and stigma. Proximal stressors also include anticipated rejection, hiding gender identity out of fear, and the cumulative experiences of being “othered” as a minority in a cisgender culture. Proximal stressors are linked to higher instances of behavioral health disparities and an increase in mental health symptoms. Cognitive dissonance theory asserts that individuals experience distress when faced with two or more incompatible cognitive elements (ie, choices). Social identity theory explains that individuals are influenced by fitting in and belonging to social groups. Alignment with one’s identified social group is likely to affect self-esteem, especially if the identification is strong (ie, an “in-group” versus an “out-group”). Escape theory states that individuals tend to avoid activities that are psychologically unpleasant. Therefore, the correct answer is (B)",counseling skills and interventions
125,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",Your diagnostic impression includes disordered adjustment with “mixed disturbance of emotions and conduct.” Why was this diagnosis chosen over Antisocial Personality Disorder?,You would like to learn more about Davone prior to giving this diagnosis.,The root of Davone's conduct is unresolved emotions.,Davone does not meet criteria for Antisocial Personality Disorder.,Adjustment disorders are preferred for individuals with criminal backgrounds.,"(A): You would like to learn more about Davone prior to giving this diagnosis.
(B): The root of Davone's conduct is unresolved emotions.
(C): Davone does not meet criteria for Antisocial Personality Disorder.
(D): Adjustment disorders are preferred for individuals with criminal backgrounds.",You would like to learn more about Davone prior to giving this diagnosis.,A,"Learning more about Davone's pattern of behaviors, experience of remorse, underlying cognitive and emotional conditions and family history is best practice prior to assigning Davone a personality disorder. Answer a) is incorrect because Davone does meet 3 out of 15 prescribed criteria for APD but upon initial assessment you have not been given adequate time to rule out other possible contributing biopsychosocial factors including any other co-occurring conditions prior to assigning a personality disorder. Answer c) is not a qualifying reason for delaying a personality disorder diagnosis because diagnoses are given based on symptoms and behavioral criteria, not on underlying reasons. Answer d) is also incorrect; people with criminal backgrounds are not given adjustment disorder diagnoses automatically. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
126,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.",You recall her brother lives out of state and that Taylor will be in another state during the virtual visit. What should you consider doing prior to the session?,Explain that you will not be able to have session and reschedule.,Consult with your agency or state laws that govern interns offering out of state services.,Send Taylor a Telemedicine consent form via email and have her send proof she signed.,Because your client lives in your state and is just visiting out of state there is no problem.,"(A): Explain that you will not be able to have session and reschedule.
(B): Consult with your agency or state laws that govern interns offering out of state services.
(C): Send Taylor a Telemedicine consent form via email and have her send proof she signed.
(D): Because your client lives in your state and is just visiting out of state there is no problem.",Consult with your agency or state laws that govern interns offering out of state services.,B,"Each state or agency has specific guidelines for how counseling interns may deliver services in these circumstances, therefore it is best practice to check on the rules governing your specific location and situation prior to conducting session. If you are unable to verify the rules for your situation, it is then best to reschedule until you can do so or return to your counseling routine. Therefore, the correct answer is (B)",professional practice and ethics
127,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What would most influence your decision to suggest a one-on-one aid to support the client through his day?,To demonstrate follow-through on the Education Act of 1996,To meet his Individual Educational Plan,To follow up on a neuropsychological assessment,To ensure his physical safety and the safety of those around him,"(A): To demonstrate follow-through on the Education Act of 1996
(B): To meet his Individual Educational Plan
(C): To follow up on a neuropsychological assessment
(D): To ensure his physical safety and the safety of those around him",To meet his Individual Educational Plan,B,"This is the best option for supporting consistency within this client's plan and would most influence your decision to assign a one-on-one aid. Therefore, the correct answer is (A)",treatment planning
128,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","   ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage\. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining","You are use using acceptance and commitment therapy (ACT) with the client, which involves combining behavioral therapy with which one of the following?",Shaping,Developing discrepancy,Mindfulness,Unbalancing,"(A): Shaping
(B): Developing discrepancy
(C): Mindfulness
(D): Unbalancing",Mindfulness,C,"ACT combines mindfulness and behavioral therapy to assist individuals with accepting distressing thoughts and feelings rather than fighting against them. ACT is an evidence-based practice for OCPD because of its focus on increasing psychological flexibility (ie, reducing rigidity). The practice of mindfulness helps clients stay in the here-and-now and accept each thought and feeling without judgment. Shaping is used in operant conditioning and involves reinforcing successive approximations to a targeted behavior. Unbalancing is associated with structural family therapy and consists of the counselor aligning with a family member or subsystem to create disequilibrium. Developing discrepancy is used with MI to help the client explore the pros and cons of making a change. Therefore, the correct answer is (A)",counseling skills and interventions
129,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","   tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her","All of the following are possible risk factors for suicide, EXCEPT:",Hopelessness about one’s ability to change one’s situation,Recklessness with decision making,Substance use,The presence of depression,"(A): Hopelessness about one’s ability to change one’s situation
(B): Recklessness with decision making
(C): Substance use
(D): The presence of depression",The presence of depression,D,"Although depression can cause suicidal ideation, it has been shown that depression alone is often not the factor that leads to suicide attempts. Rather, a combination of other issues has been proven to correlate with suicidal ideation, including a history of trauma, hopelessness, anxiety, panic attacks, substance use, and self-harm (Sommers-Flanagan & Sommers Flanagan, 2015). Substance use, recklessness, and hopelessness can all attribute to a general disturbance in the client’s ability to make sound decisions, leading to possible suicide attempts. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
130,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following assessments would be helpful before beginning therapy treating the client for PTSD?,All of the above,Multidimensional Inventory of Dissociation (MID),Dissociative Experiences Scale II (DES-II),Structured Clinical Interview for DSM - Revised (SCID-D-R),"(A): All of the above
(B): Multidimensional Inventory of Dissociation (MID)
(C): Dissociative Experiences Scale II (DES-II)
(D): Structured Clinical Interview for DSM - Revised (SCID-D-R)",All of the above,A,"Prior to treating for PTSD, it is important to assess the client's level of dissociation and each of these assessments will help do this. Most people have some level of dissociation (ie, listening to someone talk but realizing that they did not hear part or all of what was said), however those who experience traumatic events may experience greater levels of dissociation. In the presence of high levels of dissociation, individuals with PTSD can experience further traumatic reactions during treatment. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
131,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community","According to the transtheoretical, or stages of change (SOC), model, in which stage would you currently classify this client?",Precontemplation,Action,Contemplation,Maintenance,"(A): Precontemplation
(B): Action
(C): Contemplation
(D): Maintenance",Action,B,"According to the SOC model, the client is in the action stage of change. This model, developed by Miller & Rollnick (2013), outlines the following stages: precontemplation, contemplation, preparation, action, and maintenance. This client has just entered the action stage. The client has been compliant with therapy and reports four negative drug screens. The SOC model is not always linear. The client has just entered the action phase and may regress toward earlier stages or may eventually reach the maintenance stage. Individuals in the precontemplation stage are not considering a change, whereas those in the contemplation stage are beginning to consider making a change. Those in the contemplation stage are still using substances but are weighing the pros and cons of cutting back or abstaining. Individuals in the action stage have a specific behavioral plan and are committed to the process of change. When individuals become more stable in their sobriety, they have reached the maintenance stage. Therefore, the correct answer is (D)",counseling skills and interventions
132, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,Which of the following can be ruled out based on the stated symptoms?,Ketoacidosis,"Sedative, hypnotic or anxiolytic withdrawal",Alcohol withdrawal,Psychosis,"(A): Ketoacidosis
(B): Sedative, hypnotic or anxiolytic withdrawal
(C): Alcohol withdrawal
(D): Psychosis",Ketoacidosis,A,"Ketoacidosis is a diabetic complication in which the body over produces ketones and may cause hallucinations. However, one of the symptoms of ketoacidosis is sweet smelling breath. In the intake summary, it is noted that Sandy had foul smelling breath. Sandy may be showing symptoms of alcohol, sedative, hypnotic or anxiolytic withdrawal which can all cause hallucination or disorientation. Sandy may also be showing symptoms of psychosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
133,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy",Which one of the following would qualify as the client’s ritualistic safety behaviors?,Wearing a beanie or hoodie while away from home,Agreeing to contact the counselor if he experiences suicidal ideations,Identifying core beliefs that contribute to anxiety in social situations,Complying with his selective serotonin reuptake inhibitor (SSRI) medication,"(A): Wearing a beanie or hoodie while away from home
(B): Agreeing to contact the counselor if he experiences suicidal ideations
(C): Identifying core beliefs that contribute to anxiety in social situations
(D): Complying with his selective serotonin reuptake inhibitor (SSRI) medication",Wearing a beanie or hoodie while away from home,A,"Wearing a beanie or hoodie while away from home is a safety behavior. Safety behaviors are used to prevent, diminish, or escape what is perceived as a feared catastrophe. Like other avoidance behaviors, safety behaviors create a positive feedback loop that reinforces anxiety due to cognitive misattributions of safety. Complying with his SSRI medication is not considered to be a safety behavior. Unlike fast-acting medications such as benzodiazepines, SSRIs do not provide immediate onset. Carrying a fast-acting medication such as a benzodiazepine would qualify as a safety behavior. Agreeing to contact the counselor if he is experiencing suicidal ideation is not classified as a ritualistic safety behavior. Core beliefs, which are generally long held, rigid, and pervasive, contribute to the client’s anxiety rather than ensuring safety. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
134,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What is the best response to Logan's mother's request for you to help him make friends at school?,Reassure her that you will talk to his teachers to encourage positive interactions at school,Provide empathy and understanding,Assign him a mentor to help him make social connections,Discuss your role as a school therapist,"(A): Reassure her that you will talk to his teachers to encourage positive interactions at school
(B): Provide empathy and understanding
(C): Assign him a mentor to help him make social connections
(D): Discuss your role as a school therapist",Discuss your role as a school therapist,D,"As a school therapist, it is important to emphasize that you are not in a position to help Logan directly make friends at the new school. However, you can provide him with skills and strategies that will help him better manage his emotions, build self-confidence, and develop social interaction skills that may help him find other students who have similar interests and who he can connect with. Additionally, you can provide Logan's mother with resources and guidance to help her facilitate social connections for her son in the new school. Together, you can work on developing an action plan that will give Logan the tools he needs to be successful at his new school. Therefore, the correct answer is (C)",professional practice and ethics
135,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that she and her husband have separated and she is now living with her parents. She is tearful and says that the past few days have been challenging. She reports an increase in headaches and stomachaches. The client has interviewed for a teaching position at a private school but doesn’t think she can afford a pay cut. Nevertheless, the client continues to be motivated to continue with counseling and believes that she will find a good career fit, but it may take some time. You discuss using a cognitive information processing approach with the client, and she is receptive. You explain that this approach will enable you to examine the communication, analysis, synthesis, valuing, and execution (CASVE) cycle of career decision-making skills.  The client is prioritizing career options and assessing how her choices might impact her community, her significant relationships, and herself","The client is prioritizing career options and assessing how her choices might impact her community, her significant relationships, and herself. The client is in which of the following CASVE decision-making phases?",Synthesis,Communication,Valuing,Analysis,"(A): Synthesis
(B): Communication
(C): Valuing
(D): Analysis",Valuing,C,"The client is in the valuing phase of the CASVE decision-making model. The CASVE decision-making model uses a cognitive information processing approach (CIP) based on Frank Parsons’ three-factor model. When individuals are in the valuing phase, they prioritize career options and construct a cost-benefit analysis of how a new career path fits into their values. The CASVE phases are communication, analysis, synthesis, valuing, and execution. In the communication phase, a career concern is identified by examining the gap between where one sees themselves and where one would like to be. In the analysis phase, there is an acknowledgment of a career problem and an investigation into how the problem can be resolved. This generally includes obtaining an understanding of oneself and one’s viable career options. The synthesis phase involves elaborating on potential solutions and identifying areas consistent with one’s values, abilities, interests, and knowledge. The execution phase is where one determines an action plan. Therefore, the correct answer is (A)",counseling skills and interventions
136,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”",What are the three types of patterns identifiable as ODD criteria?,"angry mood, aggressiveness, criminal behavior","irritable mood, argumentative behavior, vindictiveness","depression, disagreeableness, defensiveness","sensitive, resentfulness, lawlessness","(A): angry mood, aggressiveness, criminal behavior
(B): irritable mood, argumentative behavior, vindictiveness
(C): depression, disagreeableness, defensiveness
(D): sensitive, resentfulness, lawlessness","irritable mood, argumentative behavior, vindictiveness",B,"According to the DSM-5, ODD is characterized by a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness lasting at least six months as evidenced by at least four symptoms from any of these categories. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
137, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”",Which of the following circumstances is most likely to negatively impact the counselor's work with this client?,All of the above,The client continues to refuse medication for depression,The counselor is in recovery from their own substance history,The counselor seeks weekly supervision related to treating this client,"(A): All of the above
(B): The client continues to refuse medication for depression
(C): The counselor is in recovery from their own substance history
(D): The counselor seeks weekly supervision related to treating this client",The counselor is in recovery from their own substance history,C,"Counselors who have their own history of substance use and recovery are often good addictions counselors, but it is also true that to some degree, all counselors have personal issues that influence their work with clients. It is possible that counselors with a history of recovery may be influenced by and may impose their personal recovery experiences and beliefs on their client. Supervision would be a helpful practice to avoid this potentially negative influence on the counselor's work with the client. The client's refusal to use medication for depression must be honored by the counselor under one of the ethical principles of counseling, autonomy. A client's determination to be autonomous should not impact the counselor's work with the client as the counselor should collaborate with the client to find ways to support his decision. Finally, b and c are not negative impacts so choice d is not correct. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
138, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.","Using the information provided, which of the following steps should be taken first?",Setting up initial boundaries for client and her behavior at home.,Working with mother to determine if client should stay with grandmother.,Asking client and mother if they are willing to work together to help client.,Discussing mother's thoughts and feelings about services and home visits.,"(A): Setting up initial boundaries for client and her behavior at home.
(B): Working with mother to determine if client should stay with grandmother.
(C): Asking client and mother if they are willing to work together to help client.
(D): Discussing mother's thoughts and feelings about services and home visits.",Discussing mother's thoughts and feelings about services and home visits.,D,"Addressing the parent's thoughts and feelings about needing or choosing to access services, which includes home visits, is critical to building a therapeutic relationship with both client and her parent. Depending on the mother's cultural history and beliefs, having a stranger in the home, who is acting as an authority figure, may feel demeaning, intrusive, or frightening. Building the therapeutic relationship with the client's mother is equally as important as building it with the client. Asking the client and mother if they are willing to work together may be received as a judgment that mother has not been working for her child up to this point and may be perceived as insulting. Setting up initial boundaries for the client and determining whether the client should stay with her maternal grandmother are choices made by the client's mother and the relationship may be too fragile at this first meeting for the counselor to begin making suggestions for changes for parenting. Therefore, the correct answer is (B)",counseling skills and interventions
139, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.","Given the information provided, which diagnosis is most likely to be accurate for this client?",Schizoaffective Disorder,Autism Spectrum Disorder,Bipolar I Disorder,Major Depressive Disorder,"(A): Schizoaffective Disorder
(B): Autism Spectrum Disorder
(C): Bipolar I Disorder
(D): Major Depressive Disorder",Schizoaffective Disorder,A,"The client is diagnosed with Schizoaffective Disorder. She meets criteria for a major depressive disorder including sadness, loss of appetite, fatigue, irritability, and psychomotor retardation over the past two weeks. Concurrently, the client has been experiencing delusions and hallucinations for over one year during times when she is and is not experiencing a depressive episode. Thus, she meets the criteria for the disorder. While the client is experiencing a major depressive episode, it is within the context of and better explained by the Schizoaffective diagnosis. The client exhibits no deficits in communication that are not explained through her IQ scores and does not demonstrate restricted or repetitive patterns so she does not qualify for an Autism Spectrum disorder. The client does not show symptoms of Bipolar I disorder as she has not experienced manic episodes, including pressured speech, psychomotor agitation, racing thoughts, or high-risk activities. Therefore, the correct answer is (C)",treatment planning
140,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,"To further explore relationships, the counselor should use the following technique?",Ask the child to write a story,Ask the caregiver to ask the child why she doesn't want to live with them anymore,Ask the child numerous questions about the quality of her relationship with caregivers,Explore the child's memories of their caregivers through role-play with puppets,"(A): Ask the child to write a story
(B): Ask the caregiver to ask the child why she doesn't want to live with them anymore
(C): Ask the child numerous questions about the quality of her relationship with caregivers
(D): Explore the child's memories of their caregivers through role-play with puppets",Explore the child's memories of their caregivers through role-play with puppets,D,"The best way at this point to explore the relationships Destiny has with others is by the counselor exploring Destiny's memories. This can be done through play, such as using puppets. Feelings may come out organically as opposed to through direct questions. Asking numerous questions may cause Destiny to shut down. Looking at the child's age, as well as their past trauma, Destiny may not comprehend, let alone verbalize her feelings about living with her foster parents. Additionally, she may not want to be asked this question by Ms Maze. Having the child write a story may be too difficult for Destiny at such a young age. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
141,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",The client reports that a worker from the local child protective services office met with her and that she is worried about what the coach will do in response when he finds out that she reported him. The client says that she has not returned to school but that the school has provided the classwork and homework needed to keep up; she feels like the school is supporting her well enough to not fall behind. The client confirms that all of the symptoms that she described during her last session are still present,"If you are having trouble empathizing with a client, what would be the most beneficial tactic to understanding the client experience?",Research more about experiences that you do not relate to in order to try to understand the client’s experience.,Be open with the client in that you do not understand what it was like for her to experience these circumstances.,Accept that you cannot empathize with every client experience and that is fine.,Try to relate to the core feelings associated with the client’s experience.,"(A): Research more about experiences that you do not relate to in order to try to understand the client’s experience.
(B): Be open with the client in that you do not understand what it was like for her to experience these circumstances.
(C): Accept that you cannot empathize with every client experience and that is fine.
(D): Try to relate to the core feelings associated with the client’s experience.",Try to relate to the core feelings associated with the client’s experience.,D,"Although you will not always have shared life experiences with clients, you can try to understand the core feelings related to their experiences. Although you may have never experienced sexual assault, most people can understand the feelings of fear, violation, and possibly shame. Even though you cannot understand every client’s experience the way the client does, you can still provide empathetic statements to the client based on your own experiences of those core feelings. Being open about your inexperience with the client situation can be helpful, but it does not promote an empathetic response. Research may provide more insight, but it would not help during this immediate session in terms of understanding the client’s experience. Therefore, the correct answer is (B)",counseling skills and interventions
142,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy.  During a CBT exercise, you discover that the client believes his “defective” appearance makes him unworthy of love","During a CBT exercise, you discover that the client believes his “defective” appearance makes him unworthy of love. This is an example of which of the following?",Automatic thought,Core belief,Intermediate belief,Hot thought,"(A): Automatic thought
(B): Core belief
(C): Intermediate belief
(D): Hot thought",Core belief,B,"This is an example of a core belief. Core beliefs are generally long-held, rigid, and pervasive beliefs that are often formed in childhood. The client equates his external attributes, which are distorted perceptions, with being unworthy or unloved. Cognitive restructuring is one mode of CBT used to address core beliefs. Intermediate beliefs occur between automatic thoughts and core beliefs. When an automatic thought (ie, an immediate internal reaction) is generated, there is an intermediate process involving conditions and rules. For example, “If my appearance were not defective, I would be successful and worthy” Intermediate thoughts categorize these assumptions and are driven by core beliefs. Automatic thoughts are immediate, knee-jerk reactions to events or situations. Not all automatic thoughts are negative. It is the unhelpful automatic thoughts that counselors must help clients identify when using cognitive restructuring and other CBT techniques. Hot thoughts are automatic thoughts that happen along with an emotional change. Therefore, the correct answer is (C)",counseling skills and interventions
143,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","You meet with the client alone, and he appears to be more comfortable with you because he comes in and starts talking about a video game that he plays. You share that you have played that video game before. During the session, the client mentions that his parents got his first report card of the year and found out that he was failing most of his classes. He started to say that he was worried that his dad was going to hit him because of his grades. You ask if his father hits him often, and he replies that he does several times a week. You try to inquire about the manner of hitting his father uses because a certain level of corporal punishment is legal in the state that you work in. The client says that he is not going to talk any more about this. You remind the client that you likely will need to report this to child protective services and he says, “I don’t care” in response. You spend the rest of this session processing his relationship with his parents, and he discloses that he does love them, but that they are not his real parents. You meet with the client’s parents near the end of the session, and, while talking with them, they report that he was neglected while in foster care because the foster parent was “just in it for the money.”  The client becomes upset at the end of this session after talking about the alleged physical abuse, and he begins to throw toys and any items within arm’s reach","The client becomes upset at the end of this session after talking about the alleged physical abuse, and he begins to throw toys and any items within arm’s reach. Which one of the following would be the LEAST helpful response when considering the client’s current emotional state?",Use an open body posture and a calm voice,Use the 5-4-3-2-1 grounding technique,Attempt to process the client’s present thoughts and emotions,Disengage with the client with regard to the subject at hand,"(A): Use an open body posture and a calm voice
(B): Use the 5-4-3-2-1 grounding technique
(C): Attempt to process the client’s present thoughts and emotions
(D): Disengage with the client with regard to the subject at hand",Attempt to process the client’s present thoughts and emotions,C,"When the client escalates to using physical aggression, he is likely not able to engage in processing his thoughts and emotions. It may escalate the behavior further if you attempt to have a conversation with the client. Using the 5-4-3-2-1 grounding technique is helpful because it focuses on engaging the senses and it can help the client calm his body down. Using an open body posture and a calm voice supports the client in not feeling threatened. When the client’s level of intensity is not matched, he is more likely to reduce the level of intensity of his emotions to match the counselor’s. It can be assumed that the client’s behavior is an attempt to avoid talking about a difficult topic. In behavior therapy, you would not want to allow the avoidance to occur; however, this might be related to a trauma response because it is about a physical abuse allegation. Therefore, you should strive to be understanding and sensitive about possible trauma. Therefore, the correct answer is (A)",counseling skills and interventions
144,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The client arrives for the session without her husband. Her affect is flat, and she presents as more subdued. The client explains that she has been in bed for the last 4 days, which has caused escalated conflict and tension with her husband. She says that her husband believes that they are at an impasse and threatened to leave during their fight last night. When processing the details of their altercation, the client states that her fear of being alone has become unbearable. She denies any suicidal plans but says she feels hopeless and void of purpose and is in significant levels of physical pain due to intractable migraines. You conduct a suicide risk assessment to determine the client’s level of safety",The National Action Alliance for Suicide Prevention (2018) evidence-based standard care for people with suicide risk includes all of the following elements EXCEPT:,Supervision,Caring contacts,Safety planning,Means reduction,"(A): Supervision
(B): Caring contacts
(C): Safety planning
(D): Means reduction",Supervision,A,"The National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group’sRecommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe(2018) contains recommendations for treating suicidality. All of the elements (safety planning, means reduction, and caring contacts) except supervision are included in the recommended standard care. EBPs for outpatient behavioral health include conducting a safety plan intervention during sessions when the concern for suicide risk is high. Safety planning includes frequently assessing suicidal risk and updating the safety plan during each visit until the risk subsides. Means reduction involves assessing for lethal means and arranging for their removal or reduction. Caring contacts is another evidence-based standard and practice. Caring contacts are staff members or other individuals who provide brief support to clients during high-risk periods, such as transitioning from hospitalization to a lower level of care or for missed appointments. Contacts are made via phone, texts, or letters to help prevent isolation and reduce the risk for suicide. Therefore, the correct answer is (C)",professional practice and ethics
145,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening.  The wife states that she felt her husband was not interested in her anymore and refers to this feeling returning when she tried to have sexual intercourse with him, which was not successful","The wife states that she felt her husband was not interested in her anymore and refers to this feeling returning when she tried to have sexual intercourse with him, which was not successful. Which of the following cognitive distortions best describes this thought process?",Emotional reasoning,Jumping to conclusions,“Should” statements/beliefs,Catastrophizing,"(A): Emotional reasoning
(B): Jumping to conclusions
(C): “Should” statements/beliefs
(D): Catastrophizing",Jumping to conclusions,B,"By assuming that her husband is not interested in her based on a failed attempt at a sexual interaction, the wife is jumping to conclusions in making a generalization based on a single situation. Catastrophizing is when a situation is blown out of proportion based on what occurred, and a conclusion is anticipated to be the worst possible outcome. Emotional reasoning is when an individual feels a certain way and assumes that their feelings are solely emotional and without rational justification. “Should” statements involve assuming that things should be a certain way and, when they are not, feeling a sense of distress. Therefore, the correct answer is (B)",counseling skills and interventions
146,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.","Considering the client's likely diagnosis, which of the following assessment instruments should be used when planning treatment?",Columbia Suicide Severity Rating Scale (C-SSRS),Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),Beck Depression Inventory-II (BDI-II),Beck Anxiety Inventory (BAI),"(A): Columbia Suicide Severity Rating Scale (C-SSRS)
(B): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(C): Beck Depression Inventory-II (BDI-II)
(D): Beck Anxiety Inventory (BAI)",Columbia Suicide Severity Rating Scale (C-SSRS),A,"Adults with body dysmorphic disorder exhibit high rates of suicidal ideation and suicidal attempts, and a large proportion of suicidal ideation has been attributed to concerns about appearance. There is little clinical evidence of depression in this client, however the BAI may be useful for evaluation of therapy not for planning. The MMPI-2 provides assessment of a broad range of diagnostic disorders, not treatment. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
147,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.",aged. Family History: The client reports that she is close with her parents but that they often have high expectations of her and that she worries about disappointing them. The client has an older brother who is 25 and is a lawyer. The client says some of the pressure is wanting to be as successful as her brother because she thinks her parents are really proud of him,"Based on Shawn Shea’s model for the clinical interview, which of the following statements is part of closing the intake session?",“It was great meeting with you today! I think we can do some good work together. I’ll walk you out to the lobby.”,"“It seems like your panic attacks are unexpected, but there are some things you can do to improve your management of them. I want you to read this literature on coping skills for panic symptoms.”",“Let’s talk about panic disorder so you understand more about what’s happening to you.”,"“You’ve made a great choice for yourself by deciding to start therapy. I think that if we make a good plan together, we can improve management of your panic attacks.”","(A): “It was great meeting with you today! I think we can do some good work together. I’ll walk you out to the lobby.”
(B): “It seems like your panic attacks are unexpected, but there are some things you can do to improve your management of them. I want you to read this literature on coping skills for panic symptoms.”
(C): “Let’s talk about panic disorder so you understand more about what’s happening to you.”
(D): “You’ve made a great choice for yourself by deciding to start therapy. I think that if we make a good plan together, we can improve management of your panic attacks.”","“You’ve made a great choice for yourself by deciding to start therapy. I think that if we make a good plan together, we can improve management of your panic attacks.”",D,"Validating the client’s choice to be in therapy and instilling hope that you believe that you can improve things are parts of the closing phase of the intake session according to Shea’s model. Stating that you can help is part of closing, but coupling this with recommending interventions is part of the body of the intake session. Providing psychoeducation on the diagnosis is also part of the body of the intake session. The termination phase of the intake session is when you say goodbye to the client for that current session. Therefore, the correct answer is (A)",counseling skills and interventions
148,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following statements would best help the client understand his sadness and crying?,The effects of trauma can prevent the client from experiencing normal grief.,"As the client tries to reduce his anger, his limbic system creates new defense mechanisms.","As the client works on his trauma, he is beginning to showing symptoms of depression.",Trauma is a neurological and emotional reaction and crying is an expected symptom.,"(A): The effects of trauma can prevent the client from experiencing normal grief.
(B): As the client tries to reduce his anger, his limbic system creates new defense mechanisms.
(C): As the client works on his trauma, he is beginning to showing symptoms of depression.
(D): Trauma is a neurological and emotional reaction and crying is an expected symptom.","As the client tries to reduce his anger, his limbic system creates new defense mechanisms.",B,"The effects of trauma include the development of persistent negative emotional states including fear, guilt, anger, etc, (Criterion D4) and significant alterations in arousal and reactivity, including angry outbursts with little provocation (Criterion E1). As the client's symptoms of PTSD subside, he will be better able to connect with normal emotions of grief and loss. PTSD can be associated with MDD, however, the client has described not feeling sad most days, which is a requirement (Criterion A) for an MDD diagnosis. The limbic system is controlled by hormone release and as the client works through his anger, hormones that control ""fight or flight"" such as cortisol, will be released less often into the system inducing normal function, rather than creating new defense mechanisms. While crying can certainly be a reaction to trauma, this client has not experienced that reaction and is reporting crying more now that he is beginning to feel better and less angry. These facts suggest that crying is not a symptom of his PTSD and is occurring as a result of working through his trauma. Therefore, the correct answer is (C)",counseling skills and interventions
149,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”",Which of the following should the client work on during this session?,Exploring solutions increasing intimacy,Exploring how the client and her partner learned to identify the needs of others,Exploring why the client's partner didn't attend the client's treatment sessions,Exploring when the client first started feeling angry at her partner,"(A): Exploring solutions increasing intimacy
(B): Exploring how the client and her partner learned to identify the needs of others
(C): Exploring why the client's partner didn't attend the client's treatment sessions
(D): Exploring when the client first started feeling angry at her partner",Exploring how the client and her partner learned to identify the needs of others,B,"The client has relied on subtle messages and reverse messaging (ie, ""you don't have to go"") with the hope that her partner would ""read her mind"" and meet the client's unspoken needs. Exploring how the client and her partner learned to identify other people's needs will be helpful in showing the client and her partner that they need to communicate in a way that each can understand. Exploring solutions to their intimacy issues is a symptom of the greater communication issue and resolving their communication should help them regain some intimacy. Exploring when the client first became angry focuses on situations rather than overall communication patterns, and the patterns appear to be causing the problems for the couple. Exploring ""why"" the partner didn't attend circles back to the client's communication style of not expressing her needs and focuses more on blame than on learning new communication styles. Therefore, the correct answer is (D)",counseling skills and interventions
150,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,Molly's symptoms are indicative of?,Persistent Complex Bereavement Disorder,Adjustment Disorder,Major Depressive Disorder,Post-Traumatic Stress Disorder,"(A): Persistent Complex Bereavement Disorder
(B): Adjustment Disorder
(C): Major Depressive Disorder
(D): Post-Traumatic Stress Disorder",Persistent Complex Bereavement Disorder,A,"Persistent Complex Bereavement Disorder is a diagnosis used for those who have experienced the death of someone close to them, with other specific criteria. These include longing for the deceased, preoccupation with the deceased of circumstances of the death, marked difficulty in acceptance, emotional numbness, a desire to join the deceased, and a distrust of other individuals. Molly is showing symptoms consistent with this diagnosis and symptoms have persisted for more than 6 months. Although Molly is exhibiting distress and impairment in functioning after an indefinable stressor (her father's death), it has lasted longer than 6 months. Additionally, Molly's symptoms are more severe than the diagnostic criteria for Adjustment Disorder with Depressed Mood which includes, low mood, tearfulness and feelings of hopelessness. Post-Traumatic Stress Disorder can be diagnosed after someone experiences the sudden death of a close family member. Although Molly is experiencing some symptoms of PTSD such as intrusive thoughts, Molly does not meet the criteria of persistent avoidance of stimuli that remind her of the event. In fact, she is preoccupied with the event and perseverates on details of the accident and similar events. Finally, although Molly is showing many symptoms of Major Depressive Disorder, she is focused on the loss of her father. Her symptoms are more consistent with Persistent Complex Bereavement Disorder. Due to the precipitating factor of her symptoms, Major Depressive Disorder is not the best diagnosis at this time. Therefore, the correct answer is (B)",professional practice and ethics
151,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.","The wife says to you, ""I'm still scared that he's going to start drinking again. I just don't know how to trust him after all the hurt and pain he caused us. I need him to understand that if we're ever going to rebuild our relationship, he needs to be honest with me and take responsibility for his actions."" What would you do to encourage a collaborative alliance between the wife and her husband?",Reframe the wife's fear as concern for her husband's well-being,Invite the wife to look at her husband and express her feelings directly to him,Ask the husband to share how he feels in response to his wife's disclosure,Ask the wife to expand on her thoughts about the husband as a means to encourage her further openness.,"(A): Reframe the wife's fear as concern for her husband's well-being
(B): Invite the wife to look at her husband and express her feelings directly to him
(C): Ask the husband to share how he feels in response to his wife's disclosure
(D): Ask the wife to expand on her thoughts about the husband as a means to encourage her further openness.",Invite the wife to look at her husband and express her feelings directly to him,B,"By encouraging direct communication with each other (instead of using you as a mediator or interpreter), you are nurturing a collaborative alliance between the wife and husband. Therefore, the correct answer is (D)",counseling skills and interventions
152,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,"Which of the following, if recommended by the counselor, would likely worsen Michael's tics?",Engage in sports and hobbies,Identify and challenge his irrational thoughts,Monitor sleep,Increase the consumption of energy drinks,"(A): Engage in sports and hobbies
(B): Identify and challenge his irrational thoughts
(C): Monitor sleep
(D): Increase the consumption of energy drinks",Increase the consumption of energy drinks,D,"Energy drinks and increased consumption of caffeine may worsen tics. Ways to alleviate or suppress tics can be through monitoring sleep to ensure the individual is well rested. Engaging in sports and hobbies can also reduce tics as it gives the individual something to focus on. Also, by identifying and challenging Michael's irrational thoughts, this can help to reduce stressful situations. Therefore, the correct answer is (D)",counseling skills and interventions
153,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,"If the counselor responds, ""It sounds like you feel hurt that your wife does not believe you."" This may make the client feel?",Validated,Annoyed,Vindicated,Confused,"(A): Validated
(B): Annoyed
(C): Vindicated
(D): Confused",Validated,A,"By using the intervention of reflection of feelings, a client is aware that they are heard, and their feelings are validated. Tony would likely not feel annoyed as the counselor is reflecting what he stated. Nor would he feel vindicated as that denotes some sort of feeling of satisfaction. Although the client seems conflicted about his wanting to be with his wife, the question is asking how the counselor's comments make him feel. Therefore, the correct answer is (A)",professional practice and ethics
154,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","The client has shown a flattened affect and a lack of engagement in the initial part of the session. Of the following, which evidence-based practice would be most helpful?",Person-centered therapy,Solution-focused therapy,Reality therapy,Motivational interviewing,"(A): Person-centered therapy
(B): Solution-focused therapy
(C): Reality therapy
(D): Motivational interviewing",Motivational interviewing,D,"Motivational interviewing is an evidence-based practice that focuses on identifying a person's motivation to change their behavior. It helps clients explore and resolve ambivalence, which can be beneficial in helping them overcome resistance or blocks to progress. In this case, the client's lack of engagement suggests there may be ambivalence about addressing her issues. Motivational interviewing (MI) is a technique used to evaluate the client's readiness for change. When using motivational interviewing, the therapist determines which stage of change the client is currently in. These stages include: 1) pre-contemplation, 2) contemplation, 3) preparation, 4) action, or 5) maintenance. Therefore, the correct answer is (B)",treatment planning
155,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.  Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered.",,"Which therapeutic factor is most often linked with healthy, well-functioning groups?",Transparency,Universality,Stonewalling,Structure and Framework of the group,"(A): Transparency
(B): Universality
(C): Stonewalling
(D): Structure and Framework of the group",Universality,B,"Universality means members recognize that others share similar feelings, thoughts and problems. Therefore, the correct answer is (C)",counseling skills and interventions
156,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ",Which type of group is most likely to benefit Rick?,Grief/loss group,Assertiveness training skills group,Self-help group,Psychotherapy group,"(A): Grief/loss group
(B): Assertiveness training skills group
(C): Self-help group
(D): Psychotherapy group",Psychotherapy group,D,"This is the correct answer because psychotherapy would be beneficial in treating the client's presenting problem. This collaborative form of healing can focus on interpersonal relationships or particular concerns shared by group members. Numerous psychological and emotional issues are treated in group therapy, ranging from addiction and abuse to anxiety and depression. Therefore, the correct answer is (C)",treatment planning
157,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.",,Which technique would you use with the client to help her process her feelings about her husband filing for a divorce?,Free association,Confrontation,Positive reinforcement,Reflection,"(A): Free association
(B): Confrontation
(C): Positive reinforcement
(D): Reflection",Reflection,D,"Reflection can be used to accomplish the validation she needs when it comes to her feelings. Therefore, the correct answer is (D)",counseling skills and interventions
158,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","   sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time.  When discussing the informed consent form, you cover the risks of counseling","When discussing the informed consent form, you cover the risks of counseling. Which one of the following is NOT an expected risk of counseling?",The client may need to meet with multiple counselors prior to finding a match.,The client might choose to discontinue therapy earlier than recommended.,Therapy can make the client feel worse initially.,The counselor might not have the skill set needed to best provide benefit for the client.,"(A): The client may need to meet with multiple counselors prior to finding a match.
(B): The client might choose to discontinue therapy earlier than recommended.
(C): Therapy can make the client feel worse initially.
(D): The counselor might not have the skill set needed to best provide benefit for the client.",The client might choose to discontinue therapy earlier than recommended.,B,"The client may choose to discontinue therapy early; however, this is not a risk of the counseling process, rather, a decision on the part of the client. Therapy can make things worse initially because the client may have to discuss or confront situations, thoughts, and feelings that may cause distress. This is an expected part of the therapeutic process. The client may need to meet with multiple counselors prior to finding a match who meets his needs for building rapport and who also has the skill set needed to best support the client. Therefore, the correct answer is (D)",professional practice and ethics
159,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",Which of the following are physical indicators that the current issue is causing the client distress?,Substance use history,Her statements regarding suicidality,Difficulty concentrating at school,Her behavior and affect,"(A): Substance use history
(B): Her statements regarding suicidality
(C): Difficulty concentrating at school
(D): Her behavior and affect",Her behavior and affect,D,"The client's behavior and affect are physical indicators that the client may be in a state of distress. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
160,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which of the following will best help you understand the needs and concerns of the couple?,Completing a role-play exercise using infertility issues to observe how they communicate,"Completing a separate, in-depth, biopsychosocial interview with each individual",Completing a Beck's Depression Inventory (BDI) with each individual,Completing a communication exercise to increase John's skills in responding to Jane,"(A): Completing a role-play exercise using infertility issues to observe how they communicate
(B): Completing a separate, in-depth, biopsychosocial interview with each individual
(C): Completing a Beck's Depression Inventory (BDI) with each individual
(D): Completing a communication exercise to increase John's skills in responding to Jane","Completing a separate, in-depth, biopsychosocial interview with each individual",B,"When working with couples, especially couples who seek confirmation from their partner before answering, it is helpful to have one meeting with each individual to complete an in-depth, biopsychosocial interview where each individual feels safe to disclose their own thoughts and feelings without their spouse present. This process allows the counselor to better understand the unique perspectives and needs of each member of the couple, which helps formulate an effective treatment plan for the couple. Using role-play and communication exercises provide the counselor with information about the couple's skills in communicating, but do not provide a holistic picture of the couple's needs and concerns. The BDI is limited to helping the counselor determine if either of the individuals is experiencing a depressive episode. This is important information but does not provide a holistic view of each individual. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
161, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,"Using Erikson's stages of psychosocial development, what stage is Theodore in?",Intimacy vs. isolation,Immortality vs extinction,Integrity vs. despair,Generativity vs stagnation,"(A): Intimacy vs. isolation
(B): Immortality vs extinction
(C): Integrity vs. despair
(D): Generativity vs stagnation",Immortality vs extinction,B,"Theodore seems to be in Erikson's stage of Immortality vs. Extinction in which a person is accepting of death and believes that they have led a satisfying and meaningful life. Intimacy vs isolation occurs around the age of early adulthood when an individual is developing true autonomy from their parents and establishes their own values and ideals. Integrity vs despair occurs in later adulthood when the individual has not yet accepted death but is beginning to develop a point of view about it. Generativity vs stagnation is a stage that occurs in middle adulthood. Developmental tasks include parenting, nurturing of adult relationships and the management of career and householdThe immortality vs extinction stage was added by Joan Erikson for persons over 75 years of age. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
162, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,Which of the following steps should the counselor take?,Tell her she needs to find another place to live.,Suggest finding another job.,Give Li a referral to a shelter.,Encourage Li to go to the police.,"(A): Tell her she needs to find another place to live.
(B): Suggest finding another job.
(C): Give Li a referral to a shelter.
(D): Encourage Li to go to the police.",Encourage Li to go to the police.,D,"Li is a victim of human trafficking and exploitation, and the police should be involved. The counselor should encourage Li to go to the police. If she does not, the counselor must consider the level of risk there is. Ethical Code B2a. Serious and Foreseeable Harm and Legal Requirements states that ""The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception"". A referral to a shelter, would be beneficial after the authorities are contacted. Telling Li she needs to find another place to live would not be the appropriate choice. Although this must be done, simply stating that without calling the authorities or giving her resources would not be appropriate. Li will also have to find another job eventually but the priority is keeping her safe and reporting what happened to authorities. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
163,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.  Tenth session The family arrives to today's session to review Andie's progress. The mother states that she is happy to see that the conflict between her husband and son is decreasing. She states that they are all utilizing ""I statements"" in order to express their feelings. The father states that he is trying to just let him go through this ""phase"" and find himself. You continue to explore with the family any other contributing factors that could be hindering family dynamics. You also explore an array of interventions that would be appropriate when behavior disturbances occur.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ","As a therapist, how can you best create a therapeutic environment that is inclusive and welcoming to members of the LGBTQIA+ community?",State that you are an LGBTQIA+ Friendly practice in all forms and never discriminate against a client who is a part of that community,"Join LGBTQIA+ Community organizations, add preferred pronouns on all administrative paperwork, and be aware of your own unconscious biases.","At a minimum, therapists should fully familiarize themselves with the APA guidelines, the ALGBTIC competencies, and the WPATH standards of care. Therapy sessions should be affirmative in nature. In addition, all intake forms should include a section for preferred pronouns.","Attend PRIDE organization events, hire an LGBTQIA+ consultant, and align all practice policies with inclusive language","(A): State that you are an LGBTQIA+ Friendly practice in all forms and never discriminate against a client who is a part of that community
(B): Join LGBTQIA+ Community organizations, add preferred pronouns on all administrative paperwork, and be aware of your own unconscious biases.
(C): At a minimum, therapists should fully familiarize themselves with the APA guidelines, the ALGBTIC competencies, and the WPATH standards of care. Therapy sessions should be affirmative in nature. In addition, all intake forms should include a section for preferred pronouns.
(D): Attend PRIDE organization events, hire an LGBTQIA+ consultant, and align all practice policies with inclusive language","At a minimum, therapists should fully familiarize themselves with the APA guidelines, the ALGBTIC competencies, and the WPATH standards of care. Therapy sessions should be affirmative in nature. In addition, all intake forms should include a section for preferred pronouns.",C,"To create an inclusive environment as a therapist, it is imperative to familiarize yourself with the current research and be cognizant of the language used in all administrative paperwork, informed consents, and therapy sessions. Therefore, the correct answer is (D)",professional practice and ethics
164, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.",Maria tells you she will not be needing more counseling after today. You assess she is retreating with avoidance after having opened up to you emotionally. How should you respond?,Use strategies to convince her to continue,Respect her decision but with disclaimers,Tell her she is a safety risk and insist she continue,Use reverse psychology,"(A): Use strategies to convince her to continue
(B): Respect her decision but with disclaimers
(C): Tell her she is a safety risk and insist she continue
(D): Use reverse psychology",Respect her decision but with disclaimers,B,"You cannot force any client to engage in counseling. Using motivational interviewing and other strategies can be helpful to support your client in making healthy decisions for themselves but attempting to convince someone to do something they have declared they do not want to do can backfire in strengthening their resistance. Intentionally using a ""reverse psychology"" strategy to ""trick"" or ""entice"" them into following your agenda is unethical and unprofessional. Respecting Maria's decision is the best choice, while also providing her with your clinical advisement that she remains in counseling. You can provide education useful to her decision-making process such as how having a counselor as an advocate can be more helpful to her and her family than if she were to be alone, or how the counseling relationship may increase her sense of safety and help reduce mood disturbances. Therefore, the correct answer is (A)",counseling skills and interventions
165,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","   ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer",Which of the following is a risk and prognostic factor for agoraphobia?,Interpersonal physical and sexual abuse,Neglect and/or lack of supervision,"Negative events in childhood (e.g., separation, death of a parent)",Serious social neglect,"(A): Interpersonal physical and sexual abuse
(B): Neglect and/or lack of supervision
(C): Negative events in childhood (e.g., separation, death of a parent)
(D): Serious social neglect","Negative events in childhood (e.g., separation, death of a parent)",C,"The DSM-5-TR lists negative events in childhood (eg, the separation or death of a parent) as an environmental risk and prognostic factor for agoraphobia. Serious social neglect is associated with disinhibited social engagement disorder. Interpersonal physical and sexual abuse are environmental risk and prognostic factors for dissociative identity disorder. Lastly, neglect or lack of supervision is a risk and prognostic factor for pica. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
166,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client’s son accompanies her to her appointment today. Since the initial intake, COVID-19 has become a global pandemic and has greatly impacted the client’s anxiety and fear. The client was visibly trembling when she spoke and requested that her son remain nearby. She explained that complying with the statewide mask mandate has been difficult, stating, “Wearing this mask makes me feel like I can’t breathe. It’s the same feeling I get when I’m walking up stairs or taking the elevator.” The client’s internist prescribes alprazolam (Xanax), which she has been taking for years. However, she thinks that it is no longer effective and asks if you can help her discontinue the medication. Given the COVID-19 outbreak, you discuss providing distance counseling to the client",Informed consent for distance counseling addresses issues unique to telehealth EXCEPT which of the following?,Interjurisdictional practice,Risks and benefits of telehealth,Time zone differences,Emergency procedures,"(A): Interjurisdictional practice
(B): Risks and benefits of telehealth
(C): Time zone differences
(D): Emergency procedures",Interjurisdictional practice,A,"Interjurisdictional practice is not a part of informed consent for distance counseling or telehealth. Informed consent involves sharing clear and sufficient information with the client to make an informed decision about treatment participation. Interjurisdictional practice occurs when a counselor provides services to a client across state lines. This is a legal issue that counselors must rectify before providing distance counseling. Although temporary permission for interjurisdictional practice may exist, it is rare and far less likely to be included in informed consent. All other answer items can be found in Section H2 of the ACA Code of Ethics, which outlines guidelines for informed consent and disclosure. Therefore, the correct answer is (C)",professional practice and ethics
167,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","   atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together.  You are focusing on building a therapeutic relationship with the client",You are focusing on building a therapeutic relationship with the client. Which of the following terms focuses on viewing the client as the expert of herself and responding warmly with acceptance of where the client is in her life?,Congruence,Mutuality,Identification and internalization,Unconditional positive regard,"(A): Congruence
(B): Mutuality
(C): Identification and internalization
(D): Unconditional positive regard",Unconditional positive regard,D,"This approach to building rapport is called unconditional positive regard. This is used to demonstrate to the client that you accept her as she is and are genuinely interested in understanding what she is experiencing. Congruence is about being a genuine honest person and matching your external expressions to how you internally feel. It is not related to the concept of recognizing the client as the expert of herself. Congruence provides the client with the insight that the therapist is also a human and requires the management of counselor and client boundaries because self-disclosure and being openly emotional may cause the client to want to support the counselor. Mutuality involves sharing decision making, treatment planning, and power, while the therapist and client are both learning as they go. The identification and internalization process is about modeling behaviors or skills and internalizing them. Therefore, the correct answer is (B)",counseling skills and interventions
168,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Since the intake, you have provided professional development training for school staff on transgender and gender nonconforming (TGNC) individuals. The administration supports your recommendations for keeping the client and others safe at school. The client continues to miss school, but they have had fewer absences this month. You learn that the client’s desire to be rid of their male secondary sex characteristics has become more persistent. They say that they have seen media coverage of individuals who have undergone sex reassignment surgeries and wondered what that would be like. The client also states they are confused about their sexual orientation. The client appreciates being an active participant in their treatment, and together you create relevant treatment plan goals. You discuss the upcoming family session with the client’s parents. The client articulates appropriate topics for this session and reports increased anxiety concerning their father’s participation",What is the primary purpose for inviting the client to be an active participant in their treatment?,To validate presenting concerns and establish hope,To model active listening and express empathy,To help the client gain confidence in self-advocacy,To present as a united front during the upcoming family session,"(A): To validate presenting concerns and establish hope
(B): To model active listening and express empathy
(C): To help the client gain confidence in self-advocacy
(D): To present as a united front during the upcoming family session",To validate presenting concerns and establish hope,A,"The primary purpose for collaboration with the client is to validate presenting concerns and establish hope. The therapeutic alliance consists of shared tasks, goals, and bonds (Bordin, 1978). Goals outline agreed-upon measures to alleviate the client’s symptoms. Seeking the client’s input on these measures helps instill hope and improve confidence in the therapeutic process. Presenting as a united front is incorrect. Although the counselor is an advocate for the client, family sessions value input from all members. Modeling active listening and empathy is not the primary purpose for collaborating with the client. Gaining confidence in self-advocacy is an appropriate treatment plan goal; however, the purpose of collaboration at this time is to strengthen the bond with the client to promote therapeutic change. Therefore, the correct answer is (B)",treatment planning
169,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ","Given the client's age, what level of involvement is appropriate for him to have in his treatment plan?","Every client has the right to be included in treatment planning, except those under the age of 16, who do not have that right because of their age.",Every client has the right to be included in treatment planning in a manner consistent with his or her age and level of understanding.,"Every client has the right to be included in treatment planning, except for those in a school setting who have a limited expectation of inclusion in the treatment process.",Every client has the right to be included in treatment planning regardless of age or educational status.,"(A): Every client has the right to be included in treatment planning, except those under the age of 16, who do not have that right because of their age.
(B): Every client has the right to be included in treatment planning in a manner consistent with his or her age and level of understanding.
(C): Every client has the right to be included in treatment planning, except for those in a school setting who have a limited expectation of inclusion in the treatment process.
(D): Every client has the right to be included in treatment planning regardless of age or educational status.",Every client has the right to be included in treatment planning in a manner consistent with his or her age and level of understanding.,B,"Every client should be involved in his or her own treatment. Therefore, the correct answer is (A)",treatment planning
170,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session and reports that he and his wife have been getting along better since the last session following some conversations about what they can do to get through this situation together. The client says that he wants to work on figuring out what he is going to do for work next. You and the client discuss possible options, and he says a friend offered him a job at his restaurant. The client says that he is considering it just for the money but that he has never been a server before and has some reservations. You conduct a career interest assessment and discuss the results.  The client has not been applying to jobs due to anxiety that he will not get a job due to his age",The client has not been applying to jobs due to anxiety that he will not get a job due to his age. Which of the following would be an appropriate intervention to improve his motivation to apply to jobs?,Use of a CBT thought log to process during sessions,Progressive muscle relaxation,Role-playing,Psychoeducation on relaxation techniques,"(A): Use of a CBT thought log to process during sessions
(B): Progressive muscle relaxation
(C): Role-playing
(D): Psychoeducation on relaxation techniques",Use of a CBT thought log to process during sessions,A,"CBT thought log can capture unhelpful thinking that is a barrier to applying to jobs and can be used in counseling sessions to process these thoughts in order to improve self-talk. It will be helpful to provide psychoeducation on relaxation techniques, such as progressive muscle relaxation, in order to manage anxiety when he is experiencing it; however, this would not improve motivation because it focuses on symptoms rather than on cognitive barriers. Role-playing might be helpful when it comes to interviewing, but it does not help the client with applying to jobs. Therefore, the correct answer is (C)",counseling skills and interventions
171,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,"The counselor states, ""It sounds like you are wondering about the reason you were referred to me. Perhaps we should review this together and discuss the details of our what our time together will consist of. I can then address any questions or concerns you may have."" This is an example of?",Paraphrasing and structuring,Paraphrasing and informed consent,Confrontation and structuring,Confrontation and informed consent,"(A): Paraphrasing and structuring
(B): Paraphrasing and informed consent
(C): Confrontation and structuring
(D): Confrontation and informed consent",Paraphrasing and structuring,A,"Paraphrasing is rewording the client's words to convey understanding. It can also be used for clarification. The counselor reiterates what the client stated and demonstrates that she is listening. Structuring is when the counselor reviews what will be reviewed in the session. The counselor does this by outlining the different things the session will cover. Confrontation is not the counselor confronting the client but rather the client confronting something within themselves. Informed consent is the review of the counseling process including payment, procedure, risks, and benefits. Therefore, the correct answer is (D)",counseling skills and interventions
172,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","In this session, the client discloses that he recently apologized to his ex-girlfriend for being angry at her and ending their relationship. What statement would you make to the client regarding his past and current behavior from an REBT perspective?","""Acknowledging your actions and taking responsibility for them by apologizing is a sign of growth and maturity. You are taking ownership of your life and are realizing that you can make positive changes.""","""I get angry sometimes, too. It's okay to be angry, but it's important to try to recognize when you are projecting your anger on others.""","""I want to commend you for having the courage to apologize and express yourself in a respectful way. It takes a lot of emotional maturity to be able to do this, and I'm proud of you.""","""Though it's better late than never, in what way could your apology have been more effective?""","(A): ""Acknowledging your actions and taking responsibility for them by apologizing is a sign of growth and maturity. You are taking ownership of your life and are realizing that you can make positive changes.""
(B): ""I get angry sometimes, too. It's okay to be angry, but it's important to try to recognize when you are projecting your anger on others.""
(C): ""I want to commend you for having the courage to apologize and express yourself in a respectful way. It takes a lot of emotional maturity to be able to do this, and I'm proud of you.""
(D): ""Though it's better late than never, in what way could your apology have been more effective?""","""Acknowledging your actions and taking responsibility for them by apologizing is a sign of growth and maturity. You are taking ownership of your life and are realizing that you can make positive changes.""",A,"From a REBT perspective, the client is taking responsibility for his own actions and emotions by apologizing. This type of behavior indicates that he has taken ownership of his life and realizes that no one else can make him happy; only he can create his own happiness. This shift in perspective is an example of how REBT helps individuals take control of their lives and make positive changes. By recognizing his own role in the situation and apologizing for it, the client is demonstrating a commitment to personal growth and development. Therefore, the correct answer is (D)",counseling skills and interventions
173,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and sits down. Their body language does not appear as uncomfortable as it has in previous sessions because they are sitting a little closer together. You ask both individuals what they need to work on. The wife says that she knows that she needs to rebuild trust, and the husband says that he wants to know more about what happened in the affair before they move forward. The couple report that they tried to engage in sex, but that the husband stopped during intercourse. The husband states that he could not get the idea out of his mind that his wife does not find him attractive because she was with a woman. You ask the husband what it means for their marriage if his wife does not find him attractive, and he states that it means he will not be able to please her. You then ask him what it means for the relationship if he cannot please her, and he responds that it means he cannot be a good husband. You follow up asking what it means if he cannot be a good husband, and he says that they will have a miserable marriage. You support effective communication strategies and empathize with the couple. After the session, the wife comes back to get her coffee that she left and says that she knows that she hurt her husband and is in the wrong, so she will do whatever her husband needs to rebuild trust.  In order for you to assist in stabilizing this relationship, you must focus on building trust between the individuals","In order for you to assist in stabilizing this relationship, you must focus on building trust between the individuals. All of the following will help build this trust, EXCEPT:",Increasing positive interactions,Improving conflict resolution skills,Creating a safe environment for the wife to express her feelings,Increasing empathy,"(A): Increasing positive interactions
(B): Improving conflict resolution skills
(C): Creating a safe environment for the wife to express her feelings
(D): Increasing empathy",Improving conflict resolution skills,B,"Improving conflict resolution skills is not currently indicated because you do not have indications that the clients are having difficulty managing conflict in the general sense. Creating a safe environment for the wife to express feelings is important because she feels like she cannot do so, demonstrated by her private expression to you outside of the session. Although the wife caused harm to her husband, her feelings and thoughts matter because the success of the couple requires both individuals to be able to communicate freely. Increasing positive interactions is a small step toward building a more positive relationship overall and can lead to rebuilding trust as both individuals begin to feel united again in their relationship. Increasing empathy skills is important because it helps each individual see the other’s point of view, which creates a space for trust, understanding, and possible forgiveness. Therefore, the correct answer is (A)",core counseling attributes
174,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.","Based on the information provided, which of the following would be most appropriate to state to the client?",I want to hear how and what you are feeling but I'm uncomfortable when you raise your voice.,Why does that feel uncomfortable for you?,"You are angry and feel a physical reaction to my words, but you are still able to tell me how and what you are feeling.",Can you tell me about the physical reaction you feel?,"(A): I want to hear how and what you are feeling but I'm uncomfortable when you raise your voice.
(B): Why does that feel uncomfortable for you?
(C): You are angry and feel a physical reaction to my words, but you are still able to tell me how and what you are feeling.
(D): Can you tell me about the physical reaction you feel?","You are angry and feel a physical reaction to my words, but you are still able to tell me how and what you are feeling.",C,"Summarizing the client's feelings and acknowledging that in spite of these, he is able to communicate honestly and openly with you, demonstrates you recognize his progress in addressing his emotions rather than sitting with ambivalence. This opens space for him to see that he can feel and express negative emotions without being abandoned. This will strengthen the therapeutic relationship. Asking him to tell you about the physical reaction changes the focus of the session to the mind-body connection, which is not as important right now as allowing him to express himself and feel safe in the relationship. ""Why"" questions are not used in counseling as they tend to make clients feel defensive. Counselors work to meet clients where they are and while setting boundaries for respect is important, clients often express negative emotions and should not be limited unless the manner of expressing is dangerous or clearly disrespectful to the counselor. In the case of clients with BPD, clients may test the strength of the therapeutic relationship to see if they will be abandoned. Therefore, the correct answer is (A)",counseling skills and interventions
175,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.",,What is the best way to reflect the client's feelings?,"""You've experienced a lot of major changes lately, and it's understandable that you would like things to return to how they were before the separation.""","""It's normal to feel like you have no purpose in life, especially when your children no longer need you like they did when they were growing up. Let's talk about what you can do to find your purpose again.""","""It seems like you're experiencing a lot of difficult and confusing emotions. You're feeling stressed about your marriage, alone, and uncertain about your future.""","""I can understand how difficult it must be to go through such a huge change in your life and see the person you once shared so much with now spending time with someone else.""","(A): ""You've experienced a lot of major changes lately, and it's understandable that you would like things to return to how they were before the separation.""
(B): ""It's normal to feel like you have no purpose in life, especially when your children no longer need you like they did when they were growing up. Let's talk about what you can do to find your purpose again.""
(C): ""It seems like you're experiencing a lot of difficult and confusing emotions. You're feeling stressed about your marriage, alone, and uncertain about your future.""
(D): ""I can understand how difficult it must be to go through such a huge change in your life and see the person you once shared so much with now spending time with someone else.""","""It seems like you're experiencing a lot of difficult and confusing emotions. You're feeling stressed about your marriage, alone, and uncertain about your future.""",C,"Reflection of feelings is the process of deeply considering and understanding the emotions of another person and articulating those emotions back to them in a supportive and non-judgmental way. Therefore, the correct answer is (D)",counseling skills and interventions
176, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",What are you assessing when you are evaluating Jonny's current presentation and ability to cope?,hallucinations or delusions,adult skills of daily living,depression history,here and now functioning,"(A): hallucinations or delusions
(B): adult skills of daily living
(C): depression history
(D): here and now functioning",here and now functioning,D,"Evaluating Jonny's here and now functioning is part of a mental status exam and addresses how Jonny is coping and surviving his current situation. Jonny reported not eating well, and being too stressed to sleep, which now seems to be manifesting in overwhelming emotions and the development of cognitive distortions. Conducting measurement examinations or interviewing as well as reviewing any previous charts or notes available concerning Jonny's depression diagnosis would be what you are looking for in terms of learning about his depression history. Regardless of depression history, here and now functioning can be evaluated on its own. Jonny may not be doing a great job of self-care but living alone is a good sign that he has mastered enough ADL's to be living alone at college. Hallucinations and delusions may be present during an assessment, which would change the details of the here and now functioning results. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
177,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client attends group therapy and is making therapeutic gains. Her overall anxiety has decreased, and she is engaging in more constructive thinking. Today is week 6 out of the 12 scheduled weekly group sessions. The client continues to work on increasing her assertiveness and has become less tentative with self-disclosures. She is pleasant and cooperative but remains eager to please others. Three group participants have formed a subgroup (i\. e., clique) and have excluded others. The client has begun to take social risks, and today she shares about a time when she felt most anxious. You notice the subgroup whispering and laughing after her disclosure. She nervously turns to you to gauge your response.  Three of the subgroup participants are exhibiting negative behaviors",Three of the subgroup participants are exhibiting negative behaviors. Which one of the following observations would most likely indicate that the client’s group has successfully moved on to the next stage of development?,Avoidance of controversy,Acceptance of all group members,Group momentum slows down,Members vying for leadership roles,"(A): Avoidance of controversy
(B): Acceptance of all group members
(C): Group momentum slows down
(D): Members vying for leadership roles",Acceptance of all group members,B,"Acceptance of all group members would most likely indicate that the group has successfully moved to the next stage of development. The group is currently in the middle, or storming, stage of group development. The storming stage is characterized by conflict among members, challenges toward group leaders, and the formation of alliances or subgroups. During this phase, members vie for leadership roles as the desire for power and control becomes more pronounced. According to Tuckman (1984), there are five phases of group development: (1) the forming stage is marked by avoidance of controversy, apprehension, and tentative exploration, (2) the aforementioned storming phase, (3) the norming stage, in which structure and trust evolve and all members are accepted as the group begins to bond together, (4) the performing stage, in which the group functions as a unit working toward common goals,and (5) the final stage, adjourning, in which the group’s momentum slows as the group prepares to separate and say goodbye. Therefore, the correct answer is (C)",counseling skills and interventions
178,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",Which is the quickest way for you to understand the nature and severity of the conflict within the couple's relationship?,The Relationship Assessment Scale,MMPI-3,Making the conflict the focus of the sessions.,Marital Satisfaction Survey,"(A): The Relationship Assessment Scale
(B): MMPI-3
(C): Making the conflict the focus of the sessions.
(D): Marital Satisfaction Survey",Marital Satisfaction Survey,D,"The Marital Satisfaction Survey assesses conflict within the relationship. It would be most appropriate given the presenting problems. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
179,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","   ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report.  Following the first session, the birth mother calls you from jail asking about her daughter’s treatment, and you are able to verify that this is indeed the birth mother","Following the first session, the birth mother calls you from jail asking about her daughter’s treatment, and you are able to verify that this is indeed the birth mother. Which of the following is true regarding the birth parents’ right to access information regarding their biological daughter?",Only the foster parents have access to all of the information because they are the caregivers.,The birth parents still have a right to access information if their parental rights have not been terminated.,"Regardless of whether the birth parents’ rights have been terminated, they still have access to your client’s information.","Because social services took over care of the child, they can decide if the birth parents have access to treatment information.","(A): Only the foster parents have access to all of the information because they are the caregivers.
(B): The birth parents still have a right to access information if their parental rights have not been terminated.
(C): Regardless of whether the birth parents’ rights have been terminated, they still have access to your client’s information.
(D): Because social services took over care of the child, they can decide if the birth parents have access to treatment information.",The birth parents still have a right to access information if their parental rights have not been terminated.,B,"Unless parental rights are terminated, the birth parents have rights to PHI. The foster parents are able to provide reasonable medical and mental health care for the child that they are taking care of; therefore, because they are part of the therapeutic process, they also have access to this information. Therefore, the correct answer is (C)",professional practice and ethics
180,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","This session is occurring in the client’s home in order to observe behaviors in his natural environment. The client’s parents and 8-year-old brother are present. You are observing during this session in order to gather information and then to provide psychoeducation at the end of the session to the parents. The client and his brother are sitting on the floor playing with a building toy, which the client’s parents report is often a toy that causes him frustration because he plays very specifically with it and his brother does not want to play how he does. After about 5 minutes, the client becomes visibly frustrated as he is telling his brother to put a brick in a certain place because it is the same color and his brother says he is not going to and goes to build on his own. The client continues to build and asks for the piece repeatedly over a few minutes. The client then picks up what he is building and throws it against the wall and leaves the room.  During the session, the parents leave to answer a phone call, and the client’s uncle comes into the room","During the session, the parents leave to answer a phone call, and the client’s uncle comes into the room. When the client’s uncle asks who you are and why you are in the home, which one of the following would be the most ethical response?",“I’m a friend of the family; my name is (state your name).”,"“I’m (state your name), your nephew’s counselor.”","“I’m (state your name); it’s nice to meet you. I can’t answer that question, but you’re welcome to ask your brother.”","“I’m a counselor, but I can’t say who I’m here to work with.”","(A): “I’m a friend of the family; my name is (state your name).”
(B): “I’m (state your name), your nephew’s counselor.”
(C): “I’m (state your name); it’s nice to meet you. I can’t answer that question, but you’re welcome to ask your brother.”
(D): “I’m a counselor, but I can’t say who I’m here to work with.”","“I’m (state your name); it’s nice to meet you. I can’t answer that question, but you’re welcome to ask your brother.”",C,"Working in the community provides opportunities for situations like this. You are not able to tell anyone other than the client (or who you have a release of information to talk to) why you are present and who you are working with. It is most appropriate to redirect the uncle to the client’s parents because the client is a minor and he may not be able to appropriately choose whether to reveal who you are. Telling the uncle that you are there as a friend of the family is not true and would not assist in developing trust with the client’s uncle if you end up having to coordinate services with him also. Telling the uncle that you are the nephew’s counselor would breach confidentiality, as would telling him that you are a counselor but cannot say who you are working with. Therefore, the correct answer is (D)",professional practice and ethics
181,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client has made steady progress toward reducing maladaptive eating. After several weeks of collecting self-monitoring data, you and the client successfully identify patterns that maintain the problem of binge eating. The client’s depressive symptoms have improved, and she is seeking interpersonal connections. She has set appropriate boundaries with her family and distanced herself from their church. The client briefly attended a more liberal church, experienced biphobia, and did not return. She explains, “In my parent’s church, I’m not straight enough. In the LGBTQ community, I’m not gay enough.” You have introduced her to dialectical behavioral therapy, and she attributes mindfulness to improved depressive symptoms.  The client’s depression has lifted, and she is seeking interpersonal connections","The client’s depression has lifted, and she is seeking interpersonal connections. Which one of the following theorizes that the client’s intrinsic desire for connection is driven by competence, relatedness, and autonomy?",Self-actualization process,Self-reflection method,Self-fulfilling prophecy,Self-determination theory,"(A): Self-actualization process
(B): Self-reflection method
(C): Self-fulfilling prophecy
(D): Self-determination theory",Self-determination theory,D,"Self-determination theory is based on the assumption that people are motivated by competence, connection, and autonomy, which are all required to achieve psychological growth. Self-actualization is a term used by Abraham Maslow that refers to a person’s highest level of personal fulfillment. Self-reflection is used in many approaches and is not specifically tied to a desire to have close personal relationships. A self-fulfilling prophecy is used when making future predictions and then acting in ways that guarantee that the prediction comes true. Therefore, the correct answer is (B)",counseling skills and interventions
182,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","Based on Yalom's eleven therapeutic factors of group therapy, which is most efficacious for the client?",Interpersonal Learning,Imitative Behavior,Catharsis,Existential Factors,"(A): Interpersonal Learning
(B): Imitative Behavior
(C): Catharsis
(D): Existential Factors",Interpersonal Learning,A,"The client has shown an affinity for learning from his fellow group members. Therefore, the correct answer is (C)",counseling skills and interventions
183,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors.  Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor.    You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",How does the current revelation of the client's engaging in petty theft behavior affect your treatment plan?,An effective therapist does not need to feel shackled to a plan but remains flexible and addresses the client's here-and-now behaviors.,The therapist might want to change the collaborative treatment plan but must have the parent's written consent to make any alterations.,"Given the new information regarding the client's behavior, it is appropriate to modify the treatment plan.","Consistency and structure are necessary for a successful therapeutic outcome. Once the treatment plan has been finalized, it should be changed only minimally.","(A): An effective therapist does not need to feel shackled to a plan but remains flexible and addresses the client's here-and-now behaviors.
(B): The therapist might want to change the collaborative treatment plan but must have the parent's written consent to make any alterations.
(C): Given the new information regarding the client's behavior, it is appropriate to modify the treatment plan.
(D): Consistency and structure are necessary for a successful therapeutic outcome. Once the treatment plan has been finalized, it should be changed only minimally.","Given the new information regarding the client's behavior, it is appropriate to modify the treatment plan.",C,"The treatment plan is most useful when it deals with the whole of the client's behaviors. The treatment plan needs to be flexible to meet the client's ever-changing needs. Therefore, the correct answer is (D)",treatment planning
184,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”","Using the information you have learned, which of the following is the most appropriate next step?",Help the client develop goals that can be accomplished related to her body image,Teach the client relaxation skills to be used when she puts on a bathing suit,Teach the client that this is common post-cancer and most people get better with time,Help the client begin imagining herself undressed in front of a mirror,"(A): Help the client develop goals that can be accomplished related to her body image
(B): Teach the client relaxation skills to be used when she puts on a bathing suit
(C): Teach the client that this is common post-cancer and most people get better with time
(D): Help the client begin imagining herself undressed in front of a mirror",Help the client develop goals that can be accomplished related to her body image,A,"Before beginning therapy on this area of the client's concerns, outcome goals should be developed in collaboration with the client. This helps the client identify her ideal image as well as her realistic image so the counselor and client can focus on the changes she would like to make in her body, thoughts, and emotions. Setting goals builds hope and lets clients know they are not alone. Research does show that body image concerns are normal post cancer and they do tend to get better with time. While normalizing her concerns may be helpful, it is not likely to lower the level of distress she is currently feeling. Systematic desensitization (SE) is a helpful practice in post-cancer body image counseling; however, SE is approached slowly so beginning with having the client imagine herself undressed or putting on a bathing suit at this time is likely moving too quickly. Clients often stop therapy when SE is rushed, as it increases their level of anxiety. Therefore, the correct answer is (D)",treatment planning
185,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","You meet with the client, and she reports that she started dating someone. You and the client spend some time talking about the man who she is dating and agree that he sounds like a nice person that is not taking advantage of her personality. You and the client discuss her having an increased awareness of the behaviors that she has engaged in in the past that she did not like. The client identifies that she has engaged in behavior that worries her with this boyfriend. She went out for lunch and felt compelled to buy him lunch also, even though he was not there. After exploring why the client feels an obligation to buy her boyfriend lunch when he is not present with her, it becomes clear that it is motivated by the fear that he will be offended that she bought herself lunch without thinking of him. You support the client in identifying more helpful thoughts related to this and ask her to complete a behavioral experiment regarding this situation. The client becomes frustrated that she is still struggling with relationships and says, “I think I’ll just date who I want and how I want from here on out. It’s definitely the easiest choice instead of doing all of this.” You remind the client that therapy takes some time but can be really beneficial and you praise her for engaging fully so far.  Using the psychoanalytic approach to analyze the client’s statement about doing what she wants, you want to determine the influence of the id, ego, and superego","Using the psychoanalytic approach to analyze the client’s statement about doing what she wants, you want to determine the influence of the id, ego, and superego. Which one of the following is the best definition of the Freudian concept of the id?",Focus on unconscious basic impulses of aggression and sex,Focus on the balance between morals/ideals and basic impulses,Focus on morals and ideals,Focus on beliefs about the client’s own functioning,"(A): Focus on unconscious basic impulses of aggression and sex
(B): Focus on the balance between morals/ideals and basic impulses
(C): Focus on morals and ideals
(D): Focus on beliefs about the client’s own functioning",Focus on unconscious basic impulses of aggression and sex,A,"Sigmund Freud’s psychoanalytic theory states that there are three parts of the individual’s personality: the id, ego, and superego. The id focuses on basic impulses such as aggression and sex. Morals and ideals are part of the superego, and the balance between the two is the ego. The client’s own beliefs about functioning are not a part of Freud’s view of the human personality. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
186,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client continues to be compliant with therapy but is having difficulty discontinuing his drug use. He states he uses because it changes his mood and helps him forget about not fitting in at home or school. He explains that when he speaks English or dresses in non-traditional clothing, his family says they feel like, “I’ll forget where I came from. But when I leave the house, all I hear is, ‘Go back to where you came from.’” The client states he began using at the end of 7th grade and started using daily approximately four months ago. He admits to feeling guilty about how his use affects his family but claims, “It’s not like I’m an addict or anything.” His parents arrive today with an interpreter and attend a concurrent parenting group with a psychoeducational component that addresses adolescent substance abuse","Using a motivational interviewing (MI) approach, how would you respond to the client’s uncertainty regarding his problematic drug use?",“Your disease affects your rational thinking. Can you identify and challenge those thoughts?”,“Your screening assessment tells a different story. What role is denial playing for you in this present moment?”,“You may not be ready to stop. What is it about using that you really need to hold onto?”,“Your addiction continues to harm your parents. What is the payoff for you today?”,"(A): “Your disease affects your rational thinking. Can you identify and challenge those thoughts?”
(B): “Your screening assessment tells a different story. What role is denial playing for you in this present moment?”
(C): “You may not be ready to stop. What is it about using that you really need to hold onto?”
(D): “Your addiction continues to harm your parents. What is the payoff for you today?”",“You may not be ready to stop. What is it about using that you really need to hold onto?”,C,"The use of MI is reflected in the following: “You may not be ready to stop. What is it about using that you really need to hold onto?” This statement stands apart from the other choices because it is non-confrontational, and the question appropriately addresses the client’s ambivalence. MI is used to address ambivalence and promote change. One aspect of this approach is to avoid argumentation. Avoiding argumentation is accomplished by refraining from accusations of denial or using terms like disease or addict. The idea is to roll with resistance by allowing the client to discover discrepancies between where they see currently see themselves and where they’d like to be in the future. Therefore, the correct answer is (B)",counseling skills and interventions
187,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,"In coming up with treatment plan goals, the following is least important?",Consideration of other service providers,Treatment planning should be a collaborative process with Carlos,Prior history of success with similar goals,Discussion of termination,"(A): Consideration of other service providers
(B): Treatment planning should be a collaborative process with Carlos
(C): Prior history of success with similar goals
(D): Discussion of termination",Prior history of success with similar goals,C,"One of the goals of therapy is to change patterns of behavior and one of the beliefs in therapy is that people are capable of change. Although Carlos may not have been successful in the past with some goals, he may be successful if he tries again with additional support. The treatment planning process should always be client driven, with the client establishing the priorities. Termination should be discussed in the beginning of the therapeutic relationship, so the client is aware of the expectation that the goal is for them to be self-sufficient. When treatment planning, it is important to include formal and natural supports. It is also beneficial to understand the goals that the client may be working on with others to ensure that goals do not overlap or contradict one another. Therefore, the correct answer is (D)",counseling skills and interventions
188,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",Which assessment would provide the best method for assessing the client's behavioral issues?,The Conners 3rd Edition,The Early Childhood Inventory-4,Autism Screening Instrument for Educational Planning,The Wechsler Intelligence Scale for Children,"(A): The Conners 3rd Edition
(B): The Early Childhood Inventory-4
(C): Autism Screening Instrument for Educational Planning
(D): The Wechsler Intelligence Scale for Children",The Conners 3rd Edition,A,"The Conners 3rd Edition is used to measure various behaviors in children from 6-18 years of age. It would be appropriate for this client. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
189,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.","You and the client meet 4 days after the initial intake session due to truancy because she has missed several days of school. For about half of the session, the client seems to be withdrawn. She asks you what you are required to report, and you remind her of the limits of confidentiality. The client says that she understands, and then says she is going to talk about what happened anyway. She says that her volleyball coach asked to meet with her after practice about 7 months ago and when she entered his office, he asked to look at her right thigh following a fall during practice. She continues to state that when she showed him, he started to touch her genital area from the outside of her pants. She states that she ran out of the room and went home. She explains that after this event she quit the team and told her parents that she did not want to play anymore, but recently she has started to experience distressing memories of the sexual abuse; she refuses to go to school because she would see the man daily; she has difficulty feeling happiness; and she is experiencing feelings of shame, insomnia, and difficulty concentrating. You praise the client for disclosing this information and empathize with her about how hard it must have been to share this experience",All of the following are general guidelines for mandated reporting EXCEPT:,To follow state regulations regarding time between learning of abuse or neglect and reporting the abuse or neglect,To consult with your agency prior to reporting,"If you are unsure of whether the abuse or neglect is real or if anything will come of reporting, you must submit the report anyway","If your supervisor disagrees with reporting, report the abuse or neglect anyway","(A): To follow state regulations regarding time between learning of abuse or neglect and reporting the abuse or neglect
(B): To consult with your agency prior to reporting
(C): If you are unsure of whether the abuse or neglect is real or if anything will come of reporting, you must submit the report anyway
(D): If your supervisor disagrees with reporting, report the abuse or neglect anyway",To consult with your agency prior to reporting,B,"Consulting with your agency might be the agency’s protocol, but it is not required. It is up to each individual therapist to report suspected abuse or neglect. You should report the abuse or neglect even if your supervisor or agency disagrees with you because it is not your or your agency’s responsibility to determine if a threat is credible. Each state has different regulations surrounding the amount of time that can pass between learning of abuse or neglect and reporting it, so it is important to know your state’s regulations and adhere to them. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
190,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.  Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is ""officially sleeping in the spare bedroom"" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, ""We don't talk anymore. He just berates me all the time, and that hurts a lot."" As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, ""She's a mess. I don't know what to say.""    You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed.    Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ",What would be least important to consider when meeting with partners individually?,Discussing how to handle disclosure of secrets,Clarifying issues of confidentiality,Setting boundaries to avoid unproductive alliances,Explaining limits of using social media,"(A): Discussing how to handle disclosure of secrets
(B): Clarifying issues of confidentiality
(C): Setting boundaries to avoid unproductive alliances
(D): Explaining limits of using social media",Explaining limits of using social media,D,"This would be important to go over during intake with clients as part of their initial paperwork; however, it is not particularly important to consider when meeting with partners individually. Therefore, the correct answer is (C)",professional practice and ethics
191,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What would lead you to assess for a comorbid mental health condition?,Client's negative self-talk and mood during intake,Client's limited abstract reasoning ability,Client's medical history,Client's interactions with students and teachers,"(A): Client's negative self-talk and mood during intake
(B): Client's limited abstract reasoning ability
(C): Client's medical history
(D): Client's interactions with students and teachers",Client's negative self-talk and mood during intake,A,"The client says that she feels ""stupid"" when it comes to reading. Additionally, she presents with low speech volume and slow speech flow. She often looks down at her feet, demonstrates irritability, and sighs several times during the intake. It's possible that she has depression or is at risk of developing depression if her symptoms are left untreated. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
192,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",Which diagnosis can be ruled out based on the initial assessment of John?,Anxiety Disorder,Borderline Personality Disorder,Intermittent Explosive Disorder,Alcohol Use Disorder,"(A): Anxiety Disorder
(B): Borderline Personality Disorder
(C): Intermittent Explosive Disorder
(D): Alcohol Use Disorder",Borderline Personality Disorder,B,"The diagnostic criteria of borderline personality disorder as per the DSM-5 must be indicated by five or more out of nine listed criteria, by which at this phase in care John only qualifies for three (impulsivity in at least two areas that are potentially self-damaging, affective instability due to a marked reactivity of mood and inappropriate, intense anger or difficulty controlling anger). It is plausible or reasonable to consider that John can still meet criteria for the other listed diagnoses, with further assessment. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
193,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,What other sources of information would be the most helpful at this time?,A collateral meeting with the school guidance counselor who called 911,A collateral meeting with her friend who is engaging in cutting,A family session with Molly and her mother to discuss her consideration of cutting,Past evaluations for developmental history,"(A): A collateral meeting with the school guidance counselor who called 911
(B): A collateral meeting with her friend who is engaging in cutting
(C): A family session with Molly and her mother to discuss her consideration of cutting
(D): Past evaluations for developmental history",A collateral meeting with the school guidance counselor who called 911,A,"With Molly's permission, meeting with the school guidance counselor would provide more information about what led to the recent hospitalization, especially since Molly does not want to speak about it. Also, one of the areas that Molly has shown decreased functioning in is school. By collaborating with the school social worker, strategies can be discussed to help support Molly in school. The meeting with her friend does not seem warranted at this time. However, her friend is one of her only supports. Molly has alienated herself from her softball team friends and has a tenuous relationship with her mother, so the counselor may want to bring the friend in at a later time. Although a family session may be something to explore at a further time, the question asks about sources of information that would be important at this time. Additionally, she does not seem to have a good relationship with her mother currently and she may not want to speak to her mother about this. If Molly is still considering cutting after she is provided psychoeducation, this may be warranted as an intervention. There is no indication that there are any developmental delays or history of delays. Molly was doing well in school prior to the death of her father and was in Advanced Placement classes. There are no issues with cognitive functioning. Therefore, the correct answer is (A)",professional practice and ethics
194,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",Which of the following is an example of Gottman's concept of stonewalling?,"Dale's exasperated look, folded arms, looking shaking his head in disgust",Dale rolling his eyes in response to Ruth's comment,"Dale's frustration, throwing up his hands and walking away",Dale's statement that Ruth does not listen to him,"(A): Dale's exasperated look, folded arms, looking shaking his head in disgust
(B): Dale rolling his eyes in response to Ruth's comment
(C): Dale's frustration, throwing up his hands and walking away
(D): Dale's statement that Ruth does not listen to him","Dale's frustration, throwing up his hands and walking away",C,"This is an example of stonewalling according to Gottman's 4 Horseman model. Stonewalling is a form of disengagement in which one person withdraws from the conversation and shuts down communication. Therefore, the correct answer is (C)",counseling skills and interventions
195, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",It is clear to you that Malik has returned to engaging with the boy that was involved in her traumatic experience. Which is the most direct and ethical approach for responding to this presentation?,Present your observations of her changes in behavior and ask for her perspective on what has contributed to these changes.,Gather the data mentally and inquire more information from her mother next time you speak.,Lovingly confront her obvious behaviors and gently question the wisdom of her choices.,Have Malik write down a timeline of events from before leaving Hawaii until now.,"(A): Present your observations of her changes in behavior and ask for her perspective on what has contributed to these changes.
(B): Gather the data mentally and inquire more information from her mother next time you speak.
(C): Lovingly confront her obvious behaviors and gently question the wisdom of her choices.
(D): Have Malik write down a timeline of events from before leaving Hawaii until now.",Present your observations of her changes in behavior and ask for her perspective on what has contributed to these changes.,A,"Giving your client feedback and soliciting their perspective on contributing factors is the most ethical way to guide discussion of their own development of insight. Although d is clearly the most direct approach, it is not the most ethical choice as you are pointing out observations that might be assumptions or involve content that has not yet reached her level of understanding. Answer d could also damage your rapport as you may come across as judgmental and cause her to become defensive. Answer a is indirect because you would be deriving information from a parent, and unethical if Malik did not give expressed permission for you to discuss the content of your sessions with a parent. Minors under age 18 have HIPAA rights and should be afforded the same confidentiality provisions as adults. Answer b is a great intervention to conduct with Malik but is not the most direct form of therapy as timeline therapy can involve numerous areas and goals outside of the target discussion. Therefore, the correct answer is (C)",counseling skills and interventions
196,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.","In evaluating the client's current condition, which of the following would you NOT expect to do?",Explore family of origin patterns related to loss,"Assess for Schizoaffective, Schizophrenia, or Delusional Disorder in family history",Perform a Mental-Status Exam (MSE),Assist client in exploring what would happen if she acknowledged his death,"(A): Explore family of origin patterns related to loss
(B): Assess for Schizoaffective, Schizophrenia, or Delusional Disorder in family history
(C): Perform a Mental-Status Exam (MSE)
(D): Assist client in exploring what would happen if she acknowledged his death","Assess for Schizoaffective, Schizophrenia, or Delusional Disorder in family history",B,"The client's actions are purposeful and consciously focused on relieving her feelings over her son's death. These may be cultural or familial patterns that she has learned to minimize the pain of grief. The MSE assesses for at-risk or bizarre thinking to ensure the client's safety; however, there is no indication of familial psychosis or schizophrenia-type illnesses at this time. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
197,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","   ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression","In the DSM-5-TR, ODD is classified under which of the following?",Disruptive and impulse control disorders,Bipolar and related disorders,Neurodevelopmental disorders,Trauma and stressor related disorders,"(A): Disruptive and impulse control disorders
(B): Bipolar and related disorders
(C): Neurodevelopmental disorders
(D): Trauma and stressor related disorders",Disruptive and impulse control disorders,A,"Oppositional defiant disorder is classified with disruptive and impulse control disorders. Other diagnoses listed in this classification include intermittent explosive disorder, conduct disorder, pyromania, kleptomania, and other specified and unspecified disruptive and impulse-control disorders. While the diagnosis of ADHD is highly comorbid with ODD, ADHD belongs to the neurodevelopmental disorders category. Bipolar and related disorders include bipolar 1, bipolar 2, and cyclothymic disorder. Trauma and stressor related disorders include reactive attachment disorder, social engagement disorder, posttraumatic stress disorder, acute stress disorder, other specified trauma-and-stressor-related disorder, and unspecified trauma-and stressor-related disorder. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
198,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","   eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin",Which of the following would be important to discuss when reviewing informed consent that would be uniquely different for couples counseling?,The clinician promoting the well-being of the individuals involved in counseling,The nature of counseling,The risks of counseling that includes dealing with difficult topics during sessions,Confidentiality,"(A): The clinician promoting the well-being of the individuals involved in counseling
(B): The nature of counseling
(C): The risks of counseling that includes dealing with difficult topics during sessions
(D): Confidentiality",Confidentiality,D,"A unique limit to confidentiality is the clinician’s inability to ensure that both individuals in couples counseling will not share information about the other. It is important to encourage both individuals to maintain confidentiality for each other in order to ensure a safe environment in the couples counseling session. The nature of counseling, the risks involved, and promotion of well-being are all common factors in the counseling setting. Therefore, the correct answer is (A)",professional practice and ethics
199,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","You work with the client and their parents to help the parents understand how the client conceptualizes their gender identity. You use the client’s self-identified, gender-affirming pronouns and praise the client for taking a brave first step. The client’s mother is fearful and anxious, particularly when thinking about the client’s safety. The client’s father expresses an overall lack of understanding and thinks it could be a phase. You recognize the father’s efforts to understand and help the client explain the distressing emotions associated with coming to terms with their gender identity, including an increase in severity since the onset of adolescence. The father states that he is unsure if he can accept the client’s transgender identity but says that he is committed to the counseling process","What is the main purpose of supporting the client’s use of self-identified, gender-affirming pronouns?",To lay the groundwork for reparative therapy as an evidence-based practice (EBP),To illustrate potential difficulties associated with social transitions,To normalize and validate gender diversity as a natural human variation,To help the parents become acclimated to the lifelong use of the client’s selected pronouns,"(A): To lay the groundwork for reparative therapy as an evidence-based practice (EBP)
(B): To illustrate potential difficulties associated with social transitions
(C): To normalize and validate gender diversity as a natural human variation
(D): To help the parents become acclimated to the lifelong use of the client’s selected pronouns",To normalize and validate gender diversity as a natural human variation,C,"The purpose of supporting the client’s use of self-identified, gender-affirming pronouns is to normalize and validate gender diversity as a natural human variation. Some research has shown that gender-affirmative care is associated with improved outcomes for gender dysphoria. Counselors using gender-affirmative care provide a safe and supportive environment for gender-diverse individuals through advocacy, psychoeducation, and person-centered counseling. Social transitions for TGNC include identifying preferred pronouns; however, the counselor’s primary purpose for using preferred pronouns in family therapy is to affirm, normalize, and validate gender diversity. Gender diversity is fluid; therefore, the client may or may not use the same pronouns in the future. Therefore, the correct answer is (D)",professional practice and ethics
200,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""  Fourth session The client has been ""looking forward to working with you"" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is ""hard on her.""    She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father.  Ninth session The client has reported increased dysphoria due to persistent bullying and lack of support at school. As a result, she has noted an increase in negative self-talk and feelings of worthlessness. She has also reported increased feelings of isolation, as she does not have any friends she can confide in or turn to for support. The client has also expressed that her home environment is still difficult, as her father has not entirely accepted her gender identity, leaving her feeling unsupported. The client has further said that she does not feel safe or secure at school and feels uncomfortable seeking help from her peers.    The client has further reported that her emotional regulation has been difficult. She finds herself becoming overwhelmed and frustrated more quickly than before. She has also noted difficulty concentrating on tasks and completing schoolwork. Her mood has become increasingly labile, and she has experienced more frequent thoughts of self-harm and has expressed that she doesn't know how to cope with her emotions.    The client's mental health has also been deteriorating. She has reported increased symptoms of depression and anxiety. She has difficulty sleeping, often unable to fall asleep or only sleeping for short intervals. She has been experiencing intrusive thoughts, racing thoughts, and difficulty focusing on tasks. She has also been avoiding social situations and expressed that she feels uncomfortable around people due to her negative self-image.    She does like the school psychologist but needs help setting up a meeting. You intend to reach out to the school psychologist to expand the continuum of care.","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ","Due to your own childhood experiences, you are spending a lot of time thinking about the client's well-being. What is an appropriate method of managing your emotions around this case?",Seek supervision from a colleague,Share with the school psychologist with whom you are collaborating treatment,Talk the case over with your own therapist,Put aside your emotional reactions to this case as the client is the priority,"(A): Seek supervision from a colleague
(B): Share with the school psychologist with whom you are collaborating treatment
(C): Talk the case over with your own therapist
(D): Put aside your emotional reactions to this case as the client is the priority",Seek supervision from a colleague,A,"Self-care is an important part of a therapist's work and can help maintain healthy boundaries. Therefore, the correct answer is (C)",professional practice and ethics
201,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ","Considering the couple's situation, which instrument would you use to assess their relationship?",DISC Personality Test,Female Sexual Function Index (FSFI),Fear Questionnaire (FQ),Dyadic Adjustment Scale (DAS),"(A): DISC Personality Test
(B): Female Sexual Function Index (FSFI)
(C): Fear Questionnaire (FQ)
(D): Dyadic Adjustment Scale (DAS)",Dyadic Adjustment Scale (DAS),D,"The Dyadic Adjustment Scale measures a partner's perceptions of his or her intimate relationship. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
202,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,Elaina has suffered from multiple traumatic events. The capacity for positive adaptation after a significant negative event or threat is called?,Resilience,Dynamics,Plasticity,Risk,"(A): Resilience
(B): Dynamics
(C): Plasticity
(D): Risk",Resilience,A,"Resilience is the capacity for adaption after a significant event. The amount of resilience one has can determine positive or negative outcomes in situations. Risk factors are things that increase the likelihood of negative outcomes. Plasticity is the ability for brain cells to change from various experiences. Dynamics are the behavioral and relationship patterns between people. Therefore, the correct answer is (B)",counseling skills and interventions
203,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","You and the client review his safety plan. The client believes the antidepressant has helped decrease his feelings of hopelessness and suicidality. Despite the hot and humid conditions, the client arrives at his counseling session in a hoodie. He explains that he has been getting out of the house “some” but continues to avoid social situations because of overwhelming thoughts of others staring at him and mocking his appearance. The client was a no-show for his appointment last week and has requested distance counseling to avoid anxiety experienced when leaving the house. You and the client work together to set appropriate treatment plan goals; however, this is difficult due to poor insight into his presenting problem. You provide psychoeducation about BDD and ask about his goals for the future.  The client does not believe psychotherapy is the best solution to his problems",The client does not believe psychotherapy is the best solution to his problems. How should you respond to his lack of insight and motivation to change?,"“When I look at you, I don’t see the imperfections you point out.”",“I’m wondering if you can keep a journal to record your thoughts and feelings when looking in the mirror”,“How does preoccupation with your appearance stop you from participating in life?”,“Can we examine how your distress is rooted in the core beliefs you developed as a child?”,"(A): “When I look at you, I don’t see the imperfections you point out.”
(B): “I’m wondering if you can keep a journal to record your thoughts and feelings when looking in the mirror”
(C): “How does preoccupation with your appearance stop you from participating in life?”
(D): “Can we examine how your distress is rooted in the core beliefs you developed as a child?”",“How does preoccupation with your appearance stop you from participating in life?”,C,"The best response is: “How does preoccupation with your appearance stop you from participating in life?” Individuals with BDD often exhibit poor insight due to delusional beliefs about their appearance and delusions of reference. Experts suggest psychoeducation, coupled with empathy and a non-judgmental stance, can help improve insight and increase motivation to change. Experts advise against arguing or disagreeing with inaccurate perceptions, which makes answer A incorrect. Core beliefs and individual schemas can contribute to inaccurate perceptions, particularly when the perceptions are tied to poor self-worth; however, answer C is incorrect because an individual must first develop insight and motivation prior to tying cognitive distortions to core beliefs from childhood. Recording thoughts and feelings is helpful for examining cognitive distortions; however, this response is less likely to help improve insight and increase motivation to change. Therefore, the correct answer is (B)",counseling skills and interventions
204,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.",What assessment tool would help you assess the client's presenting problems?,Functional Assessment,Beck Anxiety Inventory (BAI),Behavior Assessment Rating Scale (BRS),Continuous Performance Test (CPT),"(A): Functional Assessment
(B): Beck Anxiety Inventory (BAI)
(C): Behavior Assessment Rating Scale (BRS)
(D): Continuous Performance Test (CPT)",Beck Anxiety Inventory (BAI),B,"This is the correct answer because one of the client's presenting problems is anxiety. The Beck Anxiety Inventory determines the severity of anxiety and distinguishes between anxiety and depression. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
205,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences.  You are reviewing this case with a counseling resident, and she does not think that the client is doing anything wrong by masturbating because it is a typical part of human functioning","You are reviewing this case with a counseling resident, and she does not think that the client is doing anything wrong by masturbating because it is a typical part of human functioning. You encourage your resident to remember all of the following in regard to this client, EXCEPT:",The importance of supporting the diversity of clients,"That although you can encourage different viewpoints, you cannot impose them",That the client is not causing himself any harm by refraining from masturbation,Refraining from imposing your own values and beliefs on clients,"(A): The importance of supporting the diversity of clients
(B): That although you can encourage different viewpoints, you cannot impose them
(C): That the client is not causing himself any harm by refraining from masturbation
(D): Refraining from imposing your own values and beliefs on clients",The importance of supporting the diversity of clients,A,"The counselor should always support the diversity of their clients’ beliefs despite their own value system. It can be helpful to remember that although the resident may not agree with the client’s interpretation of his actions, there is no harm to the client in his goal to refrain from masturbation. Client-centered therapy aligns counseling goals with the client’s goals, which in this case involve removing the urges for and eventually the act of masturbation in his life. With this client, it likely would not be helpful to encourage or impose other viewpoints because they would oppose his religious beliefs, and this may also make the client feel unsupported. Therefore, the correct answer is (A)",counseling skills and interventions
206,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.",Which treatment plan intervention addressing ED is most focused on client safety?,Assign client to self-monitor and record food intake while journaling feelings.,Assess severity of level of impairment to functioning to determine appropriate level of care.,Teach client model of eating disorder development and contributing factors.,Establish rapport and therapeutic alliance for client to feel safe in sharing.,"(A): Assign client to self-monitor and record food intake while journaling feelings.
(B): Assess severity of level of impairment to functioning to determine appropriate level of care.
(C): Teach client model of eating disorder development and contributing factors.
(D): Establish rapport and therapeutic alliance for client to feel safe in sharing.",Assess severity of level of impairment to functioning to determine appropriate level of care.,B,"Assessing for the presence of recurrent inappropriate eating disorder behavior and its level of impairment to Millie's daily functioning and health is vital to ensuring she is receiving adequate treatment at the appropriate level of care. Following this assessment, it is possible a client will be referred to a higher level of care facility, therefore it should be the first step in addressing safety. A quality therapeutic alliance as in answer a is always important to enhancing a client's experience of clinical safety but does not directly correlate to addressing physical safety. Monitoring her thoughts, feelings, and food intake in answer b is appropriate once Millie has identified and recognized her condition and it is being adequately monitored by her physician as well as properly indicated in her treatment plan. Psychoeducation on eating disorder as presented in answer c will be helpful once her condition has been defined. Therefore, the correct answer is (D)",treatment planning
207,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","   k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress.”  Which mindfulness-based theory would help the client become more actively involved in values-related activities (e\. g","Which mindfulness-based theory would help the client become more actively involved in values-related activities (e.g., playing tennis or volunteering as a “big sister”)?",Adlerian therapy,Reality therapy,Acceptance and commitment therapy,Narrative therapy,"(A): Adlerian therapy
(B): Reality therapy
(C): Acceptance and commitment therapy
(D): Narrative therapy",Acceptance and commitment therapy,C,"Acceptance and commitment therapy would help the client become more actively involved in values-related activities (eg, playing tennis or volunteering as a big sister). The goal of acceptance and commitment therapy is to investigate the client’s values and encourage the client to participate in life. It is a recommended therapy for chronic pain, which the client identified as a concern. Reality therapy focuses on creating a success identity that emphasizes the importance of one’s need for love and the need to feel worthwhile. Narrative therapy assumes that the subjective account of one’s life is socially, culturally, and politically constructed. Narrative therapists work with clients to reauthor or restory their lives to externalize the problem. Therefore, the correct answer is (D)",counseling skills and interventions
208,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.  10th session As you have been working with the client over the past two and a half months, he has made significant progress with treatment goals, including mood stabilization and behavioral control. In the last session, as you reviewed the progress that the client had made over the course of treatment, you both agreed that the client was ready for termination as he felt he had gotten what he needed from therapy. The client was especially pleased when considering his progress in mood regulation and mindfulness, as well as addressing his thrill-seeking behaviors during his manic phases.    For this final session, the client arrived ten minutes late. He appears out of breath as he runs into the room. The client states that he got a call from the hospital where his sister was just admitted. As he describes the phone call, he pauses and looks out the window with tears in his eyes. You ask him how he feels. The client responds quietly, ""I don't know, my sister has been in a serious accident, and I don't know how I'll continue without her support,"" prompting you to recognize that unresolved issues may require additional therapy. You state, ""It sounds like your sister's accident has brought up a lot of emotions for you. You are feeling overwhelmed and unsure about how to cope without her support. It must be difficult to process all of this at once."" The client nods his head. You continue by telling him that it is natural to feel overwhelmed and uncertain in a situation like this. You engage him in a discussion about coping strategies or support systems that have helped him in the past when facing difficult challenges. You also ask him if it would be helpful to have additional therapy sessions during this time to which he replies, ""Yes, I don't want to undo all the progress I've made.""","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",What is your main intention when asking the client about previous coping strategies?,To evaluate the effectiveness of the client's previous coping strategies,To judge the client's ability to cope with difficult situations,To determine if the client has made any progress in managing his emotions,To empower the client by leveraging his own abilities and assets,"(A): To evaluate the effectiveness of the client's previous coping strategies
(B): To judge the client's ability to cope with difficult situations
(C): To determine if the client has made any progress in managing his emotions
(D): To empower the client by leveraging his own abilities and assets",To empower the client by leveraging his own abilities and assets,D,"By asking the client about their past coping strategies and support systems, the therapist is encouraging them to tap into their own strengths and resources. This can not only help the client feel more empowered, but it also provides the therapist with valuable insight into how they can continue to support the client in coping with their sister's accident. Therefore, the correct answer is (A)",counseling skills and interventions
209,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","   e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services",What information provided by the client and his mother is required for the diagnosis of autism spectrum disorder?,Sleep-wake disturbances,Sensory hyper-reactivity,Extreme mood lability,Impulsive outbursts,"(A): Sleep-wake disturbances
(B): Sensory hyper-reactivity
(C): Extreme mood lability
(D): Impulsive outbursts",Sensory hyper-reactivity,B,"Researchers indicate over three-quarters of those diagnosed with ASD show hypo or hyper-reactivity to sensory stimuli. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-5-TR) sensory processing difficulties as one of four types of restricted, repetitive patterns representative of the diagnosis of ASD. The client’s difficulty tolerating cafeteria noise is an example of sensory hyper-reactivity. It is common for individuals with ASD to have difficulties with sleep-wake disturbances, including insomnia, narcolepsy, and restless leg syndrome. However, the DSM-5-TR does not list sleep disturbance as a criterion for ASD. Mood lability is a comorbid symptom of ASD rather than a diagnostic criterion. For individuals with ASD, mood lability is often the result of sensory over-stimulation, difficulty tolerating a change in routine, or difficulty reading social cues. Impulsive outbursts are also commonly associated with ASD; however, the DSM-5-TR does not require this to diagnose ASD. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
210,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","   n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family",The DSM-5-TR Cultural Formulation Interview (CFI) is a clinical assessment tool used to obtain culturally relevant information across all of the following domains EXCEPT:,Experiences of racism and discrimination,Cultural factors affecting current and past help seeking behaviors,The cultural definition of the problem,"Perception of the problem’s cause, context, and support","(A): Experiences of racism and discrimination
(B): Cultural factors affecting current and past help seeking behaviors
(C): The cultural definition of the problem
(D): Perception of the problem’s cause, context, and support",Experiences of racism and discrimination,A,"The CFI does not include direct lines of inquiry for experiences of racism and discrimination. Found in Section III of DSM-5-TR, the CFI uses clinically specific lines of inquiry useful for diagnostic and treatment planning purposes to include Cultural Definition of the Problem (questions 1-3); Cultural Perceptions of Cause, Context, and Support (questions 4-10); Cultural Factors Affecting Self-Coping and Past Help Seeking (questions 11-13); and Cultural Factors Affecting Current Help Seeking (questions 14-16). When inquiring about cultural factors affecting current help seeking, practitioners are encouraged to “elicit possible concerns about the clinic or the clinician-patient relationship, including perceived racism, language barriers, or cultural differences that may undermine goodwill, communication, or care delivery” (APA, 2022). However, the CFI does not ask directly about experiences of racism and discrimination. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
211,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.",use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends,"All of the following are hormones released during masturbation or sex, EXCEPT:",Oxytocin,Cortisol,Dopamine,Testosterone,"(A): Oxytocin
(B): Cortisol
(C): Dopamine
(D): Testosterone",Cortisol,B,"Cortisol is a stress-induced hormone that is released when the fight-or-flight response is triggered. It regulates mood as it relates to stress; it also regulates the immune system, the inflammatory response, and blood sugar levels. Cortisol is not released by the act of masturbation. Oxytocin relates more to breastfeeding and childbirth; however, it is also linked with increased feelings of bonding during sexual intercourse and even while hugging. Testosterone increases stamina during sexual intercourse and the level of arousal. Dopamine is considered a “happiness” hormone and is part of the brain’s reward system that leads to increased desires for sexual intercourse in order to receive this hormonal reward. As a counselor, it is helpful to know how these hormones affect functioning because they can be a large factor in behavior and cognitions being reinforced and increasing in frequency or intensity. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
212,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",How do you instruct the client to handle his father’s remarks and dismissive attitude?,Encourage the client to differentiate his self-acceptance from his father's acceptance. Practice using “I-statements” and conflict resolution phrases,"Due to the father's intransigence, you should file a report with Child Protective Services of emotional abuse",Have the client write and deliver a letter to this father explaining what his father does that is hurtful and ways that his father could better communicate with his son.,"In order to give the client a range of options that would be difficult to convey orally, practice using coping cards in the session","(A): Encourage the client to differentiate his self-acceptance from his father's acceptance. Practice using “I-statements” and conflict resolution phrases
(B): Due to the father's intransigence, you should file a report with Child Protective Services of emotional abuse
(C): Have the client write and deliver a letter to this father explaining what his father does that is hurtful and ways that his father could better communicate with his son.
(D): In order to give the client a range of options that would be difficult to convey orally, practice using coping cards in the session",Encourage the client to differentiate his self-acceptance from his father's acceptance. Practice using “I-statements” and conflict resolution phrases,A,"By providing a safe and nurturing therapeutic relationship, you can help the client grow his self-confidence and self-acceptance. Therefore, the correct answer is (A)",counseling skills and interventions
213, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",When would be the most appropriate time to conduct your follow-up suicide assessment?,"Right in this moment with her crying, as you will get the most accurate results.",Consider a reasonable moment in the next five or ten minutes as you discuss her feelings.,"Do not bring up her suicidal thoughts unless she does, it might only trigger her more.","At the end of the session before she leaves, so you don't interrupt her thought process.","(A): Right in this moment with her crying, as you will get the most accurate results.
(B): Consider a reasonable moment in the next five or ten minutes as you discuss her feelings.
(C): Do not bring up her suicidal thoughts unless she does, it might only trigger her more.
(D): At the end of the session before she leaves, so you don't interrupt her thought process.",Consider a reasonable moment in the next five or ten minutes as you discuss her feelings.,B,"Because suicidal thoughts were present, it is your ethical responsibility and clinical best practice to readdress her mental status by conducting a follow-up suicidal assessment. This information is significant for assessing her safety, developing a pattern of data to further justify interventions and future care, and ensuring her evaluations are improving and not degrading. Confronting Malik with questions of her suicidal thoughts right as she begins crying and is sharing her trauma for the first time may not be the optimal time as you are still working to develop rapport, help her feel safe, and receive accurate information when she is thinking more clearly and not responding out of heightened emotion. It is important to understand if she has suicidal thoughts while emotional, but this can still be discussed moments later when you can help her feel more comfortable and elaborate on her feelings. Saving the suicidal assessment for the end of her session is unwise at it may bring about further discussion that you no longer have time for and neglecting to discuss it altogether is in poor judgment and not the safest option. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
214,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.",Psychotherapy often uses a technique known as psychoeducation to help clients better understand their issues and how to cope with them. Which of the following is not one of the benefits of using psychoeducation with this client?,Changes external factors contributing to her distress like her ex or mother's comments,Increases her understanding of underlying motivations for behavior,Increases her insight by providing context related to her presenting problem,Increases her motivation or willingness to make positive changes in behavior,"(A): Changes external factors contributing to her distress like her ex or mother's comments
(B): Increases her understanding of underlying motivations for behavior
(C): Increases her insight by providing context related to her presenting problem
(D): Increases her motivation or willingness to make positive changes in behavior",Changes external factors contributing to her distress like her ex or mother's comments,A,"Psychoeducation would not enable changes in negative external influences themselves - like transforming what her ex or mother actually say or do - but instead would focus on building internal resilience and coping mechanisms for the client. Therefore, the correct answer is (A)",counseling skills and interventions
215,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues.  Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand.    When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have ""one drink."" He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed.  Seventh session The client's attendance in weekly therapy sessions has been inconsistent. Today, he presents to his scheduled session, and he hands you a discharge summary from another recent hospitalization. The client states that he was on one of his ""highs,"" went to a bar, and ended up fighting with one of the other customers. He says he has no recollection of how the fight started, but the person he was fighting with told him that ""his life was useless and that he would be better off dead."" The client states that having a few drinks and driving around in his car while listening to music helps him calm down. You validate the client's attempts to identify coping skills.    The client's depression is further evidenced by his lack of motivation and interest in activities he once found enjoyable. He reports feeling overwhelming hopelessness and expresses a pervasive feeling of worthlessness. His low self-esteem is apparent in his statements and is further evidenced by his inability to recall accurately the events leading up to the altercation.    The client's risk for self-harm is elevated, given his recent suicidal ideation. He reports feeling his life has no value and that he would be better off dead. His current safety plan is inadequate to address his risk for self-harm and is further exacerbated by his use of alcohol as a coping mechanism. The client has little insight into his current mental state and cannot accurately identify the signs of his deteriorating mental health. He lacks insight into his coping skills and their potential consequences and is unable to recognize the need for more comprehensive safety planning"," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",In which of these statements are you demonstrating a Person-centered therapy technique?,"""I'm concerned that you're making a mistake and need to find other coping strategies. Think about the other people that you're putting in danger.","""I'm concerned for your safety if you drink and drive and wonder if we can explore other ways you can listen to music in a safe environment.""","""I'm concerned that you are endangering other people and being irresponsible, but I'm impressed that you found a coping skill that works for you.""","""I'm concerned that you may hurt yourself or someone else. It's important that you consider the legal consequences of drinking and driving.""","(A): ""I'm concerned that you're making a mistake and need to find other coping strategies. Think about the other people that you're putting in danger.
(B): ""I'm concerned for your safety if you drink and drive and wonder if we can explore other ways you can listen to music in a safe environment.""
(C): ""I'm concerned that you are endangering other people and being irresponsible, but I'm impressed that you found a coping skill that works for you.""
(D): ""I'm concerned that you may hurt yourself or someone else. It's important that you consider the legal consequences of drinking and driving.""","""I'm concerned for your safety if you drink and drive and wonder if we can explore other ways you can listen to music in a safe environment.""",B,"This statement affirms a positive coping skill and attempts to protect the client rather than judge the client's behavior. Therefore, the correct answer is (D)",counseling skills and interventions
216,39   Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,"According to Erikson's stages of psychosocial development, Darrel is in the stage of?",Autonomy vs. shame and doubt,Trust vs. mistrust,Industry vs. inferiority,Individual identity vs identity confusion,"(A): Autonomy vs. shame and doubt
(B): Trust vs. mistrust
(C): Industry vs. inferiority
(D): Individual identity vs identity confusion",Individual identity vs identity confusion,D,"Darrel appears to be in the stage of Individual identity vs identity confusion evidenced by the conflicting feelings of wanting autonomy from his parents and not wanting to disappoint them and questioning his career path. Industry vs inferiority occurs in middle childhood when an individual is focused on friendships, learning life skills and team play. Autonomy vs shame and doubt as well as trust vs mistrust occurs between the ages of birth to 3 years old. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
217,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.  Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself.    When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress.    Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, ""My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?"" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious.    At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ","Using a behavioral therapy approach, what would you recommend to the parents to reduce the frequency and severity of Michael's temper tantrums when his parents leave the house?",Using time-outs and taking away privileges when he has outbursts,Providing a token economy as positive reinforcement to shape the client's behavior and extinguish the negative interactions.,Providing opportunities for him to practice regulating his emotions and express himself in acceptable ways,Providing positive reinforcements for when Michael is able to remain calm when his parents leave the house,"(A): Using time-outs and taking away privileges when he has outbursts
(B): Providing a token economy as positive reinforcement to shape the client's behavior and extinguish the negative interactions.
(C): Providing opportunities for him to practice regulating his emotions and express himself in acceptable ways
(D): Providing positive reinforcements for when Michael is able to remain calm when his parents leave the house",Providing positive reinforcements for when Michael is able to remain calm when his parents leave the house,D,"Providing positive reinforcements for when Michael is able to remain calm and composed when his parents leave the house. Positive reinforcement is a key element of behavioral therapy, as it helps to reward desired behaviors and encourage them in the future. Therefore, the correct answer is (B)",counseling skills and interventions
218,Initial Intake: Age: 68 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African-American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”","Using the information provided, which referral will be most helpful for this client at this time?",A respite care agency,A new counselor who specializes only in addictions,A support group for caregivers,A psychiatrist who can prescribe medications that reduce alcohol use,"(A): A respite care agency
(B): A new counselor who specializes only in addictions
(C): A support group for caregivers
(D): A psychiatrist who can prescribe medications that reduce alcohol use",A respite care agency,A,"At this time, a respite care agency will provide the most benefits for this client. Respite care agencies provide caregivers or take the patient into their facility for a short time so that the family member can have time away and exercise self-care. Referring the client to a support group for caregivers would be suitable, except the client has already stated that he generally cancels his plans because he cannot leave his wife alone. This would make it difficult for him to attend a support group. Referral to a new counselor who only specializes in addictions is needed only if the current counselor is not competent to work in this area and does not have access to adequate supervision or consultation, as needed. Referring to psychiatry for medications to reduce alcohol use (ie, Antabuse) is not a helpful referral as the client has already stated they do not want to take medications and are not yet ready to stop drinking. Therefore, the correct answer is (A)",treatment planning
219,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.","In planning treatment for this client that is consistent with this diagnosis, which of the following would be the most effective referral?",Religious or Spiritual advisor for holistic care,Family physician for medical check up,Group counseling for support,Psychiatry for medication evaluation,"(A): Religious or Spiritual advisor for holistic care
(B): Family physician for medical check up
(C): Group counseling for support
(D): Psychiatry for medication evaluation",Psychiatry for medication evaluation,D,"Standard treatment for body dysmorphic disorder includes cognitive behavioral therapy and medication, typically SSRIs. Referral to a psychiatrist or psychiatric nurse practitioner would be the appropriate referral for treatment of this disorder. Group counseling can be supportive and help her connect with others that experience some of the same symptoms. Referral to a family physician is helpful to ensure that the client is in good physical health, but family physicians may not have the training or experience to work with body dysmorphic disorder, making a psychiatry referral the most effective. Referral to a religious or spiritual advisor, if desired, can be helpful as values play an important role in people's lives and can be an important source of strength during counseling, however the referral for medication evaluation is required for treatment of this disorder. Therefore, the correct answer is (B)",treatment planning
220,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ","Based on the narrative, what appears to be the most significant factor contributing to the client's depression and anxiety?",Relationship with children,Family dynamics,Economic class background,Unique physical characteristics,"(A): Relationship with children
(B): Family dynamics
(C): Economic class background
(D): Unique physical characteristics",Family dynamics,B,"The client comes from a Colombian background and has shared that she has long struggled to keep up with the demands of her family's Colombian culture. She struggles to meet her family's expectations in caring for her mother. Additionally, the client's husband's lack of understanding of the family dynamics adds stress. Therefore, the correct answer is (A)",counseling skills and interventions
221,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.",book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends,Which one of the following would be an appropriate referral to make for this client?,Occupational therapy,Medication management,Applied behavior analysis,Speech therapy,"(A): Occupational therapy
(B): Medication management
(C): Applied behavior analysis
(D): Speech therapy",Medication management,B,"Medication may be helpful in managing the client’s anxiety regarding situations in which he experiences rigidity. Because prescribing medications is outside of the scope of the counselor, a referral to a psychiatrist for medication management would be necessary. Occupational and speech therapy are more helpful with individuals with autism spectrum disorders that have intellectual deficits. Applied behavioral analysis is helpful for individuals with autism who experience behavioral issues but who also have trouble engaging in cognitive counseling; therefore, this client would not be a candidate for applied behavioral analysis. Therefore, the correct answer is (D)",treatment planning
222,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group, and they appear to be starting to become more comfortable with one another. You noticed that throughout the past week, when you saw your clients on their unit, they were spending more time together and that they are all talking when they come in for the session. During the session, you and the clients discuss past experiences that led to them engaging in the crimes that led to their incarceration. During this conversation, client 1 is talking about his father and how he killed a pedestrian while driving. Client 4 then asserts that client 1’s father is going to hell for killing someone. You cut off client 4 and redirect the attention back to client 1.  Toward the end of this group session, you and the group talk about how being with peers who engage in antisocial behavior often leads to all members engaging in antisocial behavior","Toward the end of this group session, you and the group talk about how being with peers who engage in antisocial behavior often leads to all members engaging in antisocial behavior. All of the following are mechanisms of peer group influence EXCEPT:",Transmission of skills and values,Extinction,Reinforcement,Social comparison,"(A): Transmission of skills and values
(B): Extinction
(C): Reinforcement
(D): Social comparison",Extinction,B,"Extinction is a behavioral modification technique that focuses on removing reinforcement of a previously reinforced behavior with the hopes that it decreases and stops the behavior. This is not part of peer group influence. Reinforcement is present peer group influence, referring to the use of coercion, teasing, encouragement, criticism, and validation to dictate desired behavior. Social comparison is when an individual compares oneself to others in the group, which could lead to the individual changing their behavior to match the group’s behavior. Transmission of skills and values happens when older or more experienced group members share values and skills with younger or less experienced group members. Therefore, the correct answer is (D)",counseling skills and interventions
223, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,Li's reaction on the subway meets the criteria for?,Panic Disorder,Hyperventilation,Panic Attack,Paroxysmal episode,"(A): Panic Disorder
(B): Hyperventilation
(C): Panic Attack
(D): Paroxysmal episode",Panic Attack,C,"What Li described meets the criteria for a panic attack. It does not yet meet the criteria for Panic Disorder which consists of repeated attacks. Hyperventilation is rapid or deep breathing often caused by panic. A Paroxysmal episode can mimic a seizure and may include loss of consciousness. Therefore, the correct answer is (B)",counseling skills and interventions
224,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""  Fourth session The client has been ""looking forward to working with you"" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is ""hard on her.""    She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father.  Ninth session The client has reported increased dysphoria due to persistent bullying and lack of support at school. As a result, she has noted an increase in negative self-talk and feelings of worthlessness. She has also reported increased feelings of isolation, as she does not have any friends she can confide in or turn to for support. The client has also expressed that her home environment is still difficult, as her father has not entirely accepted her gender identity, leaving her feeling unsupported. The client has further said that she does not feel safe or secure at school and feels uncomfortable seeking help from her peers.    The client has further reported that her emotional regulation has been difficult. She finds herself becoming overwhelmed and frustrated more quickly than before. She has also noted difficulty concentrating on tasks and completing schoolwork. Her mood has become increasingly labile, and she has experienced more frequent thoughts of self-harm and has expressed that she doesn't know how to cope with her emotions.    The client's mental health has also been deteriorating. She has reported increased symptoms of depression and anxiety. She has difficulty sleeping, often unable to fall asleep or only sleeping for short intervals. She has been experiencing intrusive thoughts, racing thoughts, and difficulty focusing on tasks. She has also been avoiding social situations and expressed that she feels uncomfortable around people due to her negative self-image.    She does like the school psychologist but needs help setting up a meeting. You intend to reach out to the school psychologist to expand the continuum of care.","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ",How often should you assess for suicidal ideation for this client?,"Daily, through the school psychologist",When the client mentions suicidal ideation,Every session,Monthly,"(A): Daily, through the school psychologist
(B): When the client mentions suicidal ideation
(C): Every session
(D): Monthly",Every session,C,"Knowing this client has a history of suicidal ideation suggests that this should be assessed during each session. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
225,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter","If the client and his wife were to pursue couples counseling, which approach would best address attachment needs and bonding?",Systematic desensitization,Rational-emotive behavioral therapy,Emotionally focused therapy,Solution-focused therapy,"(A): Systematic desensitization
(B): Rational-emotive behavioral therapy
(C): Emotionally focused therapy
(D): Solution-focused therapy",Emotionally focused therapy,C,"Emotionally focused therapy (EFT) is based on John Bowlby’s attachment theory. EFT acknowledges the role attachment plays in forming intimate bonds and lasting relationships. The goal is to tap into the couple’s capacity and desire to attain a deeper connection with one another. Systemic desensitization is a behavioral intervention used with individuals experiencing anxiety, particularly with individuals experiencing phobias. Solution-focused therapy (SFT), or solution-focused brief therapy (SFBT), is future-oriented and limited in duration. SFT focuses on the couple’s individual strengths rather than addressing more profound childhood experiences. Rational-emotive behavioral therapy (REBT) is a cognitive approach used to identify and dispute irrational thoughts. Therefore, the correct answer is (C)",counseling skills and interventions
226,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.",ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself.  The client is hesitant about sharing her experiences of physical abuse,The client is hesitant about sharing her experiences of physical abuse. How does this inform your course of treatment?,"Check in every session to see if the client is ready to talk about the physical abuse, and then strongly encourage it when you think you have a strong therapeutic rapport with her.","Encourage the client to talk about the abuse during the intake session, and remind her that the more you learn about her, the more effective treatment will be.","Allow the client a few sessions to become more comfortable, and then strongly encourage the client to talk about the physical abuse.","Allow the client the space needed to become ready on her own, and bring it up every few sessions to check in and see if she is ready.","(A): Check in every session to see if the client is ready to talk about the physical abuse, and then strongly encourage it when you think you have a strong therapeutic rapport with her.
(B): Encourage the client to talk about the abuse during the intake session, and remind her that the more you learn about her, the more effective treatment will be.
(C): Allow the client a few sessions to become more comfortable, and then strongly encourage the client to talk about the physical abuse.
(D): Allow the client the space needed to become ready on her own, and bring it up every few sessions to check in and see if she is ready.","Allow the client the space needed to become ready on her own, and bring it up every few sessions to check in and see if she is ready.",D,"When processing any sort of trauma, the counselor should follow the client’s lead regarding their readiness to discuss the trauma (in this case, abuse). There is no obligation for clients to talk about something that they do not want to, or are not ready to, talk about. It would be helpful to check in every few sessions to show this client that you remember that this was an issue she presented and to open up the opportunity to discuss it, should her willingness/readiness to do so change. Asking about the trauma every session or pressuring the client to talk about the trauma could cause more harm than good and could induce more resistance to openly discuss it. Although it is important to talk about the client’s history of physical abuse at some point (because it likely contributes to her presenting issues), the timing must be dictated by the client. Therefore, the correct answer is (C)",treatment planning
227,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","   e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination",Bullying is defined as behaviors that include all of the following components EXCEPT:,Behaviors within a larger school or community setting,Actions that are intentionally aggressive or mean,Situations involving an imbalance of power,Behaviors that are repeated over time,"(A): Behaviors within a larger school or community setting
(B): Actions that are intentionally aggressive or mean
(C): Situations involving an imbalance of power
(D): Behaviors that are repeated over time",Behaviors within a larger school or community setting,A,"Bullying is being intentionally aggressive or mean, it is repeated over time, and it involves situations in which there is an imbalance of power. Bullying can occur in a variety of settings, including school, the community, or online. There are various subtypes of bullying, including physical bullying, verbal bullying, relational bullying, and electronic bullying. This differs from teasing and other acts of aggression in that there is an imbalance of power. Power can be physical, social, intellectual, or mental. Therefore, the correct answer is (D)",professional practice and ethics
228,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",How might you address your supervisor's offer to share records with you?,You obtain your supervisor’s notes on your client's parents to better inform your treatment.,"You tell your supervisor you can discuss the issue in person, but you cannot view the case files.",You tell your supervisor that you cannot review the parent's case files.,You tell your supervisor she cannot discuss these case files until you get a written release of information from the parents.,"(A): You obtain your supervisor’s notes on your client's parents to better inform your treatment.
(B): You tell your supervisor you can discuss the issue in person, but you cannot view the case files.
(C): You tell your supervisor that you cannot review the parent's case files.
(D): You tell your supervisor she cannot discuss these case files until you get a written release of information from the parents.",You tell your supervisor that you cannot review the parent's case files.,C,"This is the best choice. The client is seeking help following a trauma in which her friend was shot. The client's presenting problem has nothing to do with the client's parents. Accessing their old therapy case records (even with their written consent for you to view the records) would not in any way be relevant to your client's current situation. Therefore, the correct answer is (A)",professional practice and ethics
229,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","Based on the information you have gathered so far on the client, which issue is least significant to address?",The client's potential triggers impacting his ability to enjoy sex,The client's weight possibly impacting his erectile dysfunction,The client's feelings regarding his wife's poor communication skills,The client's fantasies about his ex-girlfriend,"(A): The client's potential triggers impacting his ability to enjoy sex
(B): The client's weight possibly impacting his erectile dysfunction
(C): The client's feelings regarding his wife's poor communication skills
(D): The client's fantasies about his ex-girlfriend",The client's fantasies about his ex-girlfriend,D,"Although this issue might be emotionally significant for the client, it is not as important to address in therapy as his feelings of hurt and rejection from his wife's comments, exploring any underlying issues that may be impacting his ability to find pleasure in sex, and improving communication with his wife. These topics are more likely to lead to meaningful progress in the therapy sessions. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
230,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.","If you had chosen to prioritize maintaining therapeutic rapport over your mandated reporting obligations, would your actions be considered ethical or unethical?",They would be ethical because you are uphold the principle of autonomy.,They would be unethical as you are required to report the client's threat of self-harm to her parents.,They would be ethical because no therapeutic progress can occur without therapeutic rapport.,They would be unethical because the client is a minor and all information must be disclosed to the parents.,"(A): They would be ethical because you are uphold the principle of autonomy.
(B): They would be unethical as you are required to report the client's threat of self-harm to her parents.
(C): They would be ethical because no therapeutic progress can occur without therapeutic rapport.
(D): They would be unethical because the client is a minor and all information must be disclosed to the parents.",They would be unethical as you are required to report the client's threat of self-harm to her parents.,B,"Therapists are ethically obligated to disclose limits to confidentiality to the client. Any threats of self-harm, suicidal ideation, or violence must be reported to ensure their safety. Therefore, the correct answer is (C)",professional practice and ethics
231,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.","Of the following, which is an ethically appropriate action to take to address the issue associated with your treatment facility's closing in six months?","You embrace that since you are in a helping profession, you are already contributing to the community's welfare.",You express your advocacy for affordable treatment by writing an editorial for the newspaper.,You resolve to devote your time to enhancing your effectiveness as a therapist in order to counteract any negative fallout.,You recognize that your clients will be affected by this change and encourage them to contact local authorities.,"(A): You embrace that since you are in a helping profession, you are already contributing to the community's welfare.
(B): You express your advocacy for affordable treatment by writing an editorial for the newspaper.
(C): You resolve to devote your time to enhancing your effectiveness as a therapist in order to counteract any negative fallout.
(D): You recognize that your clients will be affected by this change and encourage them to contact local authorities.",You express your advocacy for affordable treatment by writing an editorial for the newspaper.,B,"The therapist has an ethical responsibility to advocate for professional and client issues. Therefore, the correct answer is (B)",professional practice and ethics
232,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,Which of the following is not part of an assessment interview?,Past evaluations and assessments,Structured interview,Unstructured interview,Observation of behavior,"(A): Past evaluations and assessments
(B): Structured interview
(C): Unstructured interview
(D): Observation of behavior",Past evaluations and assessments,A,"Past evaluations and assessments can be helpful in the overall clinical picture and can confirm information provided by the client but can be gathered later. The assessment interview should include a structured interview which follows a standard format or form, an unstructured interview which is more conversational and observation of behavior/non-verbal cues. Therefore, the correct answer is (B)",treatment planning
233,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""  Eighth session The client has been coming to therapy consistently for seven weeks. During today's session, he states that he has been able to have sex once to full term and has been practicing his relaxation skills before initiating sexual activity with his wife. The client tells you, ""My wife just doesn't do it for me anymore. With the other two women I am currently seeing, I can go two, even three times. I don't feel guilty, and it feels great to feel like a man now."" This is the first time your client has admitted his infidelity to you.    The client expresses feelings of relief to speak honestly about his infidelities and the dual benefit of ""feeling like a man again"" and being able to perform sexually. He reports that he feels more confident and his anxiety levels have decreased since engaging in extra sexual activity with the other two women and his wife.","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","You state to the client, ""Last week you were telling me that you weren't attracted to your wife. Today, you're saying that you have been having affairs, and it makes you feel more like a man. Am I understanding you correctly?"" What microskill are you using here?",Confronting,Reflecting on meaning,Reflecting the client's feelings,Clarifying,"(A): Confronting
(B): Reflecting on meaning
(C): Reflecting the client's feelings
(D): Clarifying",Clarifying,D,"You are clarifying the client's situation and gaining an understanding of how multiple partners increase his libido. Therefore, the correct answer is (B)",counseling skills and interventions
234,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services.  Some clients may need to be referred to another counselor","Some clients may need to be referred to another counselor. All of the following are appropriate reasons to make a referral, EXCEPT:",The client would benefit more from a psychiatrist or a medical specialist.,"The client and you have very different political affiliations, and their presenting problems relate to political events.",You fail to connect with the client due to personality differences.,You do not specialize in the disorder experienced by the client.,"(A): The client would benefit more from a psychiatrist or a medical specialist.
(B): The client and you have very different political affiliations, and their presenting problems relate to political events.
(C): You fail to connect with the client due to personality differences.
(D): You do not specialize in the disorder experienced by the client.","The client and you have very different political affiliations, and their presenting problems relate to political events.",B,"Political affiliations should not affect the counseling process. You must support the client’s values and beliefs even when trying to reframe what you perceive as illogical thoughts. A failed connection due to personality differences is a valid reason for referral if a connection cannot be made. Personality differences are important to consider because the therapeutic relationship relies on a real interpersonal connection between two people. If the client’s needs are outside of your competency, or if the issue at hand is a medical issue or would benefit more from psychiatric intervention, then a referral is also appropriate. Therefore, the correct answer is (D)",professional practice and ethics
235,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Using the information you have learned, which of the following should be addressed first in this session?",Suggest that client and his wife not engage in the conversations outside of sessions,Review the client's progress and help identify how these were accomplished.,"Have client explain what frustrates when he doesn't ""catch on"" right away","Tell client he's doing well and to ""just keep doing what you're doing""","(A): Suggest that client and his wife not engage in the conversations outside of sessions
(B): Review the client's progress and help identify how these were accomplished.
(C): Have client explain what frustrates when he doesn't ""catch on"" right away
(D): Tell client he's doing well and to ""just keep doing what you're doing""",Review the client's progress and help identify how these were accomplished.,B,"Reviewing the client's progress and having him identify what he has done to make changes is the correct response. The client is making small changes in lifelong personality characteristics and it will be important for the counselor and client to help him identify exactly what he has been doing that is different now. Telling him to keep doing what he is doing does not recognize the progress and does not identify the different steps he is actually making to act differently. Without this information, the client may not know how he has made his recent accomplishments. It will be important to discuss the client's frustration after reviewing his progress and identifying the changes he has made. Since the client and his wife are able to work together through the client's traits and he is able to move from angry and frustrated to feeling ""good"" or satisfied that he has understood where he struggled before, there is no reason to restrict those conversations to therapy sessions. Should the client say that these conversations are making him more upset, causing self-esteem injuries, or are nonproductive, then the counselor might ask if the client would want to restrict them to couple's sessions. Therefore, the correct answer is (B)",counseling skills and interventions
236,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","Given the current disposition and behaviors in which this client has presented herself, what would be strategies or approaches that would be most effective in forging a strong working alliance with her?",Utilize a Gestalt position to help her embrace here-and-now concerns,"Take an Adlerian approach, and assess social dynamics at this time",Use a person-centered approach to encourage self-assurance and trust,Use a solution-focused approach to identify strengths,"(A): Utilize a Gestalt position to help her embrace here-and-now concerns
(B): Take an Adlerian approach, and assess social dynamics at this time
(C): Use a person-centered approach to encourage self-assurance and trust
(D): Use a solution-focused approach to identify strengths",Use a person-centered approach to encourage self-assurance and trust,C,"The success of person-centered therapy relies on unconditional positive regard. This means the therapists must be empathetic and non-judgmental to convey their feelings of understanding, trust, and confidence. This will encourage clients to make their own decisions and choices. Therefore, the correct answer is (C)",counseling skills and interventions
237,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions",Which one of the following statements would be the most beneficial cognitive reframe for the client’s beliefs about her roommate that would address an approach from a reality perspective?,"“My thoughts aren’t reality; therefore, I should distract myself using coping skills.”","“My roommate may actually do something bad, so I need to set some boundaries with her regarding my room.”",“I should talk with my roommate about boundaries.”,"“Currently, my roommate hasn’t done anything other than enter my space without permission and borrow things, so this isn’t the same as my past experiences.”","(A): “My thoughts aren’t reality; therefore, I should distract myself using coping skills.”
(B): “My roommate may actually do something bad, so I need to set some boundaries with her regarding my room.”
(C): “I should talk with my roommate about boundaries.”
(D): “Currently, my roommate hasn’t done anything other than enter my space without permission and borrow things, so this isn’t the same as my past experiences.”","“Currently, my roommate hasn’t done anything other than enter my space without permission and borrow things, so this isn’t the same as my past experiences.”",D,"Focusing on the current situation, in which the roommate has not done anything other than disrespect boundaries, and seeing how it is different from past events is the most helpful cognitive reframe. This focuses on the reality and helps the client refrain from blowing it out of proportion. Although focusing on enforcing boundaries is helpful, it is not a cognitive reframe. Identifying that it is a possibility that the roommate may sexually assault her is not helpful because this reinforces fear and irrational thinking. Identifying that the client’s thoughts are not reality is important, but this does not focus on the root of the thoughts, which stem from a fear of a past situation becoming the present reality. Therefore, the correct answer is (B)",counseling skills and interventions
238,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client reports that he has been sleeping more than usual and that this is affecting his ability to get to work on time. He reports that his boss started noticing his tardiness and has given him a verbal warning. Combined with the fear of losing his job, he expressed worry regarding increased conflict with his girlfriend and feeling more “on edge","All of the following interventions are clinically appropriate therapeutic approaches to treating major depressive disorder, recurrent, mild EXCEPT:",Support groups,Referral for electroconvulsive therapy,Cognitive behavioral therapy (CBT),Referral for psychiatric medication management,"(A): Support groups
(B): Referral for electroconvulsive therapy
(C): Cognitive behavioral therapy (CBT)
(D): Referral for psychiatric medication management",Support groups,A,"CBT and electroconvulsive therapy are clinically proven, effective treatments for depressive disorders. Medications may be beneficial in the treatment of depression, and a referral to a psychiatrist or psychiatric nurse practitioner is required for that assessment and prescription because prescribing medications is outside of the scope of the counselor. Although support groups may be beneficial to a client, they are not clinical in nature. Therefore, support groups would not provide treatment; rather, they would provide a support system for a client. Therefore, the correct answer is (A)",treatment planning
239, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,"By saying, ""Tell me about your experience coming into a new culture and going through what you did"" the counselor is demonstrating the attribute of?",Empathy,Curiosity,Inclusion,Cultural awareness,"(A): Empathy
(B): Curiosity
(C): Inclusion
(D): Cultural awareness",Cultural awareness,D,"Cultural awareness is understanding that someone's cultural experiences and views are unique and may differ from your own. Curiosity is being inquisitive about a different culture. Empathy is trying to put yourself in the shoes of another and inclusion is providing equal access or opportunities to others who may be marginalized. Therefore, the correct answer is (A)",counseling skills and interventions
240,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","The client’s formal assessment, along with informal observations, warrants a psychiatric evaluation to assess for ADHD, and the PGM has agreed to this. The client has done well in therapy and has met her short-term counseling goals. She has processed grief and loss concerning separation from her parents and shows improvement with emotional regulation. The use of brief strategic family therapy (BSFT) has helped address patterns of interaction between the client and her PGM, and the client is having fewer tantrums. The PGM reports that the client continues to talk back, and she is not completing her chores. You plan to conduct a series of home visits to assist the PGM with parent management skills but receive word from your agency’s office indicating the client has lost insurance coverage",Which of the following aspects of parent management training (PMT) illustrates the concept of extinction?,The teacher progressively removes prompts that are no longer required for the client to stay in her seat.,"The PGM ignores temper tantrums that were previously reinforced with attention, causing the tantrums to discontinue.","The PGM’s end goal of shaping the client’s behavior (e.g., cleaning her room) is achieved by reinforcing successive approximations to the goal. (I.e., “I need you to pick your clothes up off the floor” or “I need you to pull the covers up to your pillow.”).",The client refuses to do a chore and loses a portion of her allowance.,"(A): The teacher progressively removes prompts that are no longer required for the client to stay in her seat.
(B): The PGM ignores temper tantrums that were previously reinforced with attention, causing the tantrums to discontinue.
(C): The PGM’s end goal of shaping the client’s behavior (e.g., cleaning her room) is achieved by reinforcing successive approximations to the goal. (I.e., “I need you to pick your clothes up off the floor” or “I need you to pull the covers up to your pillow.”).
(D): The client refuses to do a chore and loses a portion of her allowance.","The PGM ignores temper tantrums that were previously reinforced with attention, causing the tantrums to discontinue.",B,"Extinction is demonstrated when the client’s temper tantrums, which were previously reinforced with attention, are ignored and, as a result, discontinue. Ignoring the behavior does not automatically stop the behavior. For extinction to occur, the behavior must have previously been reinforced, and the behavior must stop after ignoring the same behavior. Punishment is illustrated when the client loses a portion of her allowance due to refusing to do a chore. One way to differentiate punishment from other aspects of PMT is that punishment refers to methods that decrease a specific behavior. Fading involves the progressive removal of prompts that were previously (and successfully) used when telling the client to stay in her seat. Fading is used after the response is consistently performed without prompts. Finally, the end goal of shaping is known as the terminal response. Therefore, the correct answer is (B)",counseling skills and interventions
241,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.  Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself.    When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress.    Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, ""My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?"" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious.    At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week.  Tenth session You have been working with Michael to develop and practice effective coping skills appropriate to his age. You have been using behavioral modification techniques to decrease his anxiety about being away from his parents. During previous sessions, you suggested that his parents leave your office space for progressively more extended periods. Michael has complied with these requests, although he was initially anxious and agitated. After five weeks, he is now able to tolerate being away from his parents for up to an hour. In today's session, the parents reflect on their son's progress since he started therapy. They believe that he has made a significant improvement. To date, there have only been ""little incidents."" The parents report that two days ago, Michael was reluctant to go to bed without them and had a minor fit. Instead of escalating the situation, they calmly reminded him of the strategies he had learned in therapy such as taking deep breaths when feeling anxious. To their surprise, Michael began using his coping skills and went to bed peacefully. Michael's mother tells you, ""It finally feels like we've turned a corner. I'm so proud of him!"" The parents have also received positive updates from Michael's teachers who say that he is doing much better in school. They report that he has made a new friend and was invited to a sleepover. Michael seems excited about the idea. His parents are not sure how he will handle being away from home overnight, but they are willing to try.    After providing you with an update, the parents leave the room to wait in the waiting room while you talk to Michael. He appears receptive and comfortable with this arrangement. He tells you, ""I kind of feel dumb for being scared. I'm sorry for causing so much trouble."" You respond affirmatively and validate his feelings. Next, you say, ""I remember when you first came to my office with your mom and dad. You were having a lot of trouble being away from them. Do you think that's still a problem for you?"" He shakes his head ""No"" and reports that he is now able to be away from his parents for longer periods of time without feeling scared or upset. You ask him what has been most helpful to him when he starts to feel anxious. He says, ""The counting and breathing stuff you showed me how to do. Also, I think about something fun that I did with my mom and dad, like that time we went to the beach and built a giant sandcastle!"" You tell him how proud you are of his progress and encourage him to keep using the coping strategies he has learned in therapy.    Near the end of the session, you invite Michael's parents back into your office to check in with them about next steps. The parents agree that Michael has made significant progress in tolerating separation and they feel that the treatment has been successful. You offer additional resources for follow-up care and suggest a plan for transitioning out of therapy. Lastly, you thank Michael and his parents for their dedication throughout the course of therapy and let them know that you are available if they have any further questions or concerns.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ","When the client says, ""I kind of feel dumb for being scared. I'm sorry for causing so much trouble."" as a response to recognizing the efficacy of therapy, what response would be most appropriate?",Reframe the client's statement into a positive affirmation of his recognition of growth.,"""You've been working really hard in therapy, and you should be proud of how far you've come.""","""It's understandable to feel scared in new or unfamiliar situations. It takes a lot of courage to face your fears and overcome them.""","""Don't be too hard on yourself. Everyone feels scared sometimes and you don't need to feel ashamed about that.""","(A): Reframe the client's statement into a positive affirmation of his recognition of growth.
(B): ""You've been working really hard in therapy, and you should be proud of how far you've come.""
(C): ""It's understandable to feel scared in new or unfamiliar situations. It takes a lot of courage to face your fears and overcome them.""
(D): ""Don't be too hard on yourself. Everyone feels scared sometimes and you don't need to feel ashamed about that.""","""It's understandable to feel scared in new or unfamiliar situations. It takes a lot of courage to face your fears and overcome them.""",C,"This response validates the client's feelings and recognizes his effort in overcoming his anxiety. It acknowledges that feeling scared is normal, and applauds the client for his bravery in tackling the challenge. This type of statement also helps to foster a positive therapeutic relationship by providing a nonjudgmental, affirming message. Therefore, the correct answer is (C)",core counseling attributes
242,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client attends a process-oriented CBT group that is nearing the middle stage of group development. The client presents today with a bright affect and arrives early to converse with two other women in the group. During group activities, she is reticent to share and is sensitive to a conflict between two members that has started to emerge. One member becomes openly critical of the group tasks and their usefulness. Other members start to weigh in and take sides. The conflict quickly escalates between two members, with one shouting at another, “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you.” Other members nod in agreement.  How would a gestalt therapist describe the boundary disturbance that characterizes the group member’s statements of “You have monopolized every session with your opinions",How would a gestalt therapist describe the boundary disturbance that characterizes the group member’s statements of “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you”?,Projection,Confluence,Deflection,Introjection,"(A): Projection
(B): Confluence
(C): Deflection
(D): Introjection",Projection,A,"Gestalt therapists use the term boundary disturbance to describe various forms of resistance. Boundary disturbances include projection, introjection, retroflection, confluence, and deflection. Gestalt therapists address boundary disturbances in the here and now, making it applicable to this client’s process-oriented group. Projection is the tendency for a person to blame the environment (ie, other people) for personality traits, thoughts, feelings, and behaviors that originate in themselves. Individuals use projection to disown or deny aspects of their personality by blaming others for their circumstances. Disowning aspects of one’s personality makes the person a victim of circumstance by assigning hidden meanings to others. During group conflict, the member’s statement, which consists of personality aspects consistent with social anxiety (ie, feelings of not being wanted, included, or judged), likely originate in elements of the member’s self and other members being in agreement. Introjection, which is the opposite of projection, is the process of assimilating information from the environment without critical discernment. This tends to develop in childhood when information from parents or authority figures is passively incorporated so that there is no identification of what one wants and needs. Deflection occurs when a distraction is created to avoid aspects of the environment that may be threatening. Examples of distractions include the use of humor, speaking for others, and asking questions. Confluence occurs when aspects of one’s internal and external environments are blurred or diffuse, which prevents one from differentiating the two. Confluence often occurs when individuals avoid conflict and possess an increased need to be accepted. Therefore, the correct answer is (D)",counseling skills and interventions
243,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","You meet with the client’s mother today to update the client’s treatment plan. Since the beginning of the school year, the client has been suspended for a combined total of 8 days. He has responded poorly to many of the behavioral classroom interventions. The mother has reluctantly granted the school permission to begin testing to determine if the client qualifies for an Individualized Education Program. You inform the mother of her parental rights pertaining to this process, particularly as they apply to protections against disability-related discrimination and the maximum number of disability-related suspensions. She is encouraged by the possibility of the client receiving additional supports that consider the client’s strengths and challenges.  You teach the mother to use time-out with the client at home",You teach the mother to use time-out with the client at home. The effectiveness of time-out is a function of which one of the following?,Counterconditioning,Punishment,Classical conditioning,Operant conditioning,"(A): Counterconditioning
(B): Punishment
(C): Classical conditioning
(D): Operant conditioning",Operant conditioning,D,"Principles of operant conditioning include extinction, punishment, reinforcement, and stimulus control. With operant conditioning, learning occurs in the presence of behavioral consequences or reinforcement. Extinction happens when the reinforcer for that response is stopped, which lessens the possibility of the behavior’s recurrence. Time-out is also known as time-out from reinforcement. When a child is sent to time-out, they are being removed from a situation that is reinforcing undesirable behavior. Classical conditioning entails paring a previously neutral stimulus with an unconditioned stimulus. Operant conditioning varies from classical conditioning in that operant conditioning involves using reinforcement or punishment to increase or decrease behavior. Punishment can be negative (eg, taking away privileges) or positive (eg, dispensing a noxious stimulus). Counterconditioning is a form of classical conditioning used to replace a negative emotional response (eg, fear) with a stimulus that elicits a positive or pleasant response (eg, happiness). Therefore, the correct answer is (A)",counseling skills and interventions
244, Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.","In addition to a potential substance use disorder, which of the following mental health disorders should be viewed as potential diagnoses based on the information provided?",Borderline Personality Disorder (BPD),General Anxiety Disorder (GAD),Narcissistic Personality Disorder (NPD),Post Traumatic Stress Disorder (PTSD),"(A): Borderline Personality Disorder (BPD)
(B): General Anxiety Disorder (GAD)
(C): Narcissistic Personality Disorder (NPD)
(D): Post Traumatic Stress Disorder (PTSD)",Borderline Personality Disorder (BPD),A,,"intake, assessment, and diagnosis"
245,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,What is the least important for the counselor to review currently?,Assess competency to provide informed consent,"Clarify that it is not the counselor's role to ""fix"" the child but to help identify patterns and reasons for behaviors",Review Carlos' successes and strengths,Discuss limits of confidentiality,"(A): Assess competency to provide informed consent
(B): Clarify that it is not the counselor's role to ""fix"" the child but to help identify patterns and reasons for behaviors
(C): Review Carlos' successes and strengths
(D): Discuss limits of confidentiality",Assess competency to provide informed consent,A,"There is no indication that Carlos and his mother are not capable of providing informed consent. It is important to address Claudia's commend about ""fixing"" Carlos. This can be incorporated in the informed consent process. Also, discussing confidentiality and the limits of confidentiality when you are treating a minor is imperative. Given Carlos' response, reviewing his successes and strengths will not only help his mother focus on the positive but it can also be a way to engage Carlos. Therefore, the correct answer is (D)",professional practice and ethics
246,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,"Of the following, which is the least important area to explore in this session?",Her relationship with her mother,What areas Elaina wants to explore,Her suspensions in school,The safety of her current relationship with her boyfriend,"(A): Her relationship with her mother
(B): What areas Elaina wants to explore
(C): Her suspensions in school
(D): The safety of her current relationship with her boyfriend",Her suspensions in school,C,"It is important for the counselor to conduct a comprehensive assessment. Although understanding the situation and reasons around her fighting in school, focusing on the school sanctions is not as important as the other information that should be obtained. It is important to assess her safety in her current relationship as she and her baby could possibly be in danger. It is also important to find out more about her current relationship with her mother, especially since Elaina is going to be a mother herself. Therefore, the correct answer is (C)",counseling skills and interventions
247,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","   ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years","Considering the client’s hesitancy to participate in counseling, which of the following instruments would you select to better understand his help-seeking behaviors?",Ethnic-Sensitive Inventory (ESI),Munroe Multicultural Attitude Scale Questionnaire (MASQUE),Iowa Cultural Understanding Assessment—Client Form,Cultural Formulation Interview (CFI),"(A): Ethnic-Sensitive Inventory (ESI)
(B): Munroe Multicultural Attitude Scale Questionnaire (MASQUE)
(C): Iowa Cultural Understanding Assessment—Client Form
(D): Cultural Formulation Interview (CFI)",Cultural Formulation Interview (CFI),D,"Developed for the DSM-5-TR, the CFI is a tool used to collect culturally relevant information related to the client’s current and past help-seeking behaviors, coping skills, treatment expectations, and other relevant socially and culturally contextualized factors (Lewis-Fernandez et al, 2020). The Ethnic-Sensitive Inventory (ESI) is a self-assessment questionnaire for counselors and related practitioners that measures counselor-client interactions in four phases of counseling (ie, from precontact to termination). The Munroe Multicultural Attitude Scale Questionnaire (MASQUE) is a tool that measures multicultural knowledge, care, and active experiences among students attending secondary educational institutions (Monroe & Pearson, 2006). Finally, the Iowa Cultural Understanding Assessment—Client Form is a questionnaire intended to provide feedback on culturally responsive care for clinical and program services. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
248,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ",Which assessment tool would be most appropriate to use with this client?,Adjective checklist (ACL),Behavioral Summarized Evaluation (BSE),ACORN Eating Disorder Inventory,Five Facet Mindfulness Questionnaire,"(A): Adjective checklist (ACL)
(B): Behavioral Summarized Evaluation (BSE)
(C): ACORN Eating Disorder Inventory
(D): Five Facet Mindfulness Questionnaire",ACORN Eating Disorder Inventory,C,"The ACORN Eating Disorder Scale is used to discover a range of eating disorder symptoms. Based on his medical history, this tool would be most beneficial. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
249,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","You meet with the client alone, and he appears to be more comfortable with you because he comes in and starts talking about a video game that he plays. You share that you have played that video game before. During the session, the client mentions that his parents got his first report card of the year and found out that he was failing most of his classes. He started to say that he was worried that his dad was going to hit him because of his grades. You ask if his father hits him often, and he replies that he does several times a week. You try to inquire about the manner of hitting his father uses because a certain level of corporal punishment is legal in the state that you work in. The client says that he is not going to talk any more about this. You remind the client that you likely will need to report this to child protective services and he says, “I don’t care” in response. You spend the rest of this session processing his relationship with his parents, and he discloses that he does love them, but that they are not his real parents. You meet with the client’s parents near the end of the session, and, while talking with them, they report that he was neglected while in foster care because the foster parent was “just in it for the money.”  Based on the information discussed in this session, you decide to begin supporting the parents in improving their son’s attachment with them","Based on the information discussed in this session, you decide to begin supporting the parents in improving their son’s attachment with them. All of the following would be beneficial homework assignments, EXCEPT:",Assigning reading homework for the parents regarding positive attachment,Having intentional weekly family time,Creating a reward system for behavior to create consistency and structure,Assigning intentional one-on-one activities with each parent and the client,"(A): Assigning reading homework for the parents regarding positive attachment
(B): Having intentional weekly family time
(C): Creating a reward system for behavior to create consistency and structure
(D): Assigning intentional one-on-one activities with each parent and the client",Creating a reward system for behavior to create consistency and structure,C,"Consistency and structure are important for anyone, but they are especially for someone with conduct disorder. Although a reward system may be beneficial in treating behavior related to conduct disorder, it is not an intervention that is focused on enhancing the parents’ understanding of attachment and is therefore the least appropriate option in meeting that goal. In fact, reward systems can potentially strain attachment. Reading related to positive attachment would be beneficial for the parents and likely would include information on attachment-enhancing activities such as intentional one-on-one activities and consistent family time. Therefore, the correct answer is (C)",counseling skills and interventions
250,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","Based on this new information, which intervention should be used during this session?",Develop suicide contract to keep client safe,Explore questions related to sexual attraction based on current employment,Explore client's experience of internal and external locus of control,Assess for alcohol use disorder and referral to Alcoholics Anonymous,"(A): Develop suicide contract to keep client safe
(B): Explore questions related to sexual attraction based on current employment
(C): Explore client's experience of internal and external locus of control
(D): Assess for alcohol use disorder and referral to Alcoholics Anonymous",Explore client's experience of internal and external locus of control,C,"The client's statements about frequent moves because of parents, losing his job because of others, and having no choice about his new employment, demonstrates an external locus of control which is the belief that his success is dependent on external forces rather than himself. His circumstances are not optimal; thus, he believes he cannot be successful, which impacts his emotional health and well-being. A suicide contract may be helpful but would have been completed in the intake if used, as the client states he has no suicidal ideation at this time. His increase in alcohol is an important clue to his lack of coping skills and should be addressed in session, but not for the purpose of diagnosis and referral at this time since it is a recent development. Exploring possible same-sex attraction may be beneficial later when the client is stable but may cause greater stress right now. Therefore, the correct answer is (D)",counseling skills and interventions
251,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","Since the fourth session, child protective services investigated the client’s abuse allegations and determined that they were unfounded. You discuss this with the client and he says he was lying because he was mad at his parents that day. You praise the client for being forthright today regarding the allegations and discuss how false allegations can be incredibly harmful to others and can strain his relationship with his parents further. You and the client process several situations similar to this in which he avoided responsibility. You empathize with the client and support his reflection on his behavior","From a behavior therapy perspective, which of the following would best define what the client does when he blames others for his actions?",Attention,Sensory needs/stimulation,Escape,Item/activity,"(A): Attention
(B): Sensory needs/stimulation
(C): Escape
(D): Item/activity",Escape,C,"The function of this client’s behavior when he blames others is to escape consequences and escape possible pain from being in trouble or having to accept his own behavior. The client is not seeking attention because he is redirecting attention. The client might blame others in an attempt to maintain access to activities or items, but in the case of a client with conduct disorder, he is likely trying to avoid punishment. There is no indication that this client is looking for sensory input or cognitive stimulation. Therefore, the correct answer is (A)",counseling skills and interventions
252,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","You meet with the client 2 weeks after the initial intake because she refused to come for the session scheduled the past week. Because of the cancellation, you decide to change the focus of your session to meet the client’s needs for comfort and security over the foster parents’ need for guidance and skills. The client engages a little more in interacting with you, and you praise her for her involvement. At one point in the session, the client hits you and goes and sits down to continue playing. At the end of the session, you provide the foster parents with ways that they can increase attachment and positive interactions with your client. You empathize with the foster parents regarding their desire to help the client feel loved and cared for","From a behavioral therapy perspective, which of the following interventions would demonstrate conflict tolerance in a manner that would meet the client’s needs when she hits you?",You minimize your reaction and prompt the client to communicate her wants or needs.,You redirect the client to another activity in order to support her with managing her strong emotions.,You disengage from the client and provide no response so as to not reinforce the behavior.,You engage the client in cognitive reframing to manage her strong emotions.,"(A): You minimize your reaction and prompt the client to communicate her wants or needs.
(B): You redirect the client to another activity in order to support her with managing her strong emotions.
(C): You disengage from the client and provide no response so as to not reinforce the behavior.
(D): You engage the client in cognitive reframing to manage her strong emotions.",You minimize your reaction and prompt the client to communicate her wants or needs.,A,"From a behavioral perspective, the function of the behavior would be to escape. In order to address this, you want to avoid reinforcing the behavior by providing a response, and you also want to prevent escape by encouraging her to communicate what she needs or wants. Encouragement to engage in cognitive reframing would not be developmentally appropriate because the client may not be able to use this skill and it is not a behavioral intervention. Choosing to disengage from the client and to not respond would not address the function of the behavior because when the function is “escape,” you would be allowing the client to escape by disengaging and would reinforce the behavior. It may be helpful to redirect the client to calm down; however, this would not address the function of the behavior. Therefore, the correct answer is (B)",counseling skills and interventions
253, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",You conduct the Columbia Suicide Severity Rating Scale (C-SSRS) with Malik. Which component is most critical to assessing her current safety?,History of family depression or suicidal ideation,The length of time it has been since her suicidal thoughts,The severity of her suicidal thoughts on a scale of 1-5,If suicidal ideations have proceeded to methods and plans,"(A): History of family depression or suicidal ideation
(B): The length of time it has been since her suicidal thoughts
(C): The severity of her suicidal thoughts on a scale of 1-5
(D): If suicidal ideations have proceeded to methods and plans",If suicidal ideations have proceeded to methods and plans,D,"While the other choices are crucial in understanding the overall safety of your client, the indicators that are most alarming and qualify for immediately raising a client's risk level are if their suicidal thoughts have developed into consideration of methods of suicide and the creation of specific plans for when and how to commit suicide. This demonstrates level of intent versus remaining in the realm of ""ideation"" and may increase or intensify the type and level of interventions applied. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
254,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ",Which statement best reflects the client's feelings about her relationship with food and eating?,"""You're feeling very anxious about eating and trying to be mindful of what you eat, which is making it more difficult for you to enjoy meals with others.""","""I can hear the distress in your voice when you talk about food and eating. It sounds like your relationship with food has been one of guilt and anxiety, which has been intensified by comments from people around you.""","""I'm sorry that you've had to deal with negative feelings about food and eating. It sounds mentally and emotionally exhausting, and I can understand why you are feeling frustrated.""","""It seems like all of your teammates have no problem with eating together, but you feel embarrassed and ashamed when they comment on your food choices.""","(A): ""You're feeling very anxious about eating and trying to be mindful of what you eat, which is making it more difficult for you to enjoy meals with others.""
(B): ""I can hear the distress in your voice when you talk about food and eating. It sounds like your relationship with food has been one of guilt and anxiety, which has been intensified by comments from people around you.""
(C): ""I'm sorry that you've had to deal with negative feelings about food and eating. It sounds mentally and emotionally exhausting, and I can understand why you are feeling frustrated.""
(D): ""It seems like all of your teammates have no problem with eating together, but you feel embarrassed and ashamed when they comment on your food choices.""","""I can hear the distress in your voice when you talk about food and eating. It sounds like your relationship with food has been one of guilt and anxiety, which has been intensified by comments from people around you.""",B,"This response accurately reflects the client's feelings about her relationship with food and eating. It acknowledges her distress and validates that she is feeling a lot of guilt and anxiety when it comes to food, which is made worse by comments from people around her. Therefore, the correct answer is (C)",counseling skills and interventions
255,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,This factor can exacerbate tics?,Putting together a puzzle,Epsom bath,Stressful/exciting events,Going for a hike,"(A): Putting together a puzzle
(B): Epsom bath
(C): Stressful/exciting events
(D): Going for a hike",Stressful/exciting events,C,"Stressful/exciting events can cause or worsen tics. An activity that is structured and requires focus such as putting a puzzle together can help suppress tics as well as enjoyable activities such as going for a hike. An Epsom bath, or any type of bath can help towards relaxation and may also help to suppress tics. It can be helpful to journal or monitor what is effective and what is not. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
256,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client reports that he has been sleeping more than usual and that this is affecting his ability to get to work on time. He reports that his boss started noticing his tardiness and has given him a verbal warning. Combined with the fear of losing his job, he expressed worry regarding increased conflict with his girlfriend and feeling more “on edge.”  The client asks the clinician to call his girlfriend for some more insight into how depression is affecting his functioning",The client asks the clinician to call his girlfriend for some more insight into how depression is affecting his functioning. What is important to obtain in order to facilitate this collaboration?,A signed informed consent form,A signed release of protected health information (PHI),A written and signed letter of consent from the client,Verbal consent from the client to collaborate with his girlfriend,"(A): A signed informed consent form
(B): A signed release of protected health information (PHI)
(C): A written and signed letter of consent from the client
(D): Verbal consent from the client to collaborate with his girlfriend",A signed release of protected health information (PHI),B,"The Healthcare Information Portability and Accountability Act of 1986 (HIPAA) Privacy Rule requires a signed release of PHI before a client’s health information is shared with individuals internal and external to a facility (except for people directly involved in the client’s care). The signed release of PHI identifies to whom the information can be provided, what information can be provided, what method of communication is permitted, and how long the communication can continue. Informed consent, although required in many circumstances, does not provide permission to release information and is more relevant to obtain from clients prior to performing procedures or interventions after the details, risks, and benefits have been thoroughly discussed. A written or verbal consent from the client would not be sufficient for this kind of contact. Therefore, the correct answer is (C)",professional practice and ethics
257,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","   fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend",Which of the following differential diagnoses should be considered for this client?,Specific learning disorder,Major depressive disorder,Substance use disorder,Generalized anxiety disorder,"(A): Specific learning disorder
(B): Major depressive disorder
(C): Substance use disorder
(D): Generalized anxiety disorder",Major depressive disorder,B,"Considering the client’s presenting problems, which include the identification of often feeling unhappy, assessing for major depressive disorders is appropriate because they can co-occur with ADHD. Anxiety may be present surrounding completing tasks; however, this anxiety is likely related to ADHD and is not indicated as a possible diagnosis. There are no reports of substance use, so this would not be considered for this client at this time. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
258,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students.  Seventh session Almost two months have passed since you first met with the client. She has been meeting you for weekly therapy sessions. During previous sessions, you continued to work on developing a sense of trust with the client which has allowed her to open up to you about the myriad of feelings that she has regarding her injury. You explored and processed feelings of grief and sadness, as well as feelings of anger and resentment. Several sessions have been dedicated to identifying automatic thoughts that have been contributing to the client's negative attitude and replacing negative self-talk like ""I'm broken"" with more positive and realistic statements. You have also been using solution-focused techniques to help her to focus on what is within her power to change and take active steps toward making those changes.    During today's session, the client agrees with you when you state that you believe she has achieved many of her goals in therapy. The client has worked through her ambivalence towards teaching the younger ballet classes and is now actively pursuing this opportunity. She reports that she finds a sense of purpose in helping the students learn and appreciate dance, as well as feel accomplished for their achievements. She says, ""It's still strange not being the student anymore, but I'm glad that I decided to try it. The kids had a performance last week, and one of the girls gave me this really sweet clay ballet shoe that she made in her art class. She told me that I'm the reason she felt 'brave enough' to keep dancing even though she was scared. That meant a lot to me.""    You then ask her about her relationship with her parents. She reports that it has improved since they had the discussion about trust. They are now more willing to listen to her opinions and have loosened some of the restrictions, though there are still some limits in place. Although they still have expectations of her and restrict certain activities, they now talk to her more openly and engage with her in a positive manner. She tells you that she would like to get all A's this semester to make her parents proud. She is getting better grades in history but states that her other classes are ""boring."" She also mentions wanting to put some limits on the amount of time she spends with her friends and ""get away from smoking as much."" She says that she is trying to be a better role model for her ballet students. You acknowledge how hard she has worked to reach this point and congratulate her on taking initiative in improving her academic performance and setting new boundaries with her friends."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.","How would you respond to the client's comment ""I'm broken"" using mindfulness-based cognitive therapy?",Engage the client in an exercise to role-play different parts of herself in order to understand why she feels broken,Reflect back to the client the feelings she experiences when she believes she is broken and validate those emotions,Encourage the client to practice self-compassion and non-judgmental awareness when she finds herself engaging in negative self-talk,Help the client to replace her negative self-talk with positive affirmations and rewards for making progress,"(A): Engage the client in an exercise to role-play different parts of herself in order to understand why she feels broken
(B): Reflect back to the client the feelings she experiences when she believes she is broken and validate those emotions
(C): Encourage the client to practice self-compassion and non-judgmental awareness when she finds herself engaging in negative self-talk
(D): Help the client to replace her negative self-talk with positive affirmations and rewards for making progress",Encourage the client to practice self-compassion and non-judgmental awareness when she finds herself engaging in negative self-talk,C,"Mindfulness-based cognitive therapy encourages the client to become aware of their thoughts, feelings, and emotions in a non-judgmental, compassionate way. By encouraging self-compassion and awareness when engaging in negative self-talk, the client can begin to recognize patterns and better understand how their thoughts are impacting their wellbeing. This understanding can help the client to make positive and realistic statements which can replace the negative self-talk. Therefore, the correct answer is (D)",counseling skills and interventions
259,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What would a client with stereotypic movements display?,"Rapid, jerky, nonrepetitive movements","Repetitive, seemingly driven, and nonfunctional motor behaviors","Excessive motor activity is associated with a feeling of inner tension, usually non-productive and repetitious","Agitated, purposeless motor activity, uninfluenced by external stimuli","(A): Rapid, jerky, nonrepetitive movements
(B): Repetitive, seemingly driven, and nonfunctional motor behaviors
(C): Excessive motor activity is associated with a feeling of inner tension, usually non-productive and repetitious
(D): Agitated, purposeless motor activity, uninfluenced by external stimuli","Repetitive, seemingly driven, and nonfunctional motor behaviors",B,"These would be considered stereotypic movements. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
260,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","The husband and wife come into the session and sit as far as they can from each other on the couch, and their individual body positions are oriented away from each other. You ask for any updates in the couple’s relationship, and the husband states that they have not been talking about the affair and continue to only communicate regarding the kids. You attempt to process with the couple what the affair means for their relationship and what events led up to the affair. During the session, the husband stops talking and looks away from his wife when she talks about how she became frustrated that her husband did not spend quality time with her prior to the affair. She thinks that this led to her seeking attention from a man outside of the couple’s relationship",Which one of the following best defines mindful listening?,Being able to summarize what is being said,Focusing on listening when someone is speaking and focusing on what you are saying when you are talking,Trying to relate to the emotions expressed by others while listening,Repeating the message that you interpreted from what was said,"(A): Being able to summarize what is being said
(B): Focusing on listening when someone is speaking and focusing on what you are saying when you are talking
(C): Trying to relate to the emotions expressed by others while listening
(D): Repeating the message that you interpreted from what was said",Focusing on listening when someone is speaking and focusing on what you are saying when you are talking,B,"Mindful listening is the act of being present when someone is speaking and when you are speaking. Relating to emotions would be better defined by empathy. Repeating the message heard is considered paraphrasing. Summarizing is only one element of mindful listening, and it does not necessarily reflect the act of being truly present as the sender and the receiver of the communication. Therefore, the correct answer is (A)",counseling skills and interventions
261,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences.  The client is engaging in all-or-nothing thinking with regard to his rationalization of masturbating again if he has already done so",The client is engaging in all-or-nothing thinking with regard to his rationalization of masturbating again if he has already done so. Which of the following would be the most helpful reframe of this thought?,"“I didn’t meet my goal, but this doesn’t have to affect the rest of my day.”",“I’ll take some time to do yoga to disconnect from this event and move forward with my day.”,"“I did mess up, but I’m only human, so I won’t beat myself up over it.”","“What happened can’t be changed, so I’ll just continue to move forward.”","(A): “I didn’t meet my goal, but this doesn’t have to affect the rest of my day.”
(B): “I’ll take some time to do yoga to disconnect from this event and move forward with my day.”
(C): “I did mess up, but I’m only human, so I won’t beat myself up over it.”
(D): “What happened can’t be changed, so I’ll just continue to move forward.”","“I didn’t meet my goal, but this doesn’t have to affect the rest of my day.”",A,"The best reframe in this case of all-or-nothing thinking is the client acknowledging that he did not meet his goal but that he has power over the rest of his day to make changes. This reframe helps the client see that one event in his day does not have to define the whole day. Acknowledging his humanity is helpful, but it does not address the client’s all-or-nothing thinking. The client saying that he “messed up” has a negative connotation, when the reality is that he is working toward a goal, which often involves setbacks. The client acknowledging that he cannot change what he did is a helpful technique, but it does not change his mindset for the rest of the day. Yoga or other calming activities also do not address all-or-nothing thinking when done in isolation (without a mental reframe); instead, these activities can be used as a diversion to avoid confronting the cognitive distortion completely. Therefore, the correct answer is (B)",counseling skills and interventions
262,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes to this session, sits down, and starts talking about how she met a man and talked to him for about an hour and was frustrated at the end of the conversation because she feels that he is “like everyone I’ve been with before.” The client continues to explain that she knows these men are not good for her and that she wants something different, but she is still talking to him. The client becomes frustrated talking about this and begins crying and breathing heavily, stating that, “I am broken and can’t have a healthy relationship.” You support the client through her strong emotions and provide empathetic listening.  The client inquires about circumstances in which you, as the counselor, are able to disclose information from your sessions with her","The client inquires about circumstances in which you, as the counselor, are able to disclose information from your sessions with her. All of the following are true regarding disclosure of information, EXCEPT:",You may disclose information to the client’s insurance company because they are a payor.,You may disclose information when the client expresses suicidal ideation with a plan and intent.,"Even if the client is deceased, you cannot disclose information.",You may disclose information when the client does not show up for a session because you are required to call the emergency contact.,"(A): You may disclose information to the client’s insurance company because they are a payor.
(B): You may disclose information when the client expresses suicidal ideation with a plan and intent.
(C): Even if the client is deceased, you cannot disclose information.
(D): You may disclose information when the client does not show up for a session because you are required to call the emergency contact.",You may disclose information when the client does not show up for a session because you are required to call the emergency contact.,D,"Reaching out to an emergency contact after one missed session is not by itself a sufficient justification for disclosure because you are unsure if the client is at imminent risk of harm. You may disclose information to the insurance company because they are a payor. You can also break confidentiality if the client is at risk of harming themselves or others. Even when the client is deceased, you must maintain confidentiality to the level requested by the client. Therefore, the correct answer is (C)",professional practice and ethics
263,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client talks about when he went to see his daughter at a dance recital and how, afterward when he went to say hello to her, she ignored him. He called his ex-wife later that day, and she denied knowing what was wrong, but when he talked to his son, the boy said, “Mommy told us you didn’t want to live with us anymore and that is why you left.” The client expresses frustration and anger with his ex-wife because she chose to leave him, and he thinks that it is not fair that she is telling the children a lie and also that it is affecting his relationship with them. The client states that he wanted to talk to you before he confronted his wife about this. You and the client discuss conflict resolution skills",All of the following are appropriate conflict resolution strategies for the client and his ex-wife EXCEPT:,Focusing on supporting your client in expressing himself effectively as the priority because he was the party that was hurt,Identifying and establishing the co-parenting goals that benefit the children and parents most,Identifying and establishing ground rules for conflict resolution,Supporting the client in empathizing with his ex-wife for deeper understanding of how the situation occurred,"(A): Focusing on supporting your client in expressing himself effectively as the priority because he was the party that was hurt
(B): Identifying and establishing the co-parenting goals that benefit the children and parents most
(C): Identifying and establishing ground rules for conflict resolution
(D): Supporting the client in empathizing with his ex-wife for deeper understanding of how the situation occurred",Focusing on supporting your client in expressing himself effectively as the priority because he was the party that was hurt,A,"With the focus of this session being conflict resolution, focusing only on one party would not be the most beneficial approach. The client does need to express himself effectively, but the individuals should take turns expressing themselves regarding the situation. Empathy toward his ex-wife would help the client understand what led her to talk with their children about the divorce in the manner that she did. The parents share custody of the children; therefore, they will need to work out what coparenting looks like and what their goals are as parents. Ground rules can add a framework for tough conversations and help the conversations stay on track toward resolution. Therefore, the correct answer is (C)",counseling skills and interventions
264,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ","When conducting a Mental Status Exam, the global impression (above average, average, below average) is assessing what dimension?",Intellect,Mood,Insight,Sensorium,"(A): Intellect
(B): Mood
(C): Insight
(D): Sensorium",Intellect,A,"Intellect is expressed in terms of global impression of the client's level of educational achievement. It is categorized as above average, average, or below average. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
265,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","   ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression","Using the DSM-5-TR criteria, how would you differentiate oppositional defiant disorder (ODD) from conduct disorder (CD)?","ODD includes destruction of property, while CD does not.","ODD includes cruelty to animals, while CD does not.","ODD includes conflict with authority, while CD does not.","ODD includes emotional dysregulation, while CD does not.","(A): ODD includes destruction of property, while CD does not.
(B): ODD includes cruelty to animals, while CD does not.
(C): ODD includes conflict with authority, while CD does not.
(D): ODD includes emotional dysregulation, while CD does not.","ODD includes emotional dysregulation, while CD does not.",D,"Criteria for ODD include emotional dysregulation, while CD does not. Both ODD and CD include the criterion of conflict with authority. Only CD includes the destruction of property and cruelty to animals. It is important to distinguish between ODD and CD, and the DSM-5-TR makes that distinction in the differential diagnosis section. The differential diagnosis section can be found after the diagnostic criteria, along with additional text descriptions such as diagnostic features. According to the DSM-5-TR, both conduct disorder and ODD are related to issues of behavior as it relates to conflict with figures of authority, but ODD behaviors are generally less severe than those of conduct disorder and do not target animals or property. Additionally the DSM-5-TR describes ODD to include issues with regulating emotions. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
266,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.",ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself,Which of the following assessment tools would be used to best support the diagnosis of dependent personality disorder?,Rorschach inkblot test,Likert scale,Symptom Checklist 90-Revised (SCL-90-R),Minnesota Multiphasic Personality Inventory-3 (MMPI-3),"(A): Rorschach inkblot test
(B): Likert scale
(C): Symptom Checklist 90-Revised (SCL-90-R)
(D): Minnesota Multiphasic Personality Inventory-3 (MMPI-3)",Minnesota Multiphasic Personality Inventory-3 (MMPI-3),D,"The MMPI-3 assesses for characteristics of many personality disorders including dependent personality disorder and can provide a large amount of information regarding an individual’s personality. Rorschach inkblots can be used in diagnosing dependent personality disorder; however, these tests have low reliability and validity. The SCL-90-R assesses 90 items that include (but are not limited to) depression, anxiety, poor appetite, and hostility. A Likert scale is not an assessment itself; rather, it is a way to scale a response to a question using answer options such as very likely, likely, unlikely, and very unlikely. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
267,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Which approach should be used to assess Shawn's level of commitment to his sobriety?,"""So, are we going to be drinking again or are we all done with that now?""","""Please share with me about your experience with recovery from alcohol dependence and what has motivated you to get to this point without drinking.""",Assume he is committed based on Biopsychosocial information and his presence in counseling,"""Do you feel like you want a drink right now or have you thought about drinking again?""","(A): ""So, are we going to be drinking again or are we all done with that now?""
(B): ""Please share with me about your experience with recovery from alcohol dependence and what has motivated you to get to this point without drinking.""
(C): Assume he is committed based on Biopsychosocial information and his presence in counseling
(D): ""Do you feel like you want a drink right now or have you thought about drinking again?""","""Please share with me about your experience with recovery from alcohol dependence and what has motivated you to get to this point without drinking.""",B,"Directly approaching the subject of Shawn's risk factors of alcohol use using a strengths-based approach from a non-judgmental stance is the best approach for learning more about Shawn's commitment to recovery. It is a significant factor in counseling Shawn considering he is currently in early remission, has low protective factors supporting him and that he is not in ongoing recovery support for his condition (which is highly recommended when completing addiction rehab). Furthermore, his parents referred him for counseling under this basis, so it is not presumptuous to present this to your client if it is in his best interest. Answer a is not empathic and does not demonstrate unconditional positive regard, answer b is not helpful as it is quite common for alcoholics in recovery to think often about drinking and reinforcing that factor at this time could either be triggering or shaming. Regarding answer d it is unwise to assume a level of commitment based on initial assessment information gathering. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
268,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","At the start of the session, the foster parents ask the client if she would mind meeting alone with you; she agrees and asks to have access to the toy bin in your office. You and the client begin to play together, and you ask her if she talked to her birth parents. The client says “yeah, Mommy talked about coming home in a few years.” You ask how she feels about living with her mother again, and she says she does not want to be with her because her mother does not want to be with her. You try to process this with the client, and she says that she likes her house and her school and does not want to leave. You meet with the foster parents and the client at the end of the session, and they report that spending quality time with the client on a daily basis has been helpful in improving their relationship. They state that they think they had been too afraid to overwhelm her and that at times they were trying to give her space, but they realize that the intentional time together has been helpful. You empathize with the foster parents and encourage them to continue to spend quality family time with her",Which of the following terms describes the client’s belief that “no one wants me”?,Thought stopping,Automatic thought,Schema,Transference,"(A): Thought stopping
(B): Automatic thought
(C): Schema
(D): Transference",Schema,C,"A schema is a core belief that one has about themselves based on what has happened to them. Schemas may be irrational or unhelpful at times, but a healthy schema leads to a strong sense of self-worth and self-esteem. Although cognitive therapy approaches might not be directly helpful for the client, the parents can assist in adjusting schemas. Automatic thoughts occur when a situation triggers a thought that is unconscious and can be negative or positive. Thought stopping is a technique that focuses on stopping a negative or irrational thought. Transference is when an individual redirects feelings and emotions about one individual to an entirely different individual. Transference is likely happening from the birth parents to the foster parents. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
269, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,Which of the following treatment modalities would not be recommended for Sandy?,Controlled drinking,Insight-oriented therapy,Rational-behavior therapy,Cognitive behavioral therapy,"(A): Controlled drinking
(B): Insight-oriented therapy
(C): Rational-behavior therapy
(D): Cognitive behavioral therapy",Controlled drinking,A,"Controlled drinking is an approach for those with mild alcohol problems and has been met with some controversy. In this approach an individual does not abstain from alcohol completely. Since Sandy displays more severe alcohol problems, this would not be an effective modality. Cognitive behavioral therapy focuses on modifying negative thoughts, behaviors and emotional responses associated with psychological distress which may decrease the desire to drink. Insight-oriented therapy is an approach in which one tries to understand their inner motivation for their actions. Rational behavior therapy looks at an individual's irrational or self-defeating thoughts and replaces them with positive messages. Therefore, the correct answer is (A)",treatment planning
270,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,One way to help Michael with his concern about school is to?,Speak to the parents about who is bullying him,Tell him to ignore the kids,Talk to the teacher about possibly leaving class if the tics worsen,Encourage the use of relaxation exercises in class,"(A): Speak to the parents about who is bullying him
(B): Tell him to ignore the kids
(C): Talk to the teacher about possibly leaving class if the tics worsen
(D): Encourage the use of relaxation exercises in class",Talk to the teacher about possibly leaving class if the tics worsen,C,"An appropriate intervention would be to collaborate with Michael's teacher to possibly let him leave class if the tics worsen. To tell him to ignore the kids would be difficult for Michael and doesn't really give him a tangible intervention. Speaking to the parents about who is bullying him may lead to further issues. Using relaxation exercises in class may not be a practical solution as it is a public not private setting. Therefore, the correct answer is (C)",professional practice and ethics
271, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.","Given the client's report of having skipped taking her medication for several days, which of the following actions should be taken?",Process with her the reasons she didn't take the medication and validate her reasons,Trust she already knows the implications and don't say anything that might affect rapport,Confront her irresponsibility of her own mental health and family's welfare,Educate her on the dangerous effects of missing medication dosages,"(A): Process with her the reasons she didn't take the medication and validate her reasons
(B): Trust she already knows the implications and don't say anything that might affect rapport
(C): Confront her irresponsibility of her own mental health and family's welfare
(D): Educate her on the dangerous effects of missing medication dosages",Educate her on the dangerous effects of missing medication dosages,D,"It is in your and your client's best interest to ensure your client is aware of the chemical changes that can occur in the brain when medications are inconsistently taken, and to understand how medication is no longer as effective when dosages are missed. The risk of negative consequences increases when a client lacks sufficient coping skills to accommodate a medication transition or has any history or symptoms of depression. Non-compliance with psychiatric medications is a common behavior of individuals with bipolar disorder and can further exacerbate a person's symptoms. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
272,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,Shar's symptoms meet the criteria for,Transvestic Disorder,Body dysmorphic disorder,Gender Dysphoria,Unspecified Gender Dysphoria,"(A): Transvestic Disorder
(B): Body dysmorphic disorder
(C): Gender Dysphoria
(D): Unspecified Gender Dysphoria",Gender Dysphoria,C,"Gender dysphoria is characterized by ""marked incongruence between one's experienced/expressed gender and assigned gender"" which is evident in Shar's current symptomology. In addition, they have expressed the desire to be rid of their current sex characteristics and has a strong desire to be of the other gender. The dissatisfaction of a body part in Body Dysmorphic Disorder is caused by the perception that it is abnormally formed. There is no evidence of this symptom in the facts. Transvestic disorder is characterized by sexual arousal from cross dressing. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
273,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","You meet with the client’s mother today to update the client’s treatment plan. Since the beginning of the school year, the client has been suspended for a combined total of 8 days. He has responded poorly to many of the behavioral classroom interventions. The mother has reluctantly granted the school permission to begin testing to determine if the client qualifies for an Individualized Education Program. You inform the mother of her parental rights pertaining to this process, particularly as they apply to protections against disability-related discrimination and the maximum number of disability-related suspensions. She is encouraged by the possibility of the client receiving additional supports that consider the client’s strengths and challenges.  The mother reports that she has tried to use planned ignoring when the client interrupts but reports that this behavior has actually worsened",The mother reports that she has tried to use planned ignoring when the client interrupts but reports that this behavior has actually worsened. This is likely attributed to which of the following?,Negative reinforcement,Response cost,Extinction burst,Behavioral activation,"(A): Negative reinforcement
(B): Response cost
(C): Extinction burst
(D): Behavioral activation",Extinction burst,C,"Planned ignoring involves deliberately ignoring a predetermined target behavior. In this case, the target behavior is interrupting. An extinction burst occurs when the client increases his maladaptive behavior (ie, interrupting) to gain the mother’s attention. If the mother does not consistently hold a firm boundary, the behavior is reinforced and becomes more difficult to extinguish. Behavioral activation is a cognitive-behavioral technique used to help clients initiate values-based activities to improved depressive symptoms. Negative reinforcement occurs when there is a behavioral change that happens with the removal of unpleasant stimuli. For example, a parent yells at their child to clean up, the client complies, and the negative stimulus (ie, yelling) discontinues. Response cost is a consequence-based strategy for ADHD that involves taking away token reinforcers in the presence of negative behaviors. Token reinforcers can be exchanged for preferred activities (ie, extra computer time). An example of response cost would be to remove a token each time the client interrupts. Therefore, the correct answer is (A)",counseling skills and interventions
274,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client has made steady progress toward reducing maladaptive eating. After several weeks of collecting self-monitoring data, you and the client successfully identify patterns that maintain the problem of binge eating. The client’s depressive symptoms have improved, and she is seeking interpersonal connections. She has set appropriate boundaries with her family and distanced herself from their church. The client briefly attended a more liberal church, experienced biphobia, and did not return. She explains, “In my parent’s church, I’m not straight enough. In the LGBTQ community, I’m not gay enough.” You have introduced her to dialectical behavioral therapy, and she attributes mindfulness to improved depressive symptoms.  The client reports being told, “There’s no way I’d go out with someone who is bisexual. They’d eventually leave me for someone from the opposite sex","The client reports being told, “There’s no way I’d go out with someone who is bisexual. They’d eventually leave me for someone from the opposite sex.” Which form of microaggression is represented by this statement?",Microinsult,Microassault,Microinvalidation,Microinjury,"(A): Microinsult
(B): Microassault
(C): Microinvalidation
(D): Microinjury",Microinsult,A,"There are three types of microaggressions: microinsults, microinvalidations, and microassaults. Microinsults are behaviors or comments that are not meant to be discriminatory and generally stem from a lack of awareness and/or reliance on stereotypes. Researchers show that microaggressions are usually cumulative and detrimental to the health and well-being of those who experience them. It is not uncommon for individuals who identify as bisexual to experience biphobia within LGBTQ communities. Microinvalidations occur when comments or experiences are dismissed or seen as irrelevant. Microinvalidations often stem from heterosexism. An example of a microinvalidation would be to assume a married female has a husband. Microassaults are intentionally discriminatory and include purposeful acts of insensitivity, rudeness, and intolerance. Microinjury is not identified as a microaggression. Therefore, the correct answer is (A)",core counseling attributes
275,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","    flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya",All of the following are strengths that your client has that can be helpful in making progress toward her goals EXCEPT:,Desire to learn,Perseverance,Insight,Energy,"(A): Desire to learn
(B): Perseverance
(C): Insight
(D): Energy",Energy,D,"Energy could be a strength for some clients, but due to the client’s diagnosis, it is also the part of bipolar disorder that causes impulsivity and lack of sleep and in turn impairs functioning. Due to bipolar disorder, the client is also experiencing hypersomnia during major depressive episodes; therefore, energy is not a reliable or constant state for the client. The desire to learn is helpful to the client as a student who is willing to take in and apply new information. Perseverance is also a strength because the client is going through a difficult adjustment and perseverance is the ability to push through the situation despite these difficulties. Insight is a strength because it means that the client can look inwardly and gain a deeper understanding of her thoughts, feelings, and actions. Therefore, the correct answer is (A)",treatment planning
276,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,Mark is displaying symptoms of?,Substance/Medication induced psychotic disorder,Schizoaffective,Brief psychotic disorder,Schizophrenia,"(A): Substance/Medication induced psychotic disorder
(B): Schizoaffective
(C): Brief psychotic disorder
(D): Schizophrenia",Schizophrenia,D,"Mark meets the criteria for Schizophrenia looking at his symptomology (hallucinations, sleep disturbances, incoherent speaking and writing, catatonia) and duration of onset. Brief psychotic disorder is ruled out as it is beyond the one month required timeframe. Schizoaffective disorder is also ruled out as there are no depressive or manic episodes. Substance/medication induced psychotic disorder is ruled out as there were no indications of substance use prior to the onset of the psychosis. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
277,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.  Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, ""On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life."" The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, ""Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!""    You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now.    At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her.",,You revise the client's treatment plan to include the new objectives she has mentioned. Which of the following would be an appropriate short-term goal to work on with the client?,Focus on her declining intellectual functioning,Discuss her childhood memories,Explore her relationship with her father and how it led her to the husband she chose,Explore her feelings about the divorce,"(A): Focus on her declining intellectual functioning
(B): Discuss her childhood memories
(C): Explore her relationship with her father and how it led her to the husband she chose
(D): Explore her feelings about the divorce",Explore her feelings about the divorce,D,"Although the client mentioned that she is considering joining an online dating app, she is still distraught about her impending divorce. Exploring her feelings more would be an appropriate short-term goal. Therefore, the correct answer is (B)",treatment planning
278,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.",rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives.  Client 3 is resistant to the group process,Client 3 is resistant to the group process. Which of the following would be a helpful tactic in engaging the client?,"Process with the client about his feelings by taking him aside during the session, reminding him that other group members may feel similarly.",Provide psychoeducation on the effectiveness of groups with borderline personality disorder.,Encourage client 3 and the other clients to process their hesitancy about therapy.,Use dyads to encourage the client to share his feelings with a peer.,"(A): Process with the client about his feelings by taking him aside during the session, reminding him that other group members may feel similarly.
(B): Provide psychoeducation on the effectiveness of groups with borderline personality disorder.
(C): Encourage client 3 and the other clients to process their hesitancy about therapy.
(D): Use dyads to encourage the client to share his feelings with a peer.",Use dyads to encourage the client to share his feelings with a peer.,D,"Using dyads (breaking away into groups of two to discuss prompted topics) can be helpful in this scenario because they provide the client an opportunity to speak with a peer, a context that may be more comfortable to hesitant group members than speaking to the therapist, whom they are yet to trust. Processing with the client alone may take up valuable group time, and processing with all clients about resistance might align them against the group process. Psychoeducation about groups might be helpful; however, this happened already during the start of the intake session and was not beneficial in preventing resistance for client 3. Therefore, the correct answer is (B)",counseling skills and interventions
279,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","Based on the client's ratings of herself as a parent, which of the following diagnostic criteria is she most likely exhibiting?",Affective instability due to a marked reactivity of mood,Chronic feelings of emptiness,Unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation,Persistently unstable sense of self,"(A): Affective instability due to a marked reactivity of mood
(B): Chronic feelings of emptiness
(C): Unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(D): Persistently unstable sense of self",Persistently unstable sense of self,D,"The client's ratings demonstrate a persistently unstable sense of self based on an inability to evaluate herself with respect to various characteristics that define motherhood. Her ratings do not appear to include her ongoing mood reactivity or continuing interpersonal relationships, as she rates herself as a 6-7 while engaging in risky and illegal behavior, recurrent ""blowing her top"" when her child appears bored, and continuing to have negative interpersonal relationships with her ex-husband and parents. Therefore, the correct answer is (D)",treatment planning
280,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client arrives twenty minutes late for his appointment today. He explains that Mondays are the days he does laundry, and he cannot come again on a Monday. You review the required components of informed consent with the client. He expresses an understanding of the counseling process and provides written consent. The client states he has re-considered counseling because he believes you can help him find another girlfriend who will have sex with him. You tell him about a small group you run with other neurodiverse men, most of whom are on the autism spectrum. He expresses an interest in joining after hearing that sexual intimacy would be part of the curriculum. He provides a more solid commitment when you tell him the group is not held on Mondays.  Applied behavior analysis (ABA), an evidence-based practice for individuals with ASD, relies on the principles of social learning theory","Applied behavior analysis (ABA), an evidence-based practice for individuals with ASD, relies on the principles of social learning theory. Which of the following best illustrates the four steps of social learning?","The group discusses appropriate sexual behavior, the client correctly recalls behavioral skills, the client applies the skills to a consensual relationship, and the client has sex.","The group discusses appropriate sexual behavior, the client correctly recalls behavioral skills, the client applies the skills to a consensual relationship, and the client does not have sex.","The group watches a video on appropriate sexual behavior, the client correctly recalls appropriate behavioral skills, the client applies the skills to a consensual relationship, and the client has sex.","The group watches a video on appropriate sexual behavior, the client correctly recalls the behavioral skills, the client applies the skills to a consensual relationship, and the client does not have sex.","(A): The group discusses appropriate sexual behavior, the client correctly recalls behavioral skills, the client applies the skills to a consensual relationship, and the client has sex.
(B): The group discusses appropriate sexual behavior, the client correctly recalls behavioral skills, the client applies the skills to a consensual relationship, and the client does not have sex.
(C): The group watches a video on appropriate sexual behavior, the client correctly recalls appropriate behavioral skills, the client applies the skills to a consensual relationship, and the client has sex.
(D): The group watches a video on appropriate sexual behavior, the client correctly recalls the behavioral skills, the client applies the skills to a consensual relationship, and the client does not have sex.","The group watches a video on appropriate sexual behavior, the client correctly recalls appropriate behavioral skills, the client applies the skills to a consensual relationship, and the client has sex.",C,"Developed by Albert Bandura, social learning theory is based on the premise that individuals repeat behaviors when certain conditions are met. The theory asserts that individuals grow and learn when four conditions (in order) are met: attention, retention, reproduction, and motivation. In answer C, the client attends to a video (attention), he recalls the skill (retention), he applies the skills to a consensual relationship (reproduction), and has sex (a motivating reinforcer). A group discussion does not include an observed model, making answers A and B incorrect. In answer D, the client accurately recalled and retained the information and applied the skill. The client did not have sex, which did not create motivation to continue to apply learned skills. Therefore, the correct answer is (C)",counseling skills and interventions
281,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","   eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin",All of the following are appropriate short-term treatment goals for the couple EXCEPT:,The couple will improve their quality time together in order to improve relationship satisfaction.,The couple will learn and implement effective communication skills.,The couple will identify and process areas of resentment that led to the affair.,The couple will process events leading up to the affair in order to identify problem areas in the relationship.,"(A): The couple will improve their quality time together in order to improve relationship satisfaction.
(B): The couple will learn and implement effective communication skills.
(C): The couple will identify and process areas of resentment that led to the affair.
(D): The couple will process events leading up to the affair in order to identify problem areas in the relationship.",The couple will improve their quality time together in order to improve relationship satisfaction.,A,"The couple is having difficulty with quality interaction at this point due to breakdowns in communication, so quality time would not be the focus for short-term goals. The couple does need to work on effective communication skills so they can work through what events led up to the affair and also so they can interact in a meaningful manner. The couple would also benefit from processing resentment because this is a common problem that leads to infidelity and is also a current barrier to the counseling process. Therefore, the correct answer is (C)",treatment planning
282,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group for the sixth session, and they are focused and appear to be more respectful toward you because it appears that you can get their attention more easily to start the session. You separate the group into dyads at the start of the session and prompt the group members to talk about feelings related to the pros and cons of engaging in school. You overhear client 4 telling client 3 that it does not matter if client 3 does well in school because he is in juvenile detention for sexual assault and therefore he cannot redeem himself. You intervene and remind client 4 of the group rules about respecting others.  Client 4 continues to accuse other members of the group of engaging in sinful activities and continues to be disruptive to the group process",Client 4 continues to accuse other members of the group of engaging in sinful activities and continues to be disruptive to the group process. All of the following are important considerations EXCEPT:,Considering to ask client 4 to sit silently or in the same room but not participate.,"Having a conversation with client 4 about finding a more appropriate group during the session because it can be a good moment to teach other group members what is tolerable in the group, especially considering the detention setting.",Whether significant attempts have been made to redirect client 4 and to reinforce group rules.,"If client 4 is actively causing harm to others, you can ask him to leave the group immediately without a discussion.","(A): Considering to ask client 4 to sit silently or in the same room but not participate.
(B): Having a conversation with client 4 about finding a more appropriate group during the session because it can be a good moment to teach other group members what is tolerable in the group, especially considering the detention setting.
(C): Whether significant attempts have been made to redirect client 4 and to reinforce group rules.
(D): If client 4 is actively causing harm to others, you can ask him to leave the group immediately without a discussion.","Having a conversation with client 4 about finding a more appropriate group during the session because it can be a good moment to teach other group members what is tolerable in the group, especially considering the detention setting.",B,"The client has been causing significant disruptions that have affected other group members, and you need to address this after the group with the client. If you plan to address the client’s disruptions and his need to be in another group provided by the facility, you do not want to do this in front of the other clients because this would present a power struggle in front of the others. It is important to consider your attempts at redirection and enforcing rules in order to assess and adjust your interventions. If the client is actively causing harm, you need to protect your other clients, which may involve ejecting the member from the group immediately or asking them to sit silently for the rest of the session. Although ejecting the client may affect his sentence, this was a decision that the client made, and attempts to refer to another group or problem-solve can be done after the group. Therefore, the correct answer is (B)",counseling skills and interventions
283,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises.  Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable.    You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times.    After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client.  Ninth session The client's parents were elated to see their daughter make significant progress in her reading at school. After careful consideration and collaboration between you, the client, her teachers, and the paraprofessional, the team has all devised a treatment plan tailored specifically to her needs. Incorporating a small group setting provided the client with the individualized attention she needed to become successful in her reading skills.    As the session came to an end today, it was clear that both the client and her parents were satisfied with the results of their hard work. To ensure that they felt comfortable moving forward and everybody was on the same page, you asked them, ""What I hear you saying is that you feel as though your daughter has met her educational goals and has the support to continue to succeed? Is that correct?"" Both of them smiled knowingly and nodded affirmatively.    With a sense of closure now achieved by this family team, the parents left feeling confident about continuing on this path towards helping their daughter reach success with reading deficits. Together they had created a practical plan which could be adapted as necessary along the way, one which would pave a brighter future for the client."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What are you attempting to do by summarizing what the client's parents told you during the session?,Decrease their anxiety,Determine the extent of their daughter's learning disability,Identify discrepancies and conflict,Allow them an opportunity to clarify any misconceptions,"(A): Decrease their anxiety
(B): Determine the extent of their daughter's learning disability
(C): Identify discrepancies and conflict
(D): Allow them an opportunity to clarify any misconceptions",Allow them an opportunity to clarify any misconceptions,D,"Summarizing serves several purposes. It presents the client with an opportunity to clarify any misconceptions that you have about them; it acts as a spring board to explore additional topics; and it helps to sum up the main points of what a person has been talking about. Therefore, the correct answer is (B)",counseling skills and interventions
284,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.  10th session During your last session with the client, she discussed the anxiety that she was feeling about going home for winter break in a few weeks. She told you that her mom and stepdad always prepare a large meal for the holidays, and the extended family members get together to eat. She expressed a desire to participate in the family festivities but concern about her mom and stepdad's lack of understanding about her illness. She told you, ""I don't want to make anyone feel bad, but I just can't eat like everyone else. It's not only the food - it's the conversations and comments about my body that really bother me."" You listened as she expressed her fear of disappointing her family and reassured her that is was okay to set boundaries and have conversations about food. Together, you brainstormed coping strategies to manage her anxiety. You also suggested that she bring a dish of food that she would be comfortable eating to the winter break gathering. At the end of the session, she asked if she could bring her parents to the next session in an effort to gain their support and to help them understand what she is going through. You agreed to her request and scheduled an appointment to meet with the client and her parents.    At the start of today's session, you introduce yourself to her parents and explain your role in helping their daughter. The client's mother tearfully shares that she had no idea her daughter was struggling so much and that she wishes she had picked up on the signs sooner. The stepfather appears quiet and reserved. You help guide a conversation between the client and her parents about her eating disorder and symptoms that she is experiencing. The client shares her fears, triggers, and struggles around food. Her stepfather speaks up and says, ""I've heard enough. This is just ridiculous. You should just be able to eat, like everyone else. Your generation has gone 'soft' and started making up problems. There are people out there who don't have any food. When I was growing up, we had nothing. Your behavior is disrespectful."" As he is talking, the client's mother is quiet and visibly uncomfortable. The client interjects, ""Are you kidding? I'm the one who's being disrespectful?"" She looks toward you and says, ""When I'm home, he cooks these extravagant meals and refuses to let me leave the table until I've eaten what he's served me because it's 'wasteful to throw away food.' It's abuse! I feel like a captive when I'm at home."" She looks back at her stepfather and says, ""All I'm asking is that you understand what I'm going through and try to be a little more supportive."" The stepfather's face turns red with anger, and he gets up to leave the room. You intervene and ask him to stay, offering a suggestion that you all take a few moments to reflect on what each person has shared before continuing the conversation. While the stepfather takes a break, you encourage the mother to open up and express her feelings. She reveals that she is scared of not being able to help her daughter and feels helpless in understanding how to come together as a family. You discuss ways that she can be supportive and provide an empathetic environment for her daughter.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","As the therapist, which of the following ethical principles is most relevant to consider in your decision about whether to report the stepfather's abusive behavior?",Nonmaleficence - avoiding causing harm by acting (or failing to act) that damages the client.,Beneficence - acting in the best interest of the client's health and empowerment.,Autonomy - respecting the client's capacity for self-determination.,Justice - treating people equitably and distributing benefits/burdens fairly.,"(A): Nonmaleficence - avoiding causing harm by acting (or failing to act) that damages the client.
(B): Beneficence - acting in the best interest of the client's health and empowerment.
(C): Autonomy - respecting the client's capacity for self-determination.
(D): Justice - treating people equitably and distributing benefits/burdens fairly.",Nonmaleficence - avoiding causing harm by acting (or failing to act) that damages the client.,A,"Nonmaleficence speaks directly to the therapist's duty to report abuse/maltreatment to authorities to protect the client from harm. This duty supersedes other principles. Therefore, the correct answer is (C)",professional practice and ethics
285,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Which intervention should be used to immediately address Nadia's risk-taking behavior and aggression toward others?,Psychoanalysis,Psychoeducation,Crisis planning,Life skills development,"(A): Psychoanalysis
(B): Psychoeducation
(C): Crisis planning
(D): Life skills development",Crisis planning,C,"Crisis planning is important regarding her risk-taking behavior and aggression towards others and is helpful to use when Nadia starts to decompensate. Psychoanalysis would not be the best treatment in this case as psychoanalysis is a longer-term treatment and Nadia is requiring more immediate symptom relief. Psychoeducation may be beneficial for Nadia to understand her symptoms of disassociation as well as how her past trauma can affect the types of relationships she seeks. However, this is not as immediate as a crisis plan. Finally, life skills development is important to improve her adaptive functioning but is a longer-term intervention. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
286,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","   mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic",Which one of the following would be the most appropriate frequency for sessions based on the client’s present suicidal ideation?,Weekly,Fortnightly (every other week),Twice weekly,Daily,"(A): Weekly
(B): Fortnightly (every other week)
(C): Twice weekly
(D): Daily",Twice weekly,C,"It is important to provide frequent sessions to this client at this point in treatment due to his reported suicidal ideation. Because the client’s risk appears moderate due to the presence of suicidal ideation with no current intent or plan, seeing him twice weekly would be most appropriate. Weekly and fortnightly (every other week) sessions might not provide the oversight and guidance needed to stabilize the client. Daily sessions would be more appropriate in the presence of intent, and it would likely not be possible due to insurance not covering that frequency of sessions. Requiring daily sessions would also indicate severe risk and, therefore, the need for a higher level of care such as hospitalization. Therefore, the correct answer is (B)",treatment planning
287,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.",Which of the following will be most appropriate to process during this session?,The client's presentation and link to a personality disorder diagnosis,New treatment goals as the client demonstrates more patience with her child,The symptoms of schizophrenia as compared to the client's presentation,The client should consider forming a new support group as her friend is not supportive,"(A): The client's presentation and link to a personality disorder diagnosis
(B): New treatment goals as the client demonstrates more patience with her child
(C): The symptoms of schizophrenia as compared to the client's presentation
(D): The client should consider forming a new support group as her friend is not supportive",The symptoms of schizophrenia as compared to the client's presentation,C,"The client's concerns about depression are linked to her worries about ending up with schizophrenia, like her mother. It will be most helpful for the counselor and the client to review the signs and criteria for schizophrenia in comparison with the client's symptoms to ease her anxiety. It would not be appropriate to suggest the client form a new support group at this time because the client is already overwhelmed. The counselor has not observed her friend and does not know if the client misperceives her friend's help or that the friend's way of helping is not effective for this client. The client is demonstrating appropriate care and patience for her child during the session. This does not mean that she has been able to modify her emotions and behavior to maintain this change and therefore the goal is not met until that occurs. This would not be the appropriate time to talk about the counselor's suspicions that the client may exhibit traits consistent with a personality disorder because the client is concerned about a possible schizophrenia diagnosis (being ""seen as crazy""). Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
288,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.  Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, ""I can't do this. You tell them."" Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents.    You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, ""We know that something is going on."" He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, ""We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl."" You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her.    The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that ""did this to our daughter."" The initial conversation is difficult, but you provide support as the family talks through their feelings.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","The client and her parents have shown evidence of a longer-term relationship issue, suggesting that outside insight could be of value. Which referral would be most appropriate for this client and her parents?",The family's pastor,A community social worker,The family physician,A psychiatrist,"(A): The family's pastor
(B): A community social worker
(C): The family physician
(D): A psychiatrist",The family's pastor,A,"Given the family's often expressed connection with their church, their pastor could offer contextualization that the parents can relate to in accepting their daughter's condition. Therefore, the correct answer is (C)",professional practice and ethics
289,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.","Considering the information provided, which is the best question to ask when setting treatment goals for the client?",What are some things that make you feel impatient and angry?,How would you know if you were more patient and less angry?,What do you think would make you more patient and less angry?,Have you ever been more patient and less angry?,"(A): What are some things that make you feel impatient and angry?
(B): How would you know if you were more patient and less angry?
(C): What do you think would make you more patient and less angry?
(D): Have you ever been more patient and less angry?",How would you know if you were more patient and less angry?,B,"When setting goals, it is important for the client to determine what it would look like if their goal was met. Having the client identify how she would know if she was more patient and less angry allows the counselor and client to develop goals that are specific, realistic, and achievable. Asking the client what would make her more patient and less angry is not helpful because if she knew this answer or could achieve it on her own, she would not be seeking help. Asking her to identify some things that make her feel impatient and angry is a helpful question when setting up objectives and interventions so that the counselor and client can choose specific areas to focus on during counseling. Asking the client whether there has been a time where she has been more patient and less angry can help the client and counselor determine if the client needs to build new skills to reach this goal or whether the client has possessed these skills in the past and needs to remember how to use them. This is an important part of planning interventions, but not an important part of setting the treatment goal. Therefore, the correct answer is (C)",counseling skills and interventions
290,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,"All of the following statements are in accordance with the standards of the Code of Ethics regarding couple counseling, except?",Counselors seek agreement and document in writing such agreement among all parties regarding the confidentiality of information,"If one part of the couple is absent for a session, individual confidentiality standards apply.","In couples and family counseling counselors clearly define who is considered ""the client"" and discuss expectations and limits of confidentiality","In the absence of an agreement to the contrary, the couple or family is the client","(A): Counselors seek agreement and document in writing such agreement among all parties regarding the confidentiality of information
(B): If one part of the couple is absent for a session, individual confidentiality standards apply.
(C): In couples and family counseling counselors clearly define who is considered ""the client"" and discuss expectations and limits of confidentiality
(D): In the absence of an agreement to the contrary, the couple or family is the client","If one part of the couple is absent for a session, individual confidentiality standards apply.",B,"It is up to the discretion of the counselor to determine if an individual should be seen when their partner is absent. All appropriate information which is shared during the individual session should be shared in the next session with all parties present. Choices A, B and C are all legitimate standards under the American Counseling Association Code of Ethics regarding couple counseling. It is imperative that at the onset of counseling a counselor defines who the client is as well as the limits to confidentiality. This information should be memorialized. If a single client is not identified, the couple is considered the client. Therefore, the correct answer is (D)",counseling skills and interventions
291,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.  Seventh session It has been almost two months since you began therapy with the client. You suggested a session in which both she and her mother were present to discuss the client's progress. She presents to today's session with her mother. The client followed up with your referral from a previous session for her to see a psychiatrist and has provided you with a release of information to communicate with her psychiatrist. The client has been prescribed an antidepressant and says she does not feel any notable change yet but the psychiatrist told her it would take a few weeks to know if the medication was working. The mother states that since her daughter started taking the antidepressant, she is sleeping more than usual and struggles to get out of bed. She has been late to school several times. She is also having trouble with motivation. You reflect the client's current state and suggest she establish a daily routine to gain a sense of control in her life. You discuss the importance of making small achievable goals and explain that taking on too much can be overwhelming, so it is more beneficial to focus on one task at a time. The mother begins listing off potential activities that her daughter should take part in. The client closes her eyes and begins to sigh. When you ask her about her reaction, she says, ""See, yet another example of my mom trying to control everything."" The mother responds by saying, ""I'm not trying to control you. Believe it or not, I just want what's best for you!""    Understanding the tension between them, you suggest a compromise. You explain that if the client completes one activity each day, her mother will not pressure her to do more. The client appears hesitant but agrees to try it out. You then turn to the mother, thanking her for being willing to compromise and understanding. You encourage them to be patient with one another and remind them that progress takes time. You suggest they continue to have regular check-ins so that each party is aware of how the other is doing in following through on the agreement. You end the session by summarizing what was discussed, reinforcing the importance of communication between the client and her mother.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ","You suggested that the client establish a daily routine to gain a sense of control in her life. Of the listed activities, which would be the best to recommend she start doing each day after school?",Share her feelings with her mother,Draw a picture that represents her feelings,Have a time of meditation,Journal her feelings and experiences,"(A): Share her feelings with her mother
(B): Draw a picture that represents her feelings
(C): Have a time of meditation
(D): Journal her feelings and experiences",Draw a picture that represents her feelings,B,"Since the client has had difficulties integrating her feelings, this exercise will help her maintain a sense not only of structure but of continuing integration. Therefore, the correct answer is (C)",counseling skills and interventions
292,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","   iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents",All of the following are considered a differential diagnosis for oppositional defiant disorder EXCEPT:,Attention-deficit/hyperactivity disorder,Social anxiety disorder,Disruptive mood dysregulation disorder,Generalized anxiety disorder,"(A): Attention-deficit/hyperactivity disorder
(B): Social anxiety disorder
(C): Disruptive mood dysregulation disorder
(D): Generalized anxiety disorder",Generalized anxiety disorder,D,"Generalized anxiety disorder would not be considered a differential diagnosis because anxiety about everyday situations does not generally lead to defiance to authority. Attention-deficit/hyperactivity disorder would be considered a differential diagnosis if failure to conform to requests of others occurs in situations that require sustained attention. Disruptive mood dysregulation disorder also presents as negative mood and temper outbursts, but these are often much more intense than in oppositional defiant disorder. Social anxiety disorder can be considered if the defiance occurs because of the fear of judgment and negative evaluation of others. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
293,Initial Intake: Age: 68 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African-American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”",Which of the following will help the client identify barriers to attaining his goals?,Processing the importance of antidepressants instead of a depressant like alcohol,Processing how difficult it is to stop using the amount of alcohol he drinks,Processing his ability to meet his wife's needs as her health continues to decline,Processing the unconscious benefits the client gets from his depression,"(A): Processing the importance of antidepressants instead of a depressant like alcohol
(B): Processing how difficult it is to stop using the amount of alcohol he drinks
(C): Processing his ability to meet his wife's needs as her health continues to decline
(D): Processing the unconscious benefits the client gets from his depression",Processing the unconscious benefits the client gets from his depression,D,"Secondary gains are the conscious or unconscious benefits that individuals get from their current way of responding to life. In this case, the client may continue to use ineffective coping skills because it is comfortable and familiar to him rather than experiencing the discomfort of change. Secondary gains include the interpersonal or social advantages that an individual may consciously or unconsciously experience because of their own illness or, in this case, the client's role as caregiver for his parents and now his wife. Identifying secondary gains is critical to determining if a client is willing to give these up to meet their stated goals. The difficulty the client will have in stopping his alcohol use may be a barrier for the client, not because of the amount he drinks, but because he uses it as a coping strategy. He has previously demonstrated the ability to stop drinking when he chooses and has noted the improvement in his thoughts and emotions. Processing the importance of antidepressants is not helpful for the client as he has previously stated his refusal to use antidepressants. Focusing on his ability to meet his wife's needs as her health declines is most likely to cause the client greater stress and increase his depressive symptoms, which will create a barrier to meeting his goals, rather than identifying the current barriers. Therefore, the correct answer is (C)",counseling skills and interventions
294,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","   age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement",Which of the substance abuse interventions offers a parent training component to reinforce drug-incompatible behaviors at home?,Motivational enhancement therapy (MET),Cognitive-behavioral therapy (CBT),Contingency management therapy (CM),Multi-systemic therapy (MST),"(A): Motivational enhancement therapy (MET)
(B): Cognitive-behavioral therapy (CBT)
(C): Contingency management therapy (CM)
(D): Multi-systemic therapy (MST)",Contingency management therapy (CM),C,"Contingency management (CM) is an evidence-based practice with a parent training component. CM works by using behavioral modification strategies, including positive reinforcement, negative reinforcement, positive punishment, and negative punishment. The goal is to reinforce abstinence-related behaviors (eg, negative drug screen) by offering low-cost vouchers or incentives. Motivational enhancement therapy is an evidence-based practice for substance abuse used to increase change talk by reducing ambivalence. Cognitive-behavioral theory is also an evidence-based practice that challenges distorting thinking and encourages healthy coping strategies. Multi-systemic therapy is a comprehensive in-home intervention for teens involved in the criminal justice system. It is a community-based, intensive intervention to assist families with collaboration with multiple systems, including schools, courts, and other community locations. Therefore, the correct answer is (D)",treatment planning
295,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",What should be your first order of business in addressing Shania's needs?,Scheduling psychiatric appointment for youngest daughter,Developing treatment plan goal for SI,Applying for government assistance,Reporting suspected child abuse,"(A): Scheduling psychiatric appointment for youngest daughter
(B): Developing treatment plan goal for SI
(C): Applying for government assistance
(D): Reporting suspected child abuse",Reporting suspected child abuse,D,"As a counselor you cannot ignore a report of child abuse. Even if the child is in another state, if you can obtain enough information to file a report with that state's department of child and family services, they can begin an investigation to ensure the child's safety. After this has been prioritized, you can continue to address Shania's and her family's needs. Therefore, the correct answer is (A)",professional practice and ethics
296,Initial Intake: Age: 68 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African-American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”",Which of the following will be most beneficial to help the client access the self-care he needs?,Invite the client's wife to session so you can help her understand why respite care is needed,Go with your client to a residential respite care facility to help him determine which one to use,All of the above,Provide psychoeducation on the concepts of boundaries and how to implement them,"(A): Invite the client's wife to session so you can help her understand why respite care is needed
(B): Go with your client to a residential respite care facility to help him determine which one to use
(C): All of the above
(D): Provide psychoeducation on the concepts of boundaries and how to implement them",Provide psychoeducation on the concepts of boundaries and how to implement them,D,"Teaching the client about the concepts of boundaries will be helpful for him in setting his own boundaries for self-care and in determining what he is able to do for his wife and what he cannot. Learning to set and maintain boundaries will help the client feel less ""stuck"". Inviting the client's wife to the session, even with the client's permission, is not likely to be beneficial as there is no established trust or therapeutic relationship between the counselor and the client's wife. His wife may feel attacked or ganged up on if the counselor advocates for respite care. It would not be unusual for a client to need support in choosing a respite care, however it would be unprofessional for the counselor to accompany the client to help him determine which facility is best. Accompanying him may breach the ethical principles of autonomy (right to self-determination or choice) and nonmaleficence (refraining from taking action that might harm another). Therefore, the correct answer is (B)",counseling skills and interventions
297, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.","As you are concluding your conversation with Avery's parents, they ask if you can also treat his twin brother Marc, who has autism spectrum disorder and is non-verbal. You should reply?","""It is unethical to provide counseling for a family member of an existing client.""","""I can't treat him or help you with that, but Google some local autism resources.""","""I am happy to conduct an assessment, but I also might refer you to an ABA Specialist.""","""Of course I can treat him! Let me check my calendar and we will get him right in!""","(A): ""It is unethical to provide counseling for a family member of an existing client.""
(B): ""I can't treat him or help you with that, but Google some local autism resources.""
(C): ""I am happy to conduct an assessment, but I also might refer you to an ABA Specialist.""
(D): ""Of course I can treat him! Let me check my calendar and we will get him right in!""","""I am happy to conduct an assessment, but I also might refer you to an ABA Specialist.""",C,"It is best practice to offer or assess each client on your own prior to agreeing to or denying services. To better understand Marc's needs, conducting an assessment can help you to rule out which conditions you can or cannot support. You should also prepare your clients to know that external support from other specialists might be an option you provide depending on the client's needs that may be outside of your scope of practice. It is not unethical to treat more than one member of the same family depending on the circumstances and situation, specifically when it comes to child siblings; often the parents of children in counseling will prefer the same counselor to meet with their different children and resolve family dynamics issues and provide insight to the parent. The situation must be screened for boundary issues and unethical dual relationships or roles. Answer d) sounds supportive and encouraging but could be giving a family false hope if agreeing to provide services without properly screening through initial assessments. Therefore, the correct answer is (A)",treatment planning
298,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.","After the first session, what should be your next steps in counseling Melanie?",Conduct an intervention immediately and refer to an inpatient rehabilitation facility,Conduct evidence-based substance use assessment screenings,Engage Melanie in discussing her use further using MI and evidence-based screening tools,Align with her empathically and refer her to a 12-Step program in her area,"(A): Conduct an intervention immediately and refer to an inpatient rehabilitation facility
(B): Conduct evidence-based substance use assessment screenings
(C): Engage Melanie in discussing her use further using MI and evidence-based screening tools
(D): Align with her empathically and refer her to a 12-Step program in her area",Engage Melanie in discussing her use further using MI and evidence-based screening tools,C,"While it may seem pertinent to conduct an intervention and refer to a rehabilitation facility, only through a thorough and detailed inventory of the type, amount, frequency, and consequences of Melanie's substance use, followed by an understanding of her perception of her usage and level of readiness to change can you make an educated next step in response to her reported legal use of marijuana. Cannabis is considered by the FDA as a schedule I drug with no accepted medical purpose and a high potential for abuse. If you feel uncomfortable or untrained in performing official screening tools, using basic counseling interventions such as Motivational Interviewing (MI) to have Melanie provide more details would be sufficient prior to considering a referral to a detox or rehab facility or even to an interventionist. Based on Melanie's denial, it is unlikely she is in a stage of change willing to undergo treatment for marijuana use and it is presumptuous to consider it the primary cause of her problems without learning more. Therefore, the correct answer is (D)",counseling skills and interventions
299,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",Which assessment instrument would be most appropriate to further evaluate the client's symptoms?,Children’s Depression Inventory (CDI),Children's Apperception Test (CAT),Adolescent Problem Severity Index,Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR),"(A): Children’s Depression Inventory (CDI)
(B): Children's Apperception Test (CAT)
(C): Adolescent Problem Severity Index
(D): Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR)",Children’s Depression Inventory (CDI),A,"The Children’s Depression Inventory (CDI) is a widely used tool to help assess the level of depressive symptoms in children and adolescents, age 7-17 years old. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
300, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,"If the counselor responds, ""So, you are not eating because it is too painful to go into the kitchen and cook for yourself and not because of a loss of appetite?"" This is an example of what counseling skill?",Reflection of feelings,Open ended questions,Clarification,Confrontation,"(A): Reflection of feelings
(B): Open ended questions
(C): Clarification
(D): Confrontation",Clarification,C,"The counselor is demonstrating the skill of clarification. The purpose of clarification is to make sure that the counselor understands the situation correctly. In this situation, the counselor is trying to determine the reason behind Theodore's significant weight loss which will also aid in the formulation of the diagnosis. A reflection of feelings would focus on the how being in the kitchen makes Theodore feel. Confrontation is not a confrontation between the client and counselor, it occurs within the client through self-examination. The question can be answered with a yes or a no, therefore it is not an open-ended question. Therefore, the correct answer is (B)",counseling skills and interventions
301,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling.  Which of the following best explains the parents’ emotional expression (e\. g","Which of the following best explains the parents’ emotional expression (e.g., criticism, anger) when interacting with the client?",Fundamental attribution error,The Dunning-Kruger effect,External locus of control,Self-serving bias,"(A): Fundamental attribution error
(B): The Dunning-Kruger effect
(C): External locus of control
(D): Self-serving bias",Fundamental attribution error,A,"Families high in emotional expression ascribe symptoms of mental disorders to internal attributes (eg, personality, intentionality). The fundamental attribution error occurs when people overemphasize personality traits and disregard situational or external explanations for behavior. Psychoeducation for families high in emotional expression uses a revised attribution model to help families shift from attributing behavior to personality towards attributing behavior to illness. Self-serving bias occurs when individuals assume personal success related to internal attributes and personal failures are related to external attributes. Individuals with an external locus of control believe that luck, environment, or other external features serve as explanations for events or outcomes. The Dunning-Kruger effect occurs when there is an overestimation of personal knowledge and skills due to an inaccurate self-appraisal. Therefore, the correct answer is (D)",counseling skills and interventions
302, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.","Leah tells you she feels ready to process her past, but whenever you ask her to share about her trauma experiences, she ends up resisting due to her disbelief that you are qualified to help her. How should you proceed?","Re-label her reason for resistance as ""fear""",Review your credentials and experience,Present the dilemma as only her decision to resolve,Suggest that you refer her out,"(A): Re-label her reason for resistance as ""fear""
(B): Review your credentials and experience
(C): Present the dilemma as only her decision to resolve
(D): Suggest that you refer her out",Present the dilemma as only her decision to resolve,C,"Placing this conflict in Leah's hands empowers her to decide whether she wants to address her trauma with you, discuss other areas only, or see a new professional. Offering a referral to a higher-level professional may not be what Leah needs, and may be seen as ""giving up"" on her or ""rejection""; quite possibly even seen as conceding to her claims that your credentials are not sufficient to treat her effectively. Recall that she has previous abandonment issues from her divorce; perhaps what will help Leah in multiple areas of her personality development is for you to remain in place unless she makes the request for another counselor. Answer b) can be seen as invalidating to her reported concerns or cause her to feel defensive if she is still not respecting your clinical perspective, although can be a good intervention to use once Leah is invested in sharing with you further. Answer c) is unnecessary unless she asks, and even then, removes the clinical focus from your client. Therefore, the correct answer is (D)",counseling skills and interventions
303,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",Which assessment tool would you use to screen for Attention-Deficit/Hyperactivity Disorder?,Ages and Stages Questionnaire,Auditory Continuous Performance Test,Autism Rating Scale,Attachment Diagnosis Assessment,"(A): Ages and Stages Questionnaire
(B): Auditory Continuous Performance Test
(C): Autism Rating Scale
(D): Attachment Diagnosis Assessment",Auditory Continuous Performance Test,B,"The Auditory Continuous Performance Test determines ADD/ADHD by assessing auditory attention deficit. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
304,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community.  When the client recounts the incident with her two sons in the park, you remain open to the client’s underlying experiences in the present moment and respond authentically","When the client recounts the incident with her two sons in the park, you remain open to the client’s underlying experiences in the present moment and respond authentically. This is an example of which one of the following?",Providing congruence,Shaping competence,Increasing differentiation,Supplying positive reinforcement,"(A): Providing congruence
(B): Shaping competence
(C): Increasing differentiation
(D): Supplying positive reinforcement",Providing congruence,A,"You are providing congruence by remaining open to the client’s underlying experiences in the present moment and responding authentically. Congruence (or genuineness) is expressed when counselors accurately attend to the interpersonal and intrapersonal aspects of the therapeutic relationship. Counselors need to be mindfully aware of their own intrapersonal experiences to skillfully respond to the client’s experiences (ie, the interpersonal facet). Increasing differentiation is a Bowenian family therapy technique. Bowen believed that optimal family functioning occurs with healthy boundaries or differentiation. Shaping competence is a technique used by structural family therapists when emphasizing the positive behaviors of family members. Positive reinforcement is a behavior modification technique used to increase desired behaviors. Therefore, the correct answer is (D)",counseling skills and interventions
305,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client contacted you to reschedule a session sooner than the one you had originally scheduled. The client reported that he continues to have difficulty getting to work on time and was told that he needs to meet with his supervisor on Friday. The client expresses anxiety surrounding this because he worries about getting fired. The client began to cry during the session when talking about worry regarding being unemployed. The client came to the session in clothes that had stains on them, and his hair was messy and appeared greasy.  During the session, the client states, “Why should I even try to get to work on time? I’m just going to get fired anyway","During the session, the client states, “Why should I even try to get to work on time? I’m just going to get fired anyway.” Which one of the following would be the most accurate cognitive distortion to describe this statement?",Labeling,Overgeneralization,Emotional reasoning,Jumping to conclusions,"(A): Labeling
(B): Overgeneralization
(C): Emotional reasoning
(D): Jumping to conclusions",Jumping to conclusions,D,"This client is jumping to conclusions with this statement because he has deduced what is going to happen with little evidence. This cognitive distortion could negatively affect his work performance. Emotional reasoning involves using a feeling to determine reality, which would not characterize the thinking reflected in his statement. Labeling occurs when an individual makes an evaluation of value based on a situation. Overgeneralization is taking a single experience and applying it to other experiences. Therefore, the correct answer is (D)",counseling skills and interventions
306,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,Possible stand-alone treatment modalities for Tony to work in with this individual therapist include all of the following except?,Aversion therapy,Sex therapy,CBT,Medication,"(A): Aversion therapy
(B): Sex therapy
(C): CBT
(D): Medication",Medication,D,"Medication alone will not be effective in treating Tony's symptoms. Medication in conjunction with the other modalities mentioned has been proven effective in treating transvestic disorder. A sex therapist has expertise in this area and may use cognitive behavioral therapy to examine Tony's thoughts which lead him to cross dress. Aversion therapy uses classical conditioning to deter unwanted behaviors. Therefore, the correct answer is (D)",treatment planning
307,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""  Fourth session The client has been ""looking forward to working with you"" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is ""hard on her.""    She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father.  Ninth session The client has reported increased dysphoria due to persistent bullying and lack of support at school. As a result, she has noted an increase in negative self-talk and feelings of worthlessness. She has also reported increased feelings of isolation, as she does not have any friends she can confide in or turn to for support. The client has also expressed that her home environment is still difficult, as her father has not entirely accepted her gender identity, leaving her feeling unsupported. The client has further said that she does not feel safe or secure at school and feels uncomfortable seeking help from her peers.    The client has further reported that her emotional regulation has been difficult. She finds herself becoming overwhelmed and frustrated more quickly than before. She has also noted difficulty concentrating on tasks and completing schoolwork. Her mood has become increasingly labile, and she has experienced more frequent thoughts of self-harm and has expressed that she doesn't know how to cope with her emotions.    The client's mental health has also been deteriorating. She has reported increased symptoms of depression and anxiety. She has difficulty sleeping, often unable to fall asleep or only sleeping for short intervals. She has been experiencing intrusive thoughts, racing thoughts, and difficulty focusing on tasks. She has also been avoiding social situations and expressed that she feels uncomfortable around people due to her negative self-image.    She does like the school psychologist but needs help setting up a meeting. You intend to reach out to the school psychologist to expand the continuum of care.","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ",What is the first step in collaborating with the school psychologist?,Explain to the parents why expanding the child's continuum of care would be crucial for her treatment.,Email the school psychologist to complete a release of information (ROI),Request consent from the parents to contact the school psychologist.,Provide the parents with a release of information,"(A): Explain to the parents why expanding the child's continuum of care would be crucial for her treatment.
(B): Email the school psychologist to complete a release of information (ROI)
(C): Request consent from the parents to contact the school psychologist.
(D): Provide the parents with a release of information",Request consent from the parents to contact the school psychologist.,C,"This allows the client and her parents to decide whether or not to coordinate treatment as well as whether or not confidential information is to be shared. Therefore, the correct answer is (C)",professional practice and ethics
308,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.","You and the client meet 4 days after the initial intake session due to truancy because she has missed several days of school. For about half of the session, the client seems to be withdrawn. She asks you what you are required to report, and you remind her of the limits of confidentiality. The client says that she understands, and then says she is going to talk about what happened anyway. She says that her volleyball coach asked to meet with her after practice about 7 months ago and when she entered his office, he asked to look at her right thigh following a fall during practice. She continues to state that when she showed him, he started to touch her genital area from the outside of her pants. She states that she ran out of the room and went home. She explains that after this event she quit the team and told her parents that she did not want to play anymore, but recently she has started to experience distressing memories of the sexual abuse; she refuses to go to school because she would see the man daily; she has difficulty feeling happiness; and she is experiencing feelings of shame, insomnia, and difficulty concentrating. You praise the client for disclosing this information and empathize with her about how hard it must have been to share this experience.  You are having difficulty disconnecting from the session today",You are having difficulty disconnecting from the session today. What is the LEAST helpful self-care technique for you to actively manage your emotions?,Go home and go to sleep.,Seek clinical supervision.,Spend time with friends after work.,Go to the gym and exercise for an hour.,"(A): Go home and go to sleep.
(B): Seek clinical supervision.
(C): Spend time with friends after work.
(D): Go to the gym and exercise for an hour.",Go home and go to sleep.,A,"Going home and going to sleep may meet physical needs for sleep if work is overwhelming; however, it may not meet your self-care needs because you are having trouble refraining from thinking about your session today. Going to sleep does not deal with the emotions that are present and therefore would not be managing your reaction to the session. Exercise, clinical supervision, and socialization could all be beneficial acts of self-care to help you focus on the present and manage your thoughts regarding your client’s situation. Therefore, the correct answer is (D)",professional practice and ethics
309,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The client arrives for the session without her husband. Her affect is flat, and she presents as more subdued. The client explains that she has been in bed for the last 4 days, which has caused escalated conflict and tension with her husband. She says that her husband believes that they are at an impasse and threatened to leave during their fight last night. When processing the details of their altercation, the client states that her fear of being alone has become unbearable. She denies any suicidal plans but says she feels hopeless and void of purpose and is in significant levels of physical pain due to intractable migraines. You conduct a suicide risk assessment to determine the client’s level of safety",You ask the client “What are your reasons for living?” What are you are trying to determine with this question?,The level of marital distress,Protective factors,The appropriate level of care,Religious or spiritual support,"(A): The level of marital distress
(B): Protective factors
(C): The appropriate level of care
(D): Religious or spiritual support",Protective factors,B,"You are trying to determine the client’s protective factors. Protective factors mitigate suicide risk and include coping skills, social support, religious beliefs, and restricted access to lethal means. The client’s level of marital distress is a risk factor that has already been determined. Religious or spiritual support is one example of a protective factor; however, the question is posed to help determine all protective factors. This question is one of a series of questions posed as part of a suicide risk assessment, which helps guide recommendations for an appropriate level of care (eg, outpatient, inpatient, residential). Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
310,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client attends group therapy and is making therapeutic gains. Her overall anxiety has decreased, and she is engaging in more constructive thinking. Today is week 6 out of the 12 scheduled weekly group sessions. The client continues to work on increasing her assertiveness and has become less tentative with self-disclosures. She is pleasant and cooperative but remains eager to please others. Three group participants have formed a subgroup (i\. e., clique) and have excluded others. The client has begun to take social risks, and today she shares about a time when she felt most anxious. You notice the subgroup whispering and laughing after her disclosure. She nervously turns to you to gauge your response",How should you respond to the negative interactions between the client and the members of the subgroup?,Use linking to help the client recognize similar feelings that she experienced in her past.,Evoke universality by asking the client to share how the experience has made her feel.,Impart information by offering your interpretation of the interaction.,Block the negative behavior and reestablish protective norms.,"(A): Use linking to help the client recognize similar feelings that she experienced in her past.
(B): Evoke universality by asking the client to share how the experience has made her feel.
(C): Impart information by offering your interpretation of the interaction.
(D): Block the negative behavior and reestablish protective norms.",Block the negative behavior and reestablish protective norms.,D,"The best response to the negative interaction is to block the negative behavior and reestablish protective norms. It is important to note that the group is in the storming stage of development. Without group cohesion, the group leader must keep members safe by taking charge and addressing conflict. Reestablishing group norms and rules involves reminders about the group rules, tasks, and purpose. Universality, one of Irvin Yalom’s group therapeutic factors, helps clients feel less alone as they relate to one another’s experiences. This is not achieved by placing pressure on the client to share, particularly as it may relate to experiences of shame. Linking connects group members to foster universality. Groups need to have a here-and-now focus, which would not apply to feelings that the client experienced in the past. Imparting information, also one of Yalom’s therapeutic factors, is not necessarily accomplished by offering your interpretation of the interaction. In doing so, you may risk isolating the client, the subgroup, and other group members. Therefore, the correct answer is (A)",counseling skills and interventions
311,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes to this session, sits down, and starts talking about how she met a man and talked to him for about an hour and was frustrated at the end of the conversation because she feels that he is “like everyone I’ve been with before.” The client continues to explain that she knows these men are not good for her and that she wants something different, but she is still talking to him. The client becomes frustrated talking about this and begins crying and breathing heavily, stating that, “I am broken and can’t have a healthy relationship.” You support the client through her strong emotions and provide empathetic listening.  The client explains that she is having difficulty paying for her session and requests to trade the produce she grows in exchange for the cost of her sessions","The client explains that she is having difficulty paying for her session and requests to trade the produce she grows in exchange for the cost of her sessions. All of the following are ethical considerations for bartering, EXCEPT:",Which individual in the counseling relationship initiates the idea of bartering,The possibility of exploitation or harm,Whether this is a common practice in the community,"Whether, upon researching and identifying the monetary value of the trade, the costs match the value of therapy","(A): Which individual in the counseling relationship initiates the idea of bartering
(B): The possibility of exploitation or harm
(C): Whether this is a common practice in the community
(D): Whether, upon researching and identifying the monetary value of the trade, the costs match the value of therapy","Whether, upon researching and identifying the monetary value of the trade, the costs match the value of therapy",D,"Identifying the match in value between the bartered items or services is not an ethical consideration related to bartering. The ACA Code of Ethics identifies that the important factors to ensure as they relate to bartering include that exploitation or harm does not occur as part of bartering, that the client initiates bartering and not the therapist, and the consideration of whether it is common practice in the community to trade goods or services. Therefore, the correct answer is (C)",professional practice and ethics
312,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.",Which of the following scales are not likely to be used in this scenario?,State-Trait Anxiety Inventory (STAI),Depression Anxiety Stress Scale (DASS),Beck Anxiety Inventory (BAI),Hamilton Anxiety Rating Scale (HARS),"(A): State-Trait Anxiety Inventory (STAI)
(B): Depression Anxiety Stress Scale (DASS)
(C): Beck Anxiety Inventory (BAI)
(D): Hamilton Anxiety Rating Scale (HARS)",Depression Anxiety Stress Scale (DASS),B,"The DASS measures the structure of negative emotional states and addresses both depression and anxiety. While a counselor may benefit from information provided in any instruments used, there was no noted depression in Taylor's case making this option the least helpful choice. On the NCMHCE, it is best to focus only on symptoms provided leading you to address the listed diagnosed condition. The BAI is a brief, self-report assessment for measuring anxiety and its severity level. The HARS helps detect the extensiveness of anxiety using clinical ratings to help better understand individuals with already diagnosed conditions. The STAI is used to measure trait and state anxiety differentiate for depression symptoms and has been used in research as an indicator of caregiver distress. Any of these would be useful at some point in Taylor's counseling process. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
313,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.","Considering the information provided, which question should the counselor ask John?",What are his family's views on having a child?,How much does John enjoy working for his uncle?,What does John do for stress relief?,How strong is John's relationship with Jane's family?,"(A): What are his family's views on having a child?
(B): How much does John enjoy working for his uncle?
(C): What does John do for stress relief?
(D): How strong is John's relationship with Jane's family?",What are his family's views on having a child?,A,"Hispanic cultures tend to be family oriented and this may influence how John views a diagnosis of infertility and the potential inability to have a biological child. This is an important question for the counselor and John to discuss. Questions about how John reduces stress can help the counselor work with John on healthy living practices, but is not specific to the issue of problematic communication due to infertility. The strength of John's relationship with his wife's family and his work satisfaction are all important questions when getting to know the client, but are not directly related to the presenting issue of decreased communication and intimacy related to infertility. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
314,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The couple acknowledge some improvement with communication, but they continue to feel significant levels of relationship distress. The client has been asking for what she needs, mainly when she is in pain and functionally limited, but she reports that the husband continues to do little to support her. The husband reiterates that he has a demanding job that depletes his energy and that he has little to give when he gets home at night. The husband’s child has been verbally abusive to the client, and her husband minimizes her concern. The client feels “stuck in the middle” when determining her stepson’s schedule and activities. The client states that her husband’s bitter ex-wife makes her new role as stepparent “nearly impossible.” To help with the postdivorce adjustment and lessen conflict, you provide information on local support groups, parent education programs through family court, and additional educational resources","The client states, “His ex-wife makes coparenting nearly impossible, and he continues to do absolutely nothing about it!” You state, “Can you turn to him and tell him what that is like for you?” What are you trying to accomplish with your request?",Increase change talk by reducing ambivalence.,Assess for transference and countertransference.,Help him “mirror” back the emotional content.,Create new experiences of emotional attachment.,"(A): Increase change talk by reducing ambivalence.
(B): Assess for transference and countertransference.
(C): Help him “mirror” back the emotional content.
(D): Create new experiences of emotional attachment.",Create new experiences of emotional attachment.,D,"You are hoping to create new experiences of emotional attachment. Emotionally focused couples therapy uses enactments to counterbalance negative interactions, uncover underlying vulnerabilities, and develop emotional attunement. Enactments increase awareness of emotional attachment by encouraging couples to engage with one another directly. Counselors using emotionally focused couples therapy enactments first work to identify the couple’s negative patterns of interaction. Counselors then help couples safely address vulnerabilities to create secure bonds with one another. Creating change talk by reducing ambivalence is a motivational interviewing technique. Although it is helpful to assess readiness for change with the couple, this is not accomplished by using enactments. Transference and countertransference are not present in this interaction. The technique of mirroring is used in imago couples therapy. Therapists use mirroring to encourage the message receiver to paraphrase or mirror back exactly what was conveyed by the message sender. Therefore, the correct answer is (A)",counseling skills and interventions
315,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",Which assessment tool would you use to conduct a comprehensive evaluation of the client's current cognitive and emotional functioning?,Beck Depression Inventory (BDI),Luria-Nebraska Neurological Battery (LNNB),Mental Status Examination (MSE),California Psychological Inventory (CPI),"(A): Beck Depression Inventory (BDI)
(B): Luria-Nebraska Neurological Battery (LNNB)
(C): Mental Status Examination (MSE)
(D): California Psychological Inventory (CPI)",Mental Status Examination (MSE),C,"The MSE is used to evaluate an individual's current psychological functioning. It assesses the individual's overall appearance, behavior, intellectual abilities, cognitive functions, and thought processes. It can also provide insight into the individual's mood, affect, memory, and insight. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
316,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.",,What method might you use initially to address the client's desire to improve his relationship with his children?,Construct a Genogram,Engaging in a role-play exercise,Examining the family constellation,Beginning family therapy,"(A): Construct a Genogram
(B): Engaging in a role-play exercise
(C): Examining the family constellation
(D): Beginning family therapy",Engaging in a role-play exercise,B,"Role-playing allows clients to identify their feelings surrounding a given situation while simultaneously learning how others may feel. These exercises also help clients learn to apply words to their feelings and more successfully navigate any interactions they may have with others. Therefore, the correct answer is (B)",counseling skills and interventions
317,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students.  Seventh session Almost two months have passed since you first met with the client. She has been meeting you for weekly therapy sessions. During previous sessions, you continued to work on developing a sense of trust with the client which has allowed her to open up to you about the myriad of feelings that she has regarding her injury. You explored and processed feelings of grief and sadness, as well as feelings of anger and resentment. Several sessions have been dedicated to identifying automatic thoughts that have been contributing to the client's negative attitude and replacing negative self-talk like ""I'm broken"" with more positive and realistic statements. You have also been using solution-focused techniques to help her to focus on what is within her power to change and take active steps toward making those changes.    During today's session, the client agrees with you when you state that you believe she has achieved many of her goals in therapy. The client has worked through her ambivalence towards teaching the younger ballet classes and is now actively pursuing this opportunity. She reports that she finds a sense of purpose in helping the students learn and appreciate dance, as well as feel accomplished for their achievements. She says, ""It's still strange not being the student anymore, but I'm glad that I decided to try it. The kids had a performance last week, and one of the girls gave me this really sweet clay ballet shoe that she made in her art class. She told me that I'm the reason she felt 'brave enough' to keep dancing even though she was scared. That meant a lot to me.""    You then ask her about her relationship with her parents. She reports that it has improved since they had the discussion about trust. They are now more willing to listen to her opinions and have loosened some of the restrictions, though there are still some limits in place. Although they still have expectations of her and restrict certain activities, they now talk to her more openly and engage with her in a positive manner. She tells you that she would like to get all A's this semester to make her parents proud. She is getting better grades in history but states that her other classes are ""boring."" She also mentions wanting to put some limits on the amount of time she spends with her friends and ""get away from smoking as much."" She says that she is trying to be a better role model for her ballet students. You acknowledge how hard she has worked to reach this point and congratulate her on taking initiative in improving her academic performance and setting new boundaries with her friends."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",What do you identify as a significant barrier to the client achieving her stated goal of getting A's in all classes?,The client's level of engagement in classes,The client's relationship with her parents,The client's medical history,The client's substance use history,"(A): The client's level of engagement in classes
(B): The client's relationship with her parents
(C): The client's medical history
(D): The client's substance use history",The client's level of engagement in classes,A,"The client describes the classes as boring, indicating that her level of engagement in the assignments may be a barrier to achieving her stated goal. Therefore, the correct answer is (C)",counseling skills and interventions
318,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","Given his presenting issues, which initial theoretical approach would work best with Rick?",Psychoanalytic therapy,Gestalt therapy,Behavioral therapy,Narrative therapy,"(A): Psychoanalytic therapy
(B): Gestalt therapy
(C): Behavioral therapy
(D): Narrative therapy",Gestalt therapy,B,"Gestalt therapy would be appropriate for this client as the main goal of this approach is to unlock blocked feelings. Gestalt therapy targets anger, grief, anxiety, and depression. The client has expressed anger toward the women in his life, has trust issues, is withdrawing, and is engaging in self-harming behaviors, all of which make Gestalt an ideal approach to use. Therefore, the correct answer is (C)",counseling skills and interventions
319, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.",Which of the following will be least helpful for the client in managing her stress or panic?,Closing eyes and breathing slowly through her nose,Find one object to focus on while breathing slowly,Avoid places and situations that trigger her stress or panic,Using a grounding technique to remind herself that she is safe,"(A): Closing eyes and breathing slowly through her nose
(B): Find one object to focus on while breathing slowly
(C): Avoid places and situations that trigger her stress or panic
(D): Using a grounding technique to remind herself that she is safe",Avoid places and situations that trigger her stress or panic,C,"Avoiding places and situations that trigger stress or panic do not help the client to manage her emotions and instead may create more fear of those triggers. Instead, it is helpful for clients to either close their eyes and breathe slowly through the nose to control hyperventilation, or to find one object to focus on while breathing slowly. Noticing everything possible about the object helps the client to distract her mind from her panic and allows her to regain control. Using a grounding technique such as 3 things I can see, 3 things I can feel, and 3 things I can hear allows the client to distract themselves from their anxiety or panic and allows them to separate themselves from their heightened emotions. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
320,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","    History of Condition: The client’s milestones were all developmentally appropriate; he was walking at ten months, toilet trained by 24 months, and speaking in complete sentences at almost 30 months. The mother describes the client as “moody” beginning in kindergarten. His temper outbursts began to escalate in intensity and duration within the last few years. During this time, there were no known associated stressors. The mother reports that the client has always had a hard time following directions and difficulty complying with authority figures. Family History: The client has two maternal half-brothers, ages 18 and 20, and has positive relationships with both of them. His parents divorced when the client was three years old, and the mother has physical custody of the child\. Before the divorce, the client witnessed verbal and physical altercations between his parents. The client’s father visits periodically, and he has been in and out of substance abuse treatment centers for most of the client’s life. When angry with his mother, the client tells her he wishes he could live with his father. The client’s maternal grandmother is diagnosed with bipolar disorder, and the client’s mother states she struggles “off and on” with depression. Aside from the father’s substance use disorder, a paternal history of mental illness is unknown",Which of the following would best help create a therapeutic alliance with this client?,Helping the client master coping skills he can successfully apply when feeling angry,"Using core facilitative conditions, such as reflection and validation",Demonstrating universality to minimize transference and instill hope,Sharing the treatment plan with the client to establish clear expectations,"(A): Helping the client master coping skills he can successfully apply when feeling angry
(B): Using core facilitative conditions, such as reflection and validation
(C): Demonstrating universality to minimize transference and instill hope
(D): Sharing the treatment plan with the client to establish clear expectations","Using core facilitative conditions, such as reflection and validation",B,"The use of humanistic, person-centered responses, including reflection and validation, significantly influence the therapeutic alliance. Helping the client to master coping skills to apply when he is feeling angry is an appropriate counseling intervention but is less likely to contribute to creating a therapeutic alliance. Including the client in the treatment planning process, rather than solely sharing the completed treatment plan, helps build and strengthen the therapeutic alliance. Presenting the client with a menu of goals and objectives is one way to include a child in developing a treatment plan. Universality and the installation of hope, part of Irvin Yalom’s curative factors, are therapeutic experiences associated with group therapy; these factors are not associated with minimizing transference. Therefore, the correct answer is (C)",counseling skills and interventions
321,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",What aspect of Rational Emotive Behavioral Therapy (REBT) would be useful for Davone?,Resolving cognitive distortions and underlying emotional disturbances,Learning unconditional self-acceptance,Reducing secondary disturbance behaviors,Framing anger as unhealthy and inappropriate,"(A): Resolving cognitive distortions and underlying emotional disturbances
(B): Learning unconditional self-acceptance
(C): Reducing secondary disturbance behaviors
(D): Framing anger as unhealthy and inappropriate",Resolving cognitive distortions and underlying emotional disturbances,A,"REBT posits that you uproot your absolutistic demands in order that cognitive distortions get corrected. Cognitive distortions are part of what prevents Davone from addressing his root issues. REBT highlights how secondary disturbances have a negative effect on behavior (feeling anxious about appearing anxious or worrying about having too much worry) however they do not seem to be present in Davone's situation. While Davone learning self-acceptance is a positive and healthy step for his well-being, he is currently undergoing severe consequences for his illegal and destructive behaviors so using a strategy that avoids inherent change can backfire. REBT also considers anger as a negative emotion (as opposed to CBT that considers some anger as healthy), but invalidating Davone's only complaint about being angry over not having his children can be harmful to your therapeutic relationship and is not realistic. Therefore, the correct answer is (B)",counseling skills and interventions
322,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.",,What would you consider as a short-term goal for this client?,Identify his emotions,Develop positive relationships with his children,Identify his Eriksonian stage of development,Reduce alcohol use,"(A): Identify his emotions
(B): Develop positive relationships with his children
(C): Identify his Eriksonian stage of development
(D): Reduce alcohol use",Identify his emotions,A,"You noted in the Mental Status Exam that the client talked about feeling angry, but his affect appeared sad. Helping the client to identify his emotions is an appropriate short-term goal and a good place to start with this client. Therefore, the correct answer is (B)",treatment planning
323, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”","While conducting a lifetime C-SSRS, Bob admits to having active suicidal thoughts and breaks down in front of you. After guiding him through a few deep breaths and offering comforting support, you update his chart. Which factors should you have assessed prior to completing the assessment?",frequency and severity of active thoughts,if method and plan exist,"history, frequency, severity, method, plan",history and past behaviors,"(A): frequency and severity of active thoughts
(B): if method and plan exist
(C): history, frequency, severity, method, plan
(D): history and past behaviors","history, frequency, severity, method, plan",C,"If this is the first C-SSRS you are completing with a client, it is assumed you will address a client's life history of thoughts and behaviors prior to assessing recent events. Then you must assess the client's ideation of method of suicide and if they have taken steps towards planning. Addressing the frequency of the thoughts as well as their severity using rating scales is significant in understanding level of debilitation and risk. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
324,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,Risk factors for generalized anxiety disorder include?,Childhood experiences of physical and sexual abuse,History of separation anxiety,Genetic loading,Respiratory disturbance,"(A): Childhood experiences of physical and sexual abuse
(B): History of separation anxiety
(C): Genetic loading
(D): Respiratory disturbance",Genetic loading,C,"One third of the risk of developing general anxiety disorder is genetic. The other two thirds are a combination of temperamental and environmental factors. Respiratory disturbance is associated with panic disorder, as well as reports of negative childhood experiences such as physical and sexual abuse. There is no evidence that a history of separation anxiety can lead to generalized anxiety disorder later in life. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
325,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","   iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents.  After you finish talking with the client’s parents, you decide to go to the living room where the client is","After you finish talking with the client’s parents, you decide to go to the living room where the client is. What would assist you in building rapport with this client?",Engage the client in talking about the video game he is playing or play the game with him.,Encourage the client to return to the home office where the session was taking place.,Initiate a conversation about sports with the client to find a common interest.,Continue the intake session in the living room with the client because he seems more comfortable here.,"(A): Engage the client in talking about the video game he is playing or play the game with him.
(B): Encourage the client to return to the home office where the session was taking place.
(C): Initiate a conversation about sports with the client to find a common interest.
(D): Continue the intake session in the living room with the client because he seems more comfortable here.",Engage the client in talking about the video game he is playing or play the game with him.,A,"The client is resistant to the therapeutic process or is uninterested. The client may respond well to you showing interest in the game that he is playing because it is his preferred activity and topic. Although it may not feel therapeutic or clinical to talk about video games, this meets the client’s developmental needs to talk about or engage in preferred activities or play. Sports may create further conversation, but it cannot be assumed that the client enjoys sports, nor is establishing common interests a priority in the therapeutic relationship. Encouraging the client to return to the office or to continue the session in the living room may not be fruitful because the client is clearly uninterested in therapy at this moment. Therefore, the correct answer is (B)",counseling skills and interventions
326,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","   ully. Family History: Several clients report coming from a single-parent home, whereas others are from a two-parent home. All clients report that they have siblings. Several clients reported having parents that were or are involved in the justice system",Which of the following would be the most appropriate short-term goal in the next month for the group?,The group will demonstrate the effective use of anger management strategies.,The group will build trust and cohesion.,The group will use assertive communication skills.,The group will demonstrate empathy in the group setting.,"(A): The group will demonstrate the effective use of anger management strategies.
(B): The group will build trust and cohesion.
(C): The group will use assertive communication skills.
(D): The group will demonstrate empathy in the group setting.",The group will build trust and cohesion.,B,"The group would most benefit from building trust and cohesion at this point in counselingbecause the correctional setting often encourages individuals to refrain from disclosure due to the fear of being targeted. Assertive communication skills, anger management strategies, and demonstrating affection will all be longer term goals as they work to develop these skills and implement them. Therefore, the correct answer is (A)",treatment planning
327,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.  Sixth session The wife presents for today's session without her husband. She reports that two nights ago, he was taken to the emergency room for pain. He had been drinking, and test results at the hospital liver indicated that his liver functioning was impaired. He continues to deny that he is drinking, but she knows this is untrue as she has been finding half-full liquor containers hidden around the house. She starts to cry, ""I don't know what I will do without him. I had to call a babysitter and get a cab to come here. I'm worried about how I'll pay for the mortgage if my husband can't work. We'll end up losing the house and our health insurance! I'm going to have to sell off everything to make ends meet!"" You respond to her fears with empathy and understanding. You are respectful of the client's thoughts and feelings and seek to understand her experience. You also explore the cognitive error that your client has made and how this is affecting her emotions.    You continue the session by asking her what her most immediate concerns are at the moment and what she needs help with. She pauses for a moment and then starts to explain how she is feeling overwhelmed by the situation and feeling helpless in being able to help her husband. She expresses a lot of fear and anxiety about her family's financial security and the potential loss of the house and health insurance if her husband's drinking continues. She expresses a need for support and understanding and worries about how she will cope without her husband. She feels isolated and alone, stating, ""I feel like my worst nightmare has come true. I've been worrying about my husband's drinking for a long time. I've heard horror stories about how addiction can ruin people's marriages, and I don't want that for us. I know it's hard for him, but it's hard for me, too."" You offer her some resources that could help her with her financial situation and ask her to put together a list of a few people she feels she can talk to for emotional support.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What would you say to demonstrate a nonjudgmental stance towards the wife?,"""It must be hard for you to watch your husband struggle with his addiction.""","""It sounds like you're making many assumptions about what could happen in the future.""","""It sounds like you're really struggling right now.""","""You mentioned that your husband's drinking issues have been present for a long time. You must be feeling really frustrated with him.""","(A): ""It must be hard for you to watch your husband struggle with his addiction.""
(B): ""It sounds like you're making many assumptions about what could happen in the future.""
(C): ""It sounds like you're really struggling right now.""
(D): ""You mentioned that your husband's drinking issues have been present for a long time. You must be feeling really frustrated with him.""","""It sounds like you're really struggling right now.""",C,"This response is affirming and shows the client that you are listening to her and understanding her pain. It also expresses sympathy and empathy without making any judgments. Therefore, the correct answer is (D)",counseling skills and interventions
328,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps.  Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, ""I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?"" You remain calm and acknowledge the client's frustration. You reply, ""You're angry with me because you feel that I'm not listening. Am I hearing you right?"" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety.    The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but ""she just doesn't get how hard it is for me."" He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, ""It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?"" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ","Based on the client's presentation, what would be included as a short-term goal in his treatment plan?",Full remission,Decrease anxiety symptoms,Eliminate harmful eating behaviors,Improve self-esteem,"(A): Full remission
(B): Decrease anxiety symptoms
(C): Eliminate harmful eating behaviors
(D): Improve self-esteem",Decrease anxiety symptoms,B,"Decreasing anxiety symptoms is considered a short-term goal for the client through techniques and medications. Therefore, the correct answer is (A)",treatment planning
329,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.  10th session As you have been working with the client over the past two and a half months, he has made significant progress with treatment goals, including mood stabilization and behavioral control. In the last session, as you reviewed the progress that the client had made over the course of treatment, you both agreed that the client was ready for termination as he felt he had gotten what he needed from therapy. The client was especially pleased when considering his progress in mood regulation and mindfulness, as well as addressing his thrill-seeking behaviors during his manic phases.    For this final session, the client arrived ten minutes late. He appears out of breath as he runs into the room. The client states that he got a call from the hospital where his sister was just admitted. As he describes the phone call, he pauses and looks out the window with tears in his eyes. You ask him how he feels. The client responds quietly, ""I don't know, my sister has been in a serious accident, and I don't know how I'll continue without her support,"" prompting you to recognize that unresolved issues may require additional therapy. You state, ""It sounds like your sister's accident has brought up a lot of emotions for you. You are feeling overwhelmed and unsure about how to cope without her support. It must be difficult to process all of this at once."" The client nods his head. You continue by telling him that it is natural to feel overwhelmed and uncertain in a situation like this. You engage him in a discussion about coping strategies or support systems that have helped him in the past when facing difficult challenges. You also ask him if it would be helpful to have additional therapy sessions during this time to which he replies, ""Yes, I don't want to undo all the progress I've made.""","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.","After additional sessions with the client, you are at the point of termination and would like to review the insights he has gained during therapy. After emphasizing that termination is a gateway to a new beginning, you ask the client to rate his progress. What is the intent behind asking the client this question?",To empower the client to recognize any future need for therapy should he begin destructive behavior.,To empower the client to assist others experiencing mood disorders and substance abuse issues by giving a testimonial,To empower the client by recognizing the accomplishments and changes that he has made in therapy,To empower the client to continue to work on unresolved issues which still need to be addressed,"(A): To empower the client to recognize any future need for therapy should he begin destructive behavior.
(B): To empower the client to assist others experiencing mood disorders and substance abuse issues by giving a testimonial
(C): To empower the client by recognizing the accomplishments and changes that he has made in therapy
(D): To empower the client to continue to work on unresolved issues which still need to be addressed",To empower the client by recognizing the accomplishments and changes that he has made in therapy,C,"You can link the client's insight to his personal growth and development and his continued areas of need. Through processing his overall value of treatment, the client can gain further insight into areas he has improved on and areas he needs to continue to examine. Sustainability is key. Therefore, the correct answer is (A)",counseling skills and interventions
330,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client","All of the following are ethical considerations for termination, EXCEPT:","The client has not paid the agreed-upon counseling fees, so consideration of termination is appropriate.",It is apparent that the client no longer needs counseling.,"You have different values than the client, so you consider termination and referral.",The therapist is at risk of harm by the client.,"(A): The client has not paid the agreed-upon counseling fees, so consideration of termination is appropriate.
(B): It is apparent that the client no longer needs counseling.
(C): You have different values than the client, so you consider termination and referral.
(D): The therapist is at risk of harm by the client.","You have different values than the client, so you consider termination and referral.",C,"Having different values is not a reason to terminate counseling because you must be able to provide counseling to others with different views and maintain objectivity. Rather, seeking counseling in the situation of different values is the appropriate consideration. When the client no longer needs counseling, termination is appropriate to consider because you are providing a service that is not needed. When the client cannot pay the agreed-upon fees, it is also appropriate to consider termination. If the counselor is at risk of harm by the client or by relationships that the client has, then termination is necessary. Therefore, the correct answer is (A)",professional practice and ethics
331,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,"To help understand Mark's present functioning and safety risks, the counselor should first gather information on?",Previous hospitalizations,Length of time at job,History of mental illness in family,Duration of severity of symptoms,"(A): Previous hospitalizations
(B): Length of time at job
(C): History of mental illness in family
(D): Duration of severity of symptoms",Duration of severity of symptoms,D,"The duration and severity of symptoms helps to understand the client's present functioning and possible safety risks. After this is discussed, part of a comprehensive intake is gathering information on the history of mental illness in family members. There is a strong contribution for genetic factors in determining risk for schizophrenia. Previous hospitalizations are important to understand severity of illness and level of functioning. The length of time that Mark was at his job is not relevant to understand his psychological history. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
332,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What best describes the purpose of your interactions with the client during this session?,"You are prompting and reinforcing each step of his treatment, strengthening all of the parts of the chain which move toward the desired behavior.","You are working to build a therapeutic alliance with the client, creating a safe place to learn to interact and build relationships.",You are observing distinct changes between the intake and this session as a result of your therapeutic interventions.,You are assessing this client's ability to work with others. His one-on-one aid will maximize his response time in adjusting to unforeseen changes.,"(A): You are prompting and reinforcing each step of his treatment, strengthening all of the parts of the chain which move toward the desired behavior.
(B): You are working to build a therapeutic alliance with the client, creating a safe place to learn to interact and build relationships.
(C): You are observing distinct changes between the intake and this session as a result of your therapeutic interventions.
(D): You are assessing this client's ability to work with others. His one-on-one aid will maximize his response time in adjusting to unforeseen changes.","You are working to build a therapeutic alliance with the client, creating a safe place to learn to interact and build relationships.",B,"This addresses the actions taken so far to establish a therapeutic alliance and a safe space. Therefore, the correct answer is (C)",counseling skills and interventions
333,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","The client presents today with a blunted affect and an irritable mood. The daughter accompanies the client and states that the results of the client’s recent PET scan show changes in the brain that may indicate Alzheimer’s disease. You process the results with the client and her daughter and provide psychoeducation on cognitive impairment, including counseling risks, benefits, and limitations. The client would like to focus on improving psychosocial issues associated with her cognitive impairment.  The client states, “People must think I’m so stupid when I can’t even remember whether or not I paid a bill.” You respond, “You feel embarrassed when you are unable to complete a task that you used to do with ease","The client states, “People must think I’m so stupid when I can’t even remember whether or not I paid a bill.” You respond, “You feel embarrassed when you are unable to complete a task that you used to do with ease.” This is an example of which of the following?",Empathetic reflecting,Reframing,Paraphrasing,Attending,"(A): Empathetic reflecting
(B): Reframing
(C): Paraphrasing
(D): Attending",Empathetic reflecting,A,"Empathetic reflecting or empathetic responding is used when a counselor responds to the client’s verbal expressions and underlying emotions. Paraphrasing is used when a counselor responds to the client’s main idea or literal meaning without using the client’s exact words. Counselors use attending by demonstrating listening and paying attention to the client. This occurs when making eye contact or assuming an attentive posture. Reframing is a communication skill that counselors use to help clients view things from a different and more positive perspective. Therefore, the correct answer is (D)",counseling skills and interventions
334,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.  Fifth session It has been a month and a half since you first met with the client and she has rescheduled multiple therapy appointments, continually citing a busy work schedule. The last time you met with her, she told you that the judge sentenced her to six months probation, provided that she follow through with Alcoholic Anonymous meetings and counseling sessions. She was also required to do 60 hours of community service. Though she was relieved to have the sentencing behind her, she remarked that she still felt shame and humiliation at having gone down that path. During that counseling session, she communicated to you that she tried to go one day without drinking but couldn't do it. She described the idea of quitting drinking as ""impossible"" because ""I have never been strong enough."" You explored the client's motivations and concerns about changing her behavior. You explained to her that while it was normal to feel overwhelmed by the thought of making changes, there were strategies that she could utilize in order to build a support system and make progress towards sobriety.    Based on the client's behavior, you do not believe that outpatient treatment is the best fit for the client at this time, and you plan to discuss alternate options with her today. She is scheduled for an afternoon session but does not show. When you attempt to call her, her phone goes directly to voicemail. You continue to wait in your office even though the client does not respond to your calls or appear for the session. You are concerned about her because although she has rescheduled appointments before, she has always done so in advance and has never been a ""no show."" You take the appropriate ethical actions to check on her.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","In consideration of the client's prior behavior of contacting you when she could not make an appointment, and given her status during today's session, what action would be most ethically appropriate for you to take at this time?",Contact the client's ex-boyfriend.,Contact the police.,Contact the client's mother.,Drive to the client's house to perform a wellness check.,"(A): Contact the client's ex-boyfriend.
(B): Contact the police.
(C): Contact the client's mother.
(D): Drive to the client's house to perform a wellness check.",Contact the client's mother.,C,"Since the client has indicated that she communicates with her mother weekly and you have a signed release to speak with her, this is an appropriate action for you to take. Therefore, the correct answer is (B)",professional practice and ethics
335,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.  15th session You have been seeing the client regularly for the past four months. He states that he is feeling ""better"" these days, and he is doing better at work. He has been taking his antidepressant medication as prescribed and feels therapy has been helpful. You review the treatment plan and discuss the progress he has made and the termination process.    Near the end of the session, he tells you, ""Well, there is one more thing. I'm worried that my wife might be having an affair. I know it's probably crazy, but I can't help but think that she's seeing someone else. And you know what, I wouldn't blame her. I haven't been the best husband with my constant depression. I just think about her leaving me, and it makes me feel afraid."" You express understanding and validate his feelings, noting that it's not uncommon for people to have affair-related thoughts when feeling insecure in their relationship. You inquire whether he has been spending time with his wife and how he and his wife have been communicating. He reports that they have been talking more and that he has been trying to be more present when he is with her. You remind him of his progress in therapy and how much better he has been feeling overall, which has likely contributed to him being able to engage more in his marriage. You suggest that as he continues to work on himself and generally feels better, his worries about his wife cheating on him will likely lessen. In the meantime, you caution against drinking to cope with his anxiety, as it can lead to further problems down the road.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.","Given the revelations within this session and considering your observations of the client during the subsequent sessions, which statement is most accurate to document in the client's therapy record?","The client and his wife are experiencing Folie à Deux, sharing jealous delusions.","The client's work conditions negatively affect his mental health, and he needs to retire earlier than planned.","Suicide risk factors have decreased, and he does not need to be screened for suicidal ideations, intent, and plan.","Suicide factors have increased, and he needs to be screened for suicidal ideations, intent, and plan.","(A): The client and his wife are experiencing Folie à Deux, sharing jealous delusions.
(B): The client's work conditions negatively affect his mental health, and he needs to retire earlier than planned.
(C): Suicide risk factors have decreased, and he does not need to be screened for suicidal ideations, intent, and plan.
(D): Suicide factors have increased, and he needs to be screened for suicidal ideations, intent, and plan.","Suicide risk factors have decreased, and he does not need to be screened for suicidal ideations, intent, and plan.",C,"The client has a history of substance use and disclosed a new major life stressor with his wife, but he has learned coping mechanisms to deal with this new fear. Screening for suicidal ideations, intent, and plan is not necessary. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
336,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","    History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork.  You and another counselor would like to start a group for individuals with social anxiety who tend to avoid performance situations (e\. g., talking in front of others, taking an exam, interviews, etc.)","You and another counselor would like to start a group for individuals with social anxiety who tend to avoid performance situations (e.g., talking in front of others, taking an exam, interviews, etc.). Which instrument would you use to help measure this?",Fear Questionnaire Social Phobia Subscale,Hamilton Anxiety Rating Scale,Liebowitz Social Anxiety Scale,Beck Anxiety Inventory,"(A): Fear Questionnaire Social Phobia Subscale
(B): Hamilton Anxiety Rating Scale
(C): Liebowitz Social Anxiety Scale
(D): Beck Anxiety Inventory",Liebowitz Social Anxiety Scale,C,"The Liebowitz Social Anxiety Rating Scale measures social anxiety; it provides measures for social anxiety and social avoidance, and there are also measures for performance anxiety and performance avoidance. Individuals with performance anxiety may also have negative performance-based appraisals leading to avoidance. Social anxiety disorder characteristics include fear of social situations fueled by cognitive distortions and reinforced by avoidance and other safety behaviors. Cognitive distortions include an underestimation of one’s performance in social situations. The Hamilton Anxiety Rating Scale is useful for measuring traits associated with GAD, including psychological distress and somatic complaints. The Beck Anxiety Inventory measures the severity of anxiety symptoms, specifically physiological and cognitive symptoms of anxiety. The Fear Questionnaire Social Phobia Subscale assesses the severity of specific phobias by focusing primarily on avoidance behaviors. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
337,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",What data would be important in tracking Ruth's and Dale's progress?,The children's interactions and grades at school,Ruth's decrease or increase in contact with her ex-husband,The frequency of intimacy in the couple's relationship,How the couple respond to their children's behavior,"(A): The children's interactions and grades at school
(B): Ruth's decrease or increase in contact with her ex-husband
(C): The frequency of intimacy in the couple's relationship
(D): How the couple respond to their children's behavior",How the couple respond to their children's behavior,D,"If the client and her husband can respond as a cohesive unit to their children more appropriately, this would indicate that they are making progress in therapy. Therefore, the correct answer is (B)",counseling skills and interventions
338,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client’s son accompanies her to her appointment today. Since the initial intake, COVID-19 has become a global pandemic and has greatly impacted the client’s anxiety and fear. The client was visibly trembling when she spoke and requested that her son remain nearby. She explained that complying with the statewide mask mandate has been difficult, stating, “Wearing this mask makes me feel like I can’t breathe. It’s the same feeling I get when I’m walking up stairs or taking the elevator.” The client’s internist prescribes alprazolam (Xanax), which she has been taking for years. However, she thinks that it is no longer effective and asks if you can help her discontinue the medication. Given the COVID-19 outbreak, you discuss providing distance counseling to the client","The American Counseling Association (ACA) Code of Ethics (2014) guidelines for distance counseling, technology, and social media includes which of the following standards?",Counselors acknowledge the differences between synchronous and asynchronous communication and use synchronous communication whenever possible to avoid missed verbal and nonverbal cues.,Counselors take reasonable precautions to ensure the confidentiality of information transmitted through technology-based communication.,Counselors inform clients that only authorized individuals have access to confidential information.,"Counselors verify their identity and the identity of the client (e.g., through the use of code words, numbers) each session.","(A): Counselors acknowledge the differences between synchronous and asynchronous communication and use synchronous communication whenever possible to avoid missed verbal and nonverbal cues.
(B): Counselors take reasonable precautions to ensure the confidentiality of information transmitted through technology-based communication.
(C): Counselors inform clients that only authorized individuals have access to confidential information.
(D): Counselors verify their identity and the identity of the client (e.g., through the use of code words, numbers) each session.",Counselors take reasonable precautions to ensure the confidentiality of information transmitted through technology-based communication.,B,"Counselors adhering to the ACA Code of Ethics “take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means” Section H3 states that counselors should take steps to verify the identity of the client, rather than their own identity and the client’s identity. This should occur “at the beginning and throughout the therapeutic process” Section H2b states that “Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (eg, colleagues, supervisors, employees, information technologists)” Finally, Section H4f states, “Counselors consider the differences between face-to-face and electronic communication (nonverbal and verbal cues) and how these may affect the counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically”. Therefore, the correct answer is (B)",professional practice and ethics
339,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,Brain abnormalities in those diagnosed with bipolar disorders occur in this area of the brain which controls cortisol levels?,Brain stem,Hippocampus,Hypothalamic-pituitary-thyroid axis,Thalamus,"(A): Brain stem
(B): Hippocampus
(C): Hypothalamic-pituitary-thyroid axis
(D): Thalamus",Hypothalamic-pituitary-thyroid axis,C,"The Hypothalamic-pituitary-thyroid axis is responsible for the production of cortisol. Abnormalities in thyroid function are frequently accompanied by changes in mood. The Thalamus communicated motor and sensory signals to the cerebral cortex. The hippocampus has a primary role in learning and memory. The brain stem is responsible for regulating some involuntary body actions. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
340,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ","As you develop a treatment plan, what long-term goal will you plan to work on with this client in therapy?",Increase rate of self-initiated verbal expressions with therapist and family members,Acquire fundamental language proficiency and the capacity for basic communication with others,Demonstrate significant improvement in sustained attention and impulse control,Increase frequency of positive social interactions with classmates at school,"(A): Increase rate of self-initiated verbal expressions with therapist and family members
(B): Acquire fundamental language proficiency and the capacity for basic communication with others
(C): Demonstrate significant improvement in sustained attention and impulse control
(D): Increase frequency of positive social interactions with classmates at school",Acquire fundamental language proficiency and the capacity for basic communication with others,B,"This is an appropriate long-term goal to work on with this client. Language proficiency and communication skills are essential to their development and social interaction. Without these skills, this client may struggle to interact with people around him, express himself, and understand what others are saying. Therefore, the correct answer is (D)",treatment planning
341, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.",Which of the following steps taken by you within Raul's school will most likely help improve his behavior over time?,Sit in Raul's classroom and observe behaviors,Set up a reward and consequences system,Periodically check in with his teachers,Review your clinical notes with his teachers,"(A): Sit in Raul's classroom and observe behaviors
(B): Set up a reward and consequences system
(C): Periodically check in with his teachers
(D): Review your clinical notes with his teachers",Periodically check in with his teachers,C,"Assuming there are appropriately signed releases of information in place, coordinating with Raul's teachers to learn more about his behaviors and whether there has been improvement is extremely helpful information in guiding your course of care. Sharing detailed clinical notes is inappropriate and unnecessary for helping Raul and breaks his confidentiality, as does sitting in his classroom to observe him. Additionally, the observation might not yield the intended results as Raul might modify his behavior if under observation. Becoming involved in a reward and consequence system for his corrective actions and behaviors in school transitions your role as a safe and unbiased helper into a disciplinarian, which may end up having detrimental implications on your therapeutic alliance. Therefore, the correct answer is (B)",treatment planning
342,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.  Eighth session You continue to work with the client in outpatient therapy. During a previous session, the client identified a few sources of support and was able to tell her parents that she switched her major. Today, the client arrives for her appointment 20 minutes early. She appears eager to see you and excited to talk with you. When she sits down, she pulls several cookbooks out of her backpack. She tells you that she plans to go home during spring break and has collected recipes for a large meal she wants to make for her family. During this session, while exploring the client's relationship with food, you discover that she spends many hours in the library reading through cookbooks and watching baking shows on her computer. She says that she has an apple for breakfast, picks up a small salad ""to go"" from the campus cafeteria every day at exactly 12:00 p.m., and bakes a sweet potato for dinner in the microwave in her room at 6:00 p.m. She looks forward to her meals and plans her day around them. She says she is envious of other people who ""can eat anything whenever they want."" She tells you she is worried that if she eats extra food, she will become obese overnight and never stop eating.  You continue to explore the client's relationship with food by asking, ""What do you think would happen if you ate whatever you wanted?"" She replies, ""I'm afraid that if I eat extra food, I'll gain weight and never be able to stop eating. I'll keep getting bigger and bigger and turn into a severely obese person."" After taking a moment to think, the client shares, ""I'm scared that if I gain weight, no one will love me or care about me. Then I'll be completely alone, and it will be all my fault because I couldn't control my eating!"" You listen compassionately as the client shares her fear. You also emphasize that this is an extreme outcome and unlikely to occur. You encourage her to think realistically about the potential consequences of eating additional food and acknowledge that there may be some negative outcomes, but they are not guaranteed or irreversible.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","Based on the narrative, when would you specify that the client is “in partial remission” for the client's diagnosis?","When the criteria for low body weight are no longer met, and the client meets the requirements for an intense fear of gaining weight or disturbance in self-perception of body weight",When criteria for disturbance in self-perception of body weight and shape is no longer met,When criteria for Anorexia Nervosa are no longer met and have not been met for a significant amount of time,When the client ceases to talk about weight-related body image issues.,"(A): When the criteria for low body weight are no longer met, and the client meets the requirements for an intense fear of gaining weight or disturbance in self-perception of body weight
(B): When criteria for disturbance in self-perception of body weight and shape is no longer met
(C): When criteria for Anorexia Nervosa are no longer met and have not been met for a significant amount of time
(D): When the client ceases to talk about weight-related body image issues.","When the criteria for low body weight are no longer met, and the client meets the requirements for an intense fear of gaining weight or disturbance in self-perception of body weight",A,"The client is considered “in partial remission” for Anorexia Nervosa, Restricting Type, when criteria for low body weight are no longer met. The client still meets the criteria for either intense fear of gaining weight or disturbance in self-perception of body weight and shape, however. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
343,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.  15th session You have been seeing the client regularly for the past four months. He states that he is feeling ""better"" these days, and he is doing better at work. He has been taking his antidepressant medication as prescribed and feels therapy has been helpful. You review the treatment plan and discuss the progress he has made and the termination process.    Near the end of the session, he tells you, ""Well, there is one more thing. I'm worried that my wife might be having an affair. I know it's probably crazy, but I can't help but think that she's seeing someone else. And you know what, I wouldn't blame her. I haven't been the best husband with my constant depression. I just think about her leaving me, and it makes me feel afraid."" You express understanding and validate his feelings, noting that it's not uncommon for people to have affair-related thoughts when feeling insecure in their relationship. You inquire whether he has been spending time with his wife and how he and his wife have been communicating. He reports that they have been talking more and that he has been trying to be more present when he is with her. You remind him of his progress in therapy and how much better he has been feeling overall, which has likely contributed to him being able to engage more in his marriage. You suggest that as he continues to work on himself and generally feels better, his worries about his wife cheating on him will likely lessen. In the meantime, you caution against drinking to cope with his anxiety, as it can lead to further problems down the road.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.","According to the DSM-5-TR, when would you revise the client's diagnosis to indicate that he is ""in full remission""?",When the client has gone 6 months without any depressive episodes or symptoms,When the client reports that he is feeling better and occupational functioning has improved,When the client has achieved all short-term treatment objectives,When the client has been free of significant depressive symptoms for at least two months,"(A): When the client has gone 6 months without any depressive episodes or symptoms
(B): When the client reports that he is feeling better and occupational functioning has improved
(C): When the client has achieved all short-term treatment objectives
(D): When the client has been free of significant depressive symptoms for at least two months",When the client has been free of significant depressive symptoms for at least two months,D,"The DSM-5-TR states that a diagnosis of Persistent Depressive Disorder, Severe can be revised to ""in full remission"" when the symptoms of depression are absent for at least two months and any residual symptoms (if present) do not significantly interfere with social, occupational, or other important areas of functioning. Therefore, if the client has been symptom free for at least two months and is able to engage in activities without significant interference or distress, the diagnosis of Persistent Depressive Disorder, severe can be revised to ""in full remission"". This would need to be reassessed regularly, as symptoms may return. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
344,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","   sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time.  The client’s sessions are court ordered",The client’s sessions are court ordered. Which of the following is the most therapeutic course of action with regard to sharing information with the court?,"Restrict access to the client’s records; even though therapy is court ordered, it does not mean that the court has access to all documentation.","Take steps to get written consent from the client, attempt to limit information given to the court, and/or prohibit the release of information if possible",Provide all of the information that the court requests per the legal requirements.,Provide minimal information to protect your counseling relationship with the client.,"(A): Restrict access to the client’s records; even though therapy is court ordered, it does not mean that the court has access to all documentation.
(B): Take steps to get written consent from the client, attempt to limit information given to the court, and/or prohibit the release of information if possible
(C): Provide all of the information that the court requests per the legal requirements.
(D): Provide minimal information to protect your counseling relationship with the client.","Take steps to get written consent from the client, attempt to limit information given to the court, and/or prohibit the release of information if possible",B,"The court can subpoena information if needed, and records must be provided in such cases. Therefore, it is best to gain consent from the client, if possible, so you are not sharing information against his wishes, while also explaining to the client certain limits in confidentiality that are unique to his circumstances. Limiting the amount of information provided to the court or attempting to restrict it altogether if it is best for the client is ideal because it protects your counseling relationship. The other answer options do not fulfill the counselor’s needs to meet court orders and to protect the counseling relationship. Sharing all information does not allow the client to have space to speak freely with you, yet you also cannot restrict all information from the court. Therefore, the correct answer is (A)",professional practice and ethics
345,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","   tion. Family History: The client has been married for 25 years. He has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together.  The client does not currently have health insurance and says he will have difficulty continuing to pay for sessions at the current rate",The client does not currently have health insurance and says he will have difficulty continuing to pay for sessions at the current rate. Which of the following would be the most ethical method for determining your payment arrangement with this client?,You consider the client’s financial hardships and adjust your self-pay rate for the client.,You maintain the self-pay rate with the client because it is important to be compensated for the service you are providing.,You and the client set up a verbal agreement to trade the client’s garden produce and woodworking in exchange for counseling services.,You refer the client to another therapist who is willing to provide pro bono services.,"(A): You consider the client’s financial hardships and adjust your self-pay rate for the client.
(B): You maintain the self-pay rate with the client because it is important to be compensated for the service you are providing.
(C): You and the client set up a verbal agreement to trade the client’s garden produce and woodworking in exchange for counseling services.
(D): You refer the client to another therapist who is willing to provide pro bono services.",You consider the client’s financial hardships and adjust your self-pay rate for the client.,A,"Based on the ACA Code of Ethics, the most ethical method in dealing with this dilemma is to consider the possible hardships imposed on the client and adjust your rate for the client (ACA Governing Council, 2014). Bartering for services is appropriate, but it requires a written contract that both parties agree on (ACA Governing Council, 2014). Maintaining the self-pay rate does not consider possible hardships for the client and would not be the most ethical consideration. Providing a referral might be appropriate, but it is most ethical to first consider an adjustment in the fee prior to referring him to another therapist. Therefore, the correct answer is (C)",professional practice and ethics
346,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.","There are several signs to cause you suspicion that Millie is high, which is not appropriate for your level of care and not permitted within your agency. What should you do?",Tell her you think she's high and that you must make a referral for higher level of care or call the police.,Continue to let her share because she might tell you on her own what is happening.,Present your observations of all concerning behaviors and ask her about them.,Remind her of your confidential relationship in hopes she admits to her using.,"(A): Tell her you think she's high and that you must make a referral for higher level of care or call the police.
(B): Continue to let her share because she might tell you on her own what is happening.
(C): Present your observations of all concerning behaviors and ask her about them.
(D): Remind her of your confidential relationship in hopes she admits to her using.",Present your observations of all concerning behaviors and ask her about them.,C,"At this stage, the most ethical choice moving forward is to present your concerns clearly and directly, and then give her an opportunity to address your observations. Millie has already broken company policies by not showing for her last appointment, arriving late, and is now presenting with reasonable suspicion of being intoxicated on the premises. Out of concern for Millie's best interest, waiting for her to share on her own or threatening her without discussing things with her first are both neglectful solutions as her counselor. You can always remind her of her confidentiality rights to support your therapeutic relationship, but this could be misleading when addressing her potential for illicit substance use or when preparing to make a referral. Therefore, the correct answer is (B)",professional practice and ethics
347,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ","Your client finds you on Facebook and sends you a friend request. According to the ACA Code of Ethics, what would be the most appropriate course of action?",Use the request to explore and review boundaries regarding social media,Accept the client's friend request as a way of decreasing the client's level of anxiety as well as a way of building rapport,Modify your Facebook page by making private,Plan to address the friend request at a later time and continue with the session,"(A): Use the request to explore and review boundaries regarding social media
(B): Accept the client's friend request as a way of decreasing the client's level of anxiety as well as a way of building rapport
(C): Modify your Facebook page by making private
(D): Plan to address the friend request at a later time and continue with the session",Use the request to explore and review boundaries regarding social media,A,"Exploring and reviewing boundaries regarding social media is the correct answer. According to the ACA, as part of informed consent, counselors explain to their client's procedure benefits and limitations as well as boundaries while using social media. Therefore, the correct answer is (B)",professional practice and ethics
348,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies.  You previously measured the effectiveness of the group intervention by administering the same standardized instrument that was once used to measure social performance anxiety",You previously measured the effectiveness of the group intervention by administering the same standardized instrument that was once used to measure social performance anxiety. Which one of the following serves as your independent variable?,The instrument used in the posttest,The instrument used in the pretest,The group intervention,Social performance and anxiety,"(A): The instrument used in the posttest
(B): The instrument used in the pretest
(C): The group intervention
(D): Social performance and anxiety",The group intervention,C,"The group intervention serves as the independent variable. An independent variable is the variable that the experimenter manipulates. Social performance anxiety serves as the dependent variable. Dependent variables are what is observed or measured as being directly affected by the independent variable. In this scenario, you wish to determine the effectiveness of the group intervention (ie, the independent variable) on social performance anxiety (ie, the dependent variable). In this study, you use the same instrument for your pretest and posttest, neither one of which serves as the independent variable. Therefore, the correct answer is (A)",treatment planning
349,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.","From a cognitive-behavioral perspective, what is the main factor contributing to the client's depression?",His family's history of depression,His drinking habits,Dissatisfaction with his job,His negative perception about himself and his environment,"(A): His family's history of depression
(B): His drinking habits
(C): Dissatisfaction with his job
(D): His negative perception about himself and his environment",His negative perception about himself and his environment,D,"CBT posits that depression is caused by distorted thoughts. Clients with depression tend to see themselves, their environment, and the future in a negative light. Therefore, the correct answer is (C)",counseling skills and interventions
350,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community.  You use behavioral activation to help the client with social isolation",You use behavioral activation to help the client with social isolation. Which treatment plan goal reflects this approach?,The client will identify two ways of reducing ambivalence and engaging in “change talk.”,The client will identify at least four individuals who fit into her “quality world.”,The client will engage in a minimum of two “values-based” activities each week.,The client will list a minimum of three faulty assumptions contributing to her “failure identity.”,"(A): The client will identify two ways of reducing ambivalence and engaging in “change talk.”
(B): The client will identify at least four individuals who fit into her “quality world.”
(C): The client will engage in a minimum of two “values-based” activities each week.
(D): The client will list a minimum of three faulty assumptions contributing to her “failure identity.”",The client will engage in a minimum of two “values-based” activities each week.,C,"Behavioral activation is a cognitive-behavioral approach for treating depressive symptoms, including those associated with social isolation. It works by positively reinforcing activities related to one’s values and enjoyment rather than waiting for depressive symptoms to diminish before engaging in these activities. Motivational interviewing is used to reduce ambivalence and elicit change talk. Identifying concepts and faulty assumptions contributing to one’s failure identity is associated with Adlerian therapy. Lastly, reality therapy suggests that one’s “quality world” is at the core of life. One’s quality world includes individuals we are closest to and those who supply us with satisfying experiences. Therefore, the correct answer is (A)",treatment planning
351,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",In which example are you demonstrating an empathic response toward the client's mother?,Share a summary of the Education Act of 1996 with the mother,Summarize her concerns about her son's behavior,Ask the client to look at you when you are interacting with him,Provide a psychoeducational session concerning the client's physical needs versus his social needs,"(A): Share a summary of the Education Act of 1996 with the mother
(B): Summarize her concerns about her son's behavior
(C): Ask the client to look at you when you are interacting with him
(D): Provide a psychoeducational session concerning the client's physical needs versus his social needs",Summarize her concerns about her son's behavior,B,"In this case, this is the best empathic response as it directly demonstrates that you understand the mother's emotions or motivations. Therefore, the correct answer is (B)",counseling skills and interventions
352,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,What type of treatment would not be beneficial for treating Mark?,Self-management strategies,Assertive community treatment,Supportive therapy with psychoeducation,Antipsychotic medications alone,"(A): Self-management strategies
(B): Assertive community treatment
(C): Supportive therapy with psychoeducation
(D): Antipsychotic medications alone",Antipsychotic medications alone,D,"Antipsychotic medication alone is not as effective for treating Schizophrenia. Effective treatment includes a combination of antipsychotic medication as well as wraparound services. These services include supportive therapy with a focus on psychoeducation to help the person better understand their diagnoses. Services also include assertive community treatment which includes a team of a psychiatrist therapist and peer advocate to help manage crises medication and community resources. Finally, self-management strategies are useful in helping the client with everyday life skills. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
353,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”","Speaking with Lottie's mother after session, you mention her comment about getting in trouble for admitting to feeling unsafe. Lottie's mother assures you she is safe, saying she has told stories in the past which led to unsubstantiated reports and cancelled investigations. What should you do?",Continue to monitor the situation.,Confront Lottie about the storytelling.,Ask to have a session at Lottie's house.,File a report anyway out of safety concerns.,"(A): Continue to monitor the situation.
(B): Confront Lottie about the storytelling.
(C): Ask to have a session at Lottie's house.
(D): File a report anyway out of safety concerns.",Continue to monitor the situation.,A,"Lottie's mother's explanation of storytelling is plausible, especially considering what you already know of Lottie's behaviors. However, it does not mean you should remove your attention from this factor while counseling Lottie. Continued safety questions, learning more about Lottie's traumatic past, and continual communication with her mother are all healthy and appropriate actions to take as you further assess their situation. Having a home visit is a clinical choice between you, your supervisor, and your client, but it does not yet seem warranted in this case as Lottie continues to be capable of coming into the office for sessions and you have not had many sessions yet with her. You still do not have enough information to substantiate any reporting. Confronting Lottie about storytelling is a choice you can make if you witness the storytelling yourself, however it seems Lottie's response to your safety question was her way of applying her own efforts to no longer tell stories. Therefore, the correct answer is (C)",counseling skills and interventions
354,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks.  When this session is over, you check your online dating profile and notice that a past client’s sister reached out to you showing interest in going on a date. You and this past client terminated 3 years ago","When this session is over, you check your online dating profile and notice that a past client’s sister reached out to you showing interest in going on a date. You and this past client terminated 3 years ago. Which one of the following is aligned with the ethical guidelines of the American Counseling Association (ACA)?",You cannot date this person because she is related to a former client and 5 years have not passed since terminating the counseling relationship.,Document your decision and how the relationship is nonexploitative prior to going on a date with this client’s sister.,"You did not have a counseling relationship with your past client’s sister, so this does not prohibit you from dating her.",You can proceed with a date because it has been 3 years since you worked with her sister.,"(A): You cannot date this person because she is related to a former client and 5 years have not passed since terminating the counseling relationship.
(B): Document your decision and how the relationship is nonexploitative prior to going on a date with this client’s sister.
(C): You did not have a counseling relationship with your past client’s sister, so this does not prohibit you from dating her.
(D): You can proceed with a date because it has been 3 years since you worked with her sister.",You cannot date this person because she is related to a former client and 5 years have not passed since terminating the counseling relationship.,A,"According to ACA ethical guidelines, dating a former client and/or someone related to that client cannot be considered until at least 5 years have passed since terminating the counseling relationship; therefore, you cannot date this individual. In a case in which 5 years had already passed, it is also necessary to provide supporting documentation that this would not be an exploitative relationship. Therefore, the correct answer is (D)",professional practice and ethics
355,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","  You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown",Borderline personality disorder (BPD) is clustered with similar personality disorders characterized by which of the following traits?,Acute mood lability and social isolation,Fearful thinking and impulsive behavior,Dramatic and overly emotional behavior,Odd or eccentric behavior,"(A): Acute mood lability and social isolation
(B): Fearful thinking and impulsive behavior
(C): Dramatic and overly emotional behavior
(D): Odd or eccentric behavior",Dramatic and overly emotional behavior,C,"BPD is clustered with similar personality disorders characterized by dramatic and overly emotional behavior. The DSM-5-TR groups personality disorders into three clusters (ie, cluster A, cluster B, and cluster C). Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Individuals with personality disorders in cluster A often exhibit odd or eccentric behavior. Cluster B personality disorders include borderline, histrionic, antisocial, and narcissistic personality disorders. Individuals with cluster B personality disorders can be described as dramatic, emotional, or erratic. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Individuals in cluster C are characterized as anxious and fearful. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
356,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",How should you respond to her request to meet with her via telehealth for her next session?,"As the client is still a resident in the same state in which you practice, you agree to meet with her for a virtual session.",Recommend postponing the next counseling session until after the client returns from her trip.,Ask her to complete a telehealth consent form prior to scheduling the session.,"Prior to offering out-of-state services, you consult with your relevant governing agency or state laws.","(A): As the client is still a resident in the same state in which you practice, you agree to meet with her for a virtual session.
(B): Recommend postponing the next counseling session until after the client returns from her trip.
(C): Ask her to complete a telehealth consent form prior to scheduling the session.
(D): Prior to offering out-of-state services, you consult with your relevant governing agency or state laws.","Prior to offering out-of-state services, you consult with your relevant governing agency or state laws.",D,"Depending on the area in which you practice, there may be certain restrictions and regulations related to providing telehealth services outside of the state. It is best for you to consult with your relevant governing agency before providing service in any other state. Therefore, the correct answer is (A)",professional practice and ethics
357,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.  Sixth session You have seen the client every week since the initial intake. During today's session, the client tells you she has written a suicide note and left it in her room. Her mother is waiting in the lobby for the session to end. You tell the client you must bring her mother into the session and discuss the suicide note. You explain to the client that her mother's presence is necessary to explore and understand why the suicide note was written. The client expresses frustration and says, “You can’t bring my mom in here! She won’t understand why I wrote the note!” You empathize with her feelings, but also explain that it is important to discuss the reasons for writing the suicide note with her mother present. You reassure the client that you will guide the conversation to explore why she wrote the note and support her in addressing any underlying issues. You explain that understanding these reasons is an essential step toward moving forward and developing healthier coping strategies. The client reluctantly agrees, but insists on speaking with you alone first before bringing her mother into the session. You emphasize that it is important for her to be honest about her emotions and to talk about her experiences in order to identify the root cause of her distress. Throughout the conversation, you provide validation and affirmation in order to create a safe space for her to express her feelings. You remind her that she does not have to face the situation alone, and that you can work together to find a way forward.    Once the client has had an opportunity to share her thoughts and feelings, you ask if she is ready for you to invite her mother in. She agrees, and the mother joins you in session. You explain to the mother that her daughter wrote a suicide note and that the two of you have been discussing the suicide note and why it was written. You emphasize that your goal is to better understand the circumstances leading up to this situation, so that you can work together to find a way forward. You state that your primary focus is on finding solutions, rather than assigning blame or judgment. The mother looks at you in disbelief and says, ""What do you mean, she wrote a note saying she was going to kill herself? What are we doing here? I'm paying you to help my daughter, not make things worse!"" She grabs her daughter's hand and storms out, after expressing her anger loudly the whole way to her car.    You are unsure of how to proceed, so you discuss the case with your supervisor. Your supervisor listens and notes your concerns, offering advice and guidance on better handling the situation. He then suggests that you reach out to the client's primary care physician to discuss the possibility of hospitalization and other forms of support that might be available to the client. After further discussion, you call the client's physician and discuss the options.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",What is the best strategy to de-escalate the mother's anger in session?,Explain that suicidal gestures are common with depression and that this is not a reflection of the client's progress or lack thereof in therapy,Explain that understanding the circumstances leading up to this situation is an essential step toward moving forward,Validate her feelings and emphasize that her daughter’s wellbeing is your primary focus,"Employ therapeutic silence, to help the mother explore her own feelings.","(A): Explain that suicidal gestures are common with depression and that this is not a reflection of the client's progress or lack thereof in therapy
(B): Explain that understanding the circumstances leading up to this situation is an essential step toward moving forward
(C): Validate her feelings and emphasize that her daughter’s wellbeing is your primary focus
(D): Employ therapeutic silence, to help the mother explore her own feelings.",Validate her feelings and emphasize that her daughter’s wellbeing is your primary focus,C,"An effective strategy would involve validating her feelings, listening to her perspective, and reassuring her that you are actively seeking solutions for her daughter's wellbeing. Therefore, the correct answer is (D)",counseling skills and interventions
358,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client has made steady progress toward reducing maladaptive eating. After several weeks of collecting self-monitoring data, you and the client successfully identify patterns that maintain the problem of binge eating. The client’s depressive symptoms have improved, and she is seeking interpersonal connections. She has set appropriate boundaries with her family and distanced herself from their church. The client briefly attended a more liberal church, experienced biphobia, and did not return. She explains, “In my parent’s church, I’m not straight enough. In the LGBTQ community, I’m not gay enough.” You have introduced her to dialectical behavioral therapy, and she attributes mindfulness to improved depressive symptoms.  Your agency collects client satisfaction surveys that include a 5-point Likert rating scale. You notice that the client selected only neutral (i\. e., all 3s) answers","Your agency collects client satisfaction surveys that include a 5-point Likert rating scale. You notice that the client selected only neutral (i.e., all 3s) answers. This is most likely the result of which one of the following?",Central tendency bias,Primacy bias,The halo effect,Leniency bias,"(A): Central tendency bias
(B): Primacy bias
(C): The halo effect
(D): Leniency bias",Central tendency bias,A,"This is an example of central tendency bias. Central tendency bias occurs when a person rates items using only middle scores. This can happen when using a 5-point Likert scale and is prevented by instead using a 4-point Likert scale, which would force an individual’s score to fall to the left or right of the center. Leniency bias is when raters use only favorable ratings even though they believe that there is room for improvement. The halo effect is the tendency for a rater to allow one good trait to overshadow others. Individuals engaged in the primacy bias allow information received early on to take precedence over information received later. Therefore, the correct answer is (C)",professional practice and ethics
359,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","You meet with the client and review a log that he brings in that documents how often he masturbated over the past week. The client’s log showed that he masturbates about three to four times per day. The client appears to masturbate more when his roommates are not in the apartment and late at night when his time is less structured. The client reports that he has a job interview in a few days at a nonprofit agency that works with children to ensure that they have clothing. He feels that this will be meaningful work and is encouraged because he knows the supervisor there from a previous job, and he thinks that the supervisor is a respectful person. The client expresses worry that he will not be competent at the job based on how he is doing at his current place of employment. You support the client with reframing his anxious thoughts about the interview.  The client often appears embarrassed when talking with you about masturbation","The client often appears embarrassed when talking with you about masturbation. All of the following could be helpful in increasing the client’s level of comfort with this conversation, EXCEPT:",Normalizing,Self-awareness,Immediacy,Summarizing,"(A): Normalizing
(B): Self-awareness
(C): Immediacy
(D): Summarizing",Summarizing,D,"Although summarizing shows that you are listening, it does not necessarily actively support the client in feeling more comfortable regarding a topic. Immediacy is when you address what you are seeing in the session, when you see it. This may induce some discomfort, but it will likely lead to talking through the anxiety, shame, and guilt that the client feels when talking about this topic. Self-awareness of the counselor applies to the verbal and nonverbal reactions that the counselor portrays while the client opens up about his struggles with masturbation. The counselor should maintain self-awareness when reacting to the client on this topic so as to create a safe environment of openness and to deepen therapeutic rapport. Although normalizing would likely not be helpful for the client in the sense of normalizing masturbation (because this is a religious and, therefore, internal struggle for him), it might be helpful to normalize the client’s humanity as an imperfect being who struggles with certain behaviors. Therefore, the correct answer is (D)",counseling skills and interventions
360,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",Which best describes the legal requirements regarding your psychotherapy notes and reports for this client?,"Even though you are a licensed psychotherapist, as an employee of the school system, you are not required to keep psychotherapy notes, since your final report is a public record.","Even though you are a licensed psychotherapist, as an employee of the school, your psychotherapy notes and reports are part of the student's record.","Even though you are an employee of the school, your psychotherapy notes are confidential. Your final report is part of the student's record.","Even though you are a school employee, all communication and notes regarding your client are confidential.","(A): Even though you are a licensed psychotherapist, as an employee of the school system, you are not required to keep psychotherapy notes, since your final report is a public record.
(B): Even though you are a licensed psychotherapist, as an employee of the school, your psychotherapy notes and reports are part of the student's record.
(C): Even though you are an employee of the school, your psychotherapy notes are confidential. Your final report is part of the student's record.
(D): Even though you are a school employee, all communication and notes regarding your client are confidential.","Even though you are an employee of the school, your psychotherapy notes are confidential. Your final report is part of the student's record.",C,"Except for the usual exceptions of abuse and self-harm, therapy sessions follow rules of confidentiality. Therefore, the correct answer is (A)",professional practice and ethics
361,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.","Using the information you have learned, which of the next steps is most appropriate?",Schedule John for a series of assessments to determine his mental status,Refer John to his family physician,Schedule John to meet with a support group,Refer John to a psychiatrist for evaluation and medical management of depression,"(A): Schedule John for a series of assessments to determine his mental status
(B): Refer John to his family physician
(C): Schedule John to meet with a support group
(D): Refer John to a psychiatrist for evaluation and medical management of depression",Refer John to a psychiatrist for evaluation and medical management of depression,D,"John is demonstrating physical signs of depression and has self-assessed his emotional state as depressed. The most appropriate action is to refer him to psychiatry to have him evaluated and determine whether antidepressants are warranted. Only medical providers are allowed to dispense antidepressants. John took an SSRI previously with good results and his mood has decreased since stopping them 6-8 months ago. A psychiatrist will use this information to determine John's treatment for depression. You could refer him to his family physician but his doctor's previous linkage of his affective state with his blood pressure may influence how his doctor approaches the issue. Psychiatry specialists are experts in initial diagnosing and prescribing medication for depression. Once an effective level is achieved, John should follow up with his family doctor. Scheduling John for testing is unnecessary as you are observing depressive symptoms, John is affirming he feels depressed, and moving into treatment is the next step. Having John attend a support group may be helpful for him once his depression is controlled. This will provide a safe place for him to practice communication skills and vulnerability in sharing his thoughts and feelings. Therefore, the correct answer is (D)",treatment planning
362,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.",Which of the following counseling skills or interventions should be employed during this session?,Open-ended questions,Reflection,Self-disclosure,Exploring family of origin patterns related to loss,"(A): Open-ended questions
(B): Reflection
(C): Self-disclosure
(D): Exploring family of origin patterns related to loss",Reflection,B,"Reflections of feelings or affect allow the client to feel heard and understood. This is particularly important when a client feels others are not listening to them. Open-ended questions and family patterns can be helpful in treating loss but are not effective without a strong therapeutic bond. Self-disclosure focuses on the counselor's experience, rather than on the client's experience. Therefore, the correct answer is (A)",counseling skills and interventions
363,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client comes to the session reporting that he and his girlfriend attempted to have sex the past week, and he wrote down some thoughts he was having on his CBT thought log. The client and the clinician reviewed his thoughts and engaged in cognitive reframing to support him in creating new scripts to use when engaging in sex. The client also wrote down physical responses to anxiety that he was experiencing before and during sex that included muscle tension and increased heart rate. You ask the client what his life would be like if he did not feel that he can’t satisfy his significant other, and he does not respond immediately","You ask the client what his life would be like if he did not feel that he can’t satisfy his significant other, and he does not respond immediately. All of the following are important aspects of the use of silence EXCEPT:","The client appears uncomfortable with the silence, so you provide him with a prompt to say whatever is coming to his mind.","Your client may provide a meaningful response as a result of the silence, so you maintain the silence.","After providing a period of silence, you use attending skills to let the client know it is his turn to speak.","The client is not responding to the silence, so you continue talking to try to elicit more information.","(A): The client appears uncomfortable with the silence, so you provide him with a prompt to say whatever is coming to his mind.
(B): Your client may provide a meaningful response as a result of the silence, so you maintain the silence.
(C): After providing a period of silence, you use attending skills to let the client know it is his turn to speak.
(D): The client is not responding to the silence, so you continue talking to try to elicit more information.","The client is not responding to the silence, so you continue talking to try to elicit more information.",D,"You should continue to maintain silence instead of continuing talking because you are missing the opportunity to use silence by continuing silence. Maintaining silence, providing a prompt to respond to the silence, and the use of attending skills to encourage silence are all helpful skills to prompt a response to the use of silence. Therefore, the correct answer is (B)",counseling skills and interventions
364,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,"By conducting extensive research, the counselor is demonstrating",Multicultural sensitivity,Non-judgmental stance,Unconditional positive regard,Empathetic Attunement,"(A): Multicultural sensitivity
(B): Non-judgmental stance
(C): Unconditional positive regard
(D): Empathetic Attunement",Multicultural sensitivity,A,"Culture encompasses many things that make the client unique such as gender. By the counselor taking the time to do extensive research on a topic they are not familiar with, they show multicultural sensitivity. Unconditional positive regard is warmth and acceptance towards the client while not focusing on past transgressions. Empathetic attunement is the ability to put oneself in the shoes of another. Having a non-judgmental stance in not judging in comparison to personal standards. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
365,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","  You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown.  After reviewing the client’s hospital records, you conduct an unstructured interview to confirm and retain the diagnosis of substance use disorder","After reviewing the client’s hospital records, you conduct an unstructured interview to confirm and retain the diagnosis of substance use disorder. Your clinical judgment may have been influenced by which of the following?",The Hawthorne effect,Affect heuristic,Overconfidence bias,Confirmation bias,"(A): The Hawthorne effect
(B): Affect heuristic
(C): Overconfidence bias
(D): Confirmation bias",Confirmation bias,D,"Individuals subject to confirmation bias seek information that confirms an initial hypothesis while rejecting information that does not fit the theory. An unstructured interview consists of open-ended questions used to arrive at a diagnosis, whereas structured interviews use a standardized list of questions. Semistructured assessments offer flexibility between the two. Unstructured interviews are subject to bias, particularly for an unseasoned clinician. Overconfidence bias, a form of hindsight bias, occurs when counselors overestimate their ability to make sound clinical decisions. Overconfidence bias occurs when answers to difficult clinical decisions seem apparent when viewed retrospectively. Affect heuristic is used when counselors base clinical decisions on the feelings experienced when interacting with a client. For example, if a client becomes angry or irrational during a diagnostic assessment, which produces countertransference, the counselor may be quick to assign a BPD diagnosis. The Hawthorne effect is the tendency for individuals to change their behavior in response to knowing they are being monitored or observed. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
366,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Using the information you have learned, which of the following will not be helpful in focusing on change?",Help the client practice visualizing her home and yard without clutter,Help the client identify barriers to making the changes she would like to make,Help the client identify strengths that she possesses that can help her make changes,Help the client practice relaxation exercises to relieve anxiety,"(A): Help the client practice visualizing her home and yard without clutter
(B): Help the client identify barriers to making the changes she would like to make
(C): Help the client identify strengths that she possesses that can help her make changes
(D): Help the client practice relaxation exercises to relieve anxiety",Help the client practice visualizing her home and yard without clutter,A,"Helping the client visualize her home and yard without the clutter is most likely to cause the client higher anxiety. Hoarding represents an attachment to possessions and visualizing her possessions gone may upset her. It will be more helpful for the counselor to help the client identify the strengths that she possesses and can draw on as she tries to make changes in the way she thinks about things. Identifying barriers to her success will be helpful as these are areas that can be proactively processed and rehearsed for so that the client has a plan in place when they occur. Using relaxation exercises will be helpful when barriers are encountered and particularly when the client and her support system begin clearing her home and yard. Therefore, the correct answer is (A)",counseling skills and interventions
367,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ","When you see that the client likes anime, you pull out your Nintendo Switch and ask him if he wants to play Dragon Ball FighterZ. Which explanation is appropriate, given he just threatened to kill his classmates and himself this week?",The client's past threat to harm himself and others should be addressed first before providing rewards.,Using gaming would only be appropriate in subsequent sessions after therapeutic goals have been established.,Playing games with the client minimizes the severity of his actions and reinforces his denial.,"Engaging in a therapeutic activity that engages the client helps establish rapport, which is paramount at this stage.","(A): The client's past threat to harm himself and others should be addressed first before providing rewards.
(B): Using gaming would only be appropriate in subsequent sessions after therapeutic goals have been established.
(C): Playing games with the client minimizes the severity of his actions and reinforces his denial.
(D): Engaging in a therapeutic activity that engages the client helps establish rapport, which is paramount at this stage.","Engaging in a therapeutic activity that engages the client helps establish rapport, which is paramount at this stage.",D,"As indicated, the client became agitated and defensive whenever the topic of him threatening to kill his classmates and himself was brought up, and he is now unwilling to talk to you. Unless you can establish rapport with the client, you will not be able to work with him regarding the incident at school. If he were willing to work with you, you would first address his threat to harm himself and others. Therefore, the correct answer is (A)",counseling skills and interventions
368, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",Which of the following is the least appropriate way to demonstrate cultural sensitivity to Malik?,Ask her to tell you more about her heritage and its importance to her.,Discuss with her the similarities and differences about Hawaiian and mainland culture.,Share with her your extensive knowledge of Hawaii and how you loved vacationing there.,Conduct interventions that increase her self-esteem in her heritage.,"(A): Ask her to tell you more about her heritage and its importance to her.
(B): Discuss with her the similarities and differences about Hawaiian and mainland culture.
(C): Share with her your extensive knowledge of Hawaii and how you loved vacationing there.
(D): Conduct interventions that increase her self-esteem in her heritage.",Share with her your extensive knowledge of Hawaii and how you loved vacationing there.,C,"Personal anecdotes about your connection to her culture that do not adequately reflect or support your client's concerns are not useful in counseling. It is also insensitive to present yourself as ""expert"" in the topic of their heritage. As a counselor it is your responsibility to help your client feel safe and secure so they can share about themselves and how their thoughts, beliefs, cultural attitudes, and experiences shape and affect their moods, behaviors, and reactions to different situations. Not everyone from the same culture feels and thinks the same way about their acculturation stress, so working with Malik to learn more about how she specifically feels is paramount in understanding how to help her. Interventions b, c and d are all effective and positive ways of addressing her heritage, learning more about her feelings, and helping her overcome her anxiety. Therefore, the correct answer is (A)",core counseling attributes
369,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","   fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend.  You have been diagnosed with ADHD and experience similar struggles that you want to share with the client",You have been diagnosed with ADHD and experience similar struggles that you want to share with the client. Which one of the following is the most helpful description of effective self-disclosure?,Sharing personal experiences can enrich the counseling relationship.,You use self-disclosure when it is beneficial for displaying your empathetic understanding and when it benefits the counseling relationship.,You use self-disclosure in order to develop rapport with your client.,No level of self-disclosure is appropriate because you are counseling the client and do not want to risk them having to support your emotional needs.,"(A): Sharing personal experiences can enrich the counseling relationship.
(B): You use self-disclosure when it is beneficial for displaying your empathetic understanding and when it benefits the counseling relationship.
(C): You use self-disclosure in order to develop rapport with your client.
(D): No level of self-disclosure is appropriate because you are counseling the client and do not want to risk them having to support your emotional needs.",You use self-disclosure when it is beneficial for displaying your empathetic understanding and when it benefits the counseling relationship.,B,"The use of self-disclosure is a helpful therapeutic tool in demonstrating empathy and can benefit the counseling relationship when used appropriately. Self-disclosure should only occur when it would be beneficial to the therapeutic process; it should be used discriminately. Completely refraining from using self-disclosure prevents the counselor from access to a potentially helpful tool. Therefore, the correct answer is (D)",counseling skills and interventions
370,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.",,What concurrent referral might you consider for this client?,Support group,Behavior analyst,Clinical hypnotist,Career counselor,"(A): Support group
(B): Behavior analyst
(C): Clinical hypnotist
(D): Career counselor",Support group,A,"A support group specific to individuals entering a new phase of life (such as singleness after a recent divorce) may benefit this client. Therefore, the correct answer is (A)",treatment planning
371,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling  Marital Discord Diagnoses:  You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago.  The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of  The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce","During the initial session, which of the following would you use to create a therapeutic alliance with the couple?",Encourage the use of “I” statements and teach effective problem solving.,Empathize with and validate the client’s physical and emotional pain.,Explain your clinical approach to help define the treatment focus.,Summarize the couple’s concerns and assess readiness for change.,"(A): Encourage the use of “I” statements and teach effective problem solving.
(B): Empathize with and validate the client’s physical and emotional pain.
(C): Explain your clinical approach to help define the treatment focus.
(D): Summarize the couple’s concerns and assess readiness for change.",Summarize the couple’s concerns and assess readiness for change.,D,"Summarizing shared concerns and assessing readiness for change can help create a therapeutic alliance with the couple. During the initial stage of treatment, building a therapeutic alliance can be accomplished by assisting the couple in conceptualizing the presenting problem. This can be done by using core counseling techniques, including, but not limited to, summarization, empathy, attending, encouraging, genuineness, and congruence. In addition, counselors can use a motivational enhancement approach to determine a couple’s readiness for change. Assessing a couple’s readiness to change contributes to the therapeutic alliance by fostering hope. Explaining your clinical approach to define the treatment focus is not the best option because it does not elicit the couple’s input for what they need and hope to get out of therapy. Empathizing and validating the client’s pain addresses the client’s needs, but this does not address the couple’s needs. Further, this response may alienate the husband and potentially deprive him of the opportunity to later express this sentiment to his wife. Encouraging “I” statements and problem solving are helpful interventions, but this is not the best option for creating a collaborative therapeutic alliance. Therefore, the correct answer is (C)",counseling skills and interventions
372,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.",What assessment tool should be used to evaluate Millie's risk of suicidality?,Beck Depression Inventory,Mental Status Examination,Columbia Suicide Severity Rating Scale,Hamilton Depression Rating Scale,"(A): Beck Depression Inventory
(B): Mental Status Examination
(C): Columbia Suicide Severity Rating Scale
(D): Hamilton Depression Rating Scale",Columbia Suicide Severity Rating Scale,C,"Using the Columbia Suicide Severity Rating Scale, you will learn Millie's history of actual suicidal ideation or behaviors and her current level of risk based on several factors contributing to a severity score. The Hamilton Rating Scale for Depression measures depression in individuals before, during and after treatment, and the Beck Depression Inventory is useful to measure behavioral manifestations and severity of depression across one's lifespan. You can conduct a mental status exam to screen for suicide risk, however in the mental status exam presented here, Millie is denying active suicidal ideation and is also presenting with incongruent affect causing difficulty with discernment of her actual condition. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
373,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.",ntly. Family History: The client has an older brother who transports the client to appointments and periodically checks in with the client. Hospital records indicate that the client becomes increasingly agitated during visits with his parents. The hospital social worker noted that his father was critical and dismissive toward the client during family therapy. The client’s mother is diagnosed with generalized anxiety disorder and had to quit her job due to the overwhelming burden of the client’s care. The father blames the client for the excessive toll his illness has placed on the family,How would you classify the type of delusion the client is experiencing?,Grandiose,Nihilistic,Persecutory,Somatic,"(A): Grandiose
(B): Nihilistic
(C): Persecutory
(D): Somatic",Persecutory,C,"The client’s delusions are persecutory. The DSM-5-TR recognizes the following types of schizophrenic delusions: persecutory, grandiose, somatic, erotomania, and jealousy. Subtypes are determined by the client’s primary symptoms and can change over time. Persecutory delusions involve the fixed belief that someone intends to harm the individual. For this client, it is the shadow man. Nihilistic delusions are thoughts that center around the belief that complete devastation or catastrophe is soon approaching. Grandiose delusions occur when there is a preoccupation with believing that one is of great significance, is famous, or has other exceptional talents or traits. Somatic delusions are fixed beliefs concerning one’s health or organ functioning. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
374,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","   ence. Family History: The client is married and has a 10-year-old daughter from a previous marriage. The client explains that her father was “distant and quiet unless he was drinking.” She remembers hearing that her paternal grandfather declared bankruptcy “at least once” due to gambling losses. The client’s mother has been diagnosed with bipolar disorder, with acute episodes requiring hospitalization. The client indicates that a former therapist also diagnosed her with bipolar disorder, but she rejects the diagnosis stating her symptoms are “nothing like my mother’s",Which intervention would you select to help the client process grief related to her job loss?,Acceptance and commitment therapy (ACT),Reality therapy (RT),Solution-focused brief therapy (SFBT),Interpersonal psychotherapy (IPT),"(A): Acceptance and commitment therapy (ACT)
(B): Reality therapy (RT)
(C): Solution-focused brief therapy (SFBT)
(D): Interpersonal psychotherapy (IPT)",Interpersonal psychotherapy (IPT),D,"Interpersonal psychotherapy (IPT) is an evidence-based practice for bipolar II disorder that addresses interpersonal deficits, including life transitions, conflict at home or in the work environment, and managing grief and loss. Grief and loss can pertain to losing another person or losing a healthy sense of self. IPT is beneficial for individuals with bipolar II disorder because psychosocial stressors can exacerbate diagnosis-specific symptoms. William Glasser is credited with developing reality therapy, which is based on the assumption that individuals are responsible for appropriately choosing behaviors to meet their goals, desires, and needs. Solution-focused therapy, or solution-focused brief therapy, is grounded in the assumption that individuals can make positive choices and can adopt workable solutions to problems. Acceptance and commitment therapy combines mindfulness and behavioral therapy elements to assist individuals with greater self-acceptance of uncomfortable feelings. Therefore, the correct answer is (D)",treatment planning
375,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ","After assessing the client, you determine that her ""feeling of giving up"" does not require hospitalization or will lead to self mutilation. You do need to address her current emotive crisis. What feelings do you identify as the most significant to address in this session?",Grief,Shock and betrayal,Sadness and anger,Fear of the future,"(A): Grief
(B): Shock and betrayal
(C): Sadness and anger
(D): Fear of the future",Shock and betrayal,B,"It is important to address the feelings of betrayal and abandonment the client feels, as these will have a much more significant impact on the client's emotional state. Betrayal can devastate a person's emotional state, particularly when it comes to the dissolution of a marriage. The client in question has been dealt a heavy blow, as her husband has unexpectedly left her without warning. For the client, the betrayal of trust and feeling of abandonment can be overwhelming and deeply painful. The client already has trust issues and may find it difficult to trust anyone again or to see relationships in the same light as before. Therefore, the correct answer is (A)",counseling skills and interventions
376, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.","Leah decides to share about her traumatic divorce that occurred at the same time as her separation from the military. She explains that she pushes away the people who show concern for her, and understands it is likely due to fear of abandonment. What would help her learn more about this?",Myers-Briggs Type Indicator,BPD checklist,Adult Separation Anxiety Questionnaire,Schema Therapy,"(A): Myers-Briggs Type Indicator
(B): BPD checklist
(C): Adult Separation Anxiety Questionnaire
(D): Schema Therapy",Schema Therapy,D,"Schema therapy combines elements of CBT, psychoanalysis, attachment theory, and emotion-focused therapy, which aims to teach you how to ensure your emotional needs are met in a healthy way that does not cause distress. To understand this in Schema therapy, one must take the Young Schema Questionnaire which leads you to identify your Early Maladaptive Schemas. Abandonment is one of the issues focused on and assessed for using the YSQ. Regarding answer b), Leah does not meet criteria for BPD solely because she is afraid of abandonment. A disorder checklist will not help her learn more about the connection between her trauma and active behaviors. The Adult Separation Anxiety Questionnaire is a 27-item self-report that examines symptoms of separation anxiety experienced after 18 years of age, but also does not apply to this situation as the two phenomena may be linked but are different clinical presentations. The Myers-Briggs Type Indicator is an introspective self-report that indicates different psychological preferences in how people perceive the world and make decisions, often used for professional development purposes. Therefore, the correct answer is (A)",counseling skills and interventions
377,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.  Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms.  Ninth session Rober arrives elated at the session, appearing happy, talkative, and smiling. He states that he has felt this way for four days now, which has not been the typical length of time or the intensity of his positive mood episodes. He reports that his family relationships are satisfactory, and he has been somewhat successful at his part-time job at the local lumberyard. However, he is angry with his manager, who says he has been too distracted this past week and spends more time talking with customers than working. He is still drinking three beers at night to sleep but reports that he has not had to sleep much this past week and feels ""wide awake."" He says he is ready to open his own business but isn't sure what he wants to do yet.  Roger reports feeling energized, creative, and motivated over the past several days. He has come up with many new business ideas that he is eager to pursue, including opening a restaurant, starting a landscaping company, and developing a crypto blockchain. Roger stays up late into the night brainstorming ideas and making extensive plans. He feels compelled to act on his ideas immediately and has already taken steps to register business names and research loans. However, the next day, Roger often changes course, dropping previous ideas for new ones that seem even more exciting. His friends notice his frenzied pace in bouncing from idea to idea, worrying he has taken on too much. But Roger reassures them this surge of creativity allows him to see endless possibilities for his future business success. Though well-intended, their skepticism only pushes him to work harder to bring his visions to life.  Roger also mentions experiencing increased sociability and talkativeness lately. He says he has frequently called and texted friends and family to share his business ideas and other excited thoughts. Roger speaks rapidly, his thoughts racing as he tries to get loved ones as enthused as he feels. Though some gently try to interject realistic concerns, he remains unchecked in his ambitious optimism. A few close friends have expressed concern over Roger's intensified pace and plans, but he brushes them off, feeling very optimistic and self-assured about his ideas. Roger's confidence borders on grandiose as he envisions an incredibly successful entrepreneurial future. Attempts by caring friends and family to restrain his inflated self-assurance are met with irritation, as Roger feels unable to focus on anything but chasing his next big idea. He's optimistic that his new crypto blockchain will rival and surpass Bitcoin in a matter of months.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.","When a client presents in a hypomanic state, what is the initial determination that a therapist must make?",Is the client suitable for starting a physical workout to channel excess energy?,Is the client under the influence of substances?,Is the client going to require hospitalization?,Is the client able to safely make decisions for themselves and are they a risk to other's around them?,"(A): Is the client suitable for starting a physical workout to channel excess energy?
(B): Is the client under the influence of substances?
(C): Is the client going to require hospitalization?
(D): Is the client able to safely make decisions for themselves and are they a risk to other's around them?",Is the client able to safely make decisions for themselves and are they a risk to other's around them?,D,"This will allow a therapists to respect a client's autonomy while still upholding the duty to protect. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
378,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.  Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself.    When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress.    Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, ""My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?"" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious.    At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ",Why would you give the client a referral to his pediatrician?,For advice on anxiety-specific nutrition,For a medical second opinion,For a more thorough psychological exam,For anti-anxiety medication evaluation,"(A): For advice on anxiety-specific nutrition
(B): For a medical second opinion
(C): For a more thorough psychological exam
(D): For anti-anxiety medication evaluation",For anti-anxiety medication evaluation,D,"There are age-appropriate medications which can lend short-term help in cases of anxiety disorder in youths. Therefore, the correct answer is (B)",treatment planning
379,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.  10th session During your last session with the client, she discussed the anxiety that she was feeling about going home for winter break in a few weeks. She told you that her mom and stepdad always prepare a large meal for the holidays, and the extended family members get together to eat. She expressed a desire to participate in the family festivities but concern about her mom and stepdad's lack of understanding about her illness. She told you, ""I don't want to make anyone feel bad, but I just can't eat like everyone else. It's not only the food - it's the conversations and comments about my body that really bother me."" You listened as she expressed her fear of disappointing her family and reassured her that is was okay to set boundaries and have conversations about food. Together, you brainstormed coping strategies to manage her anxiety. You also suggested that she bring a dish of food that she would be comfortable eating to the winter break gathering. At the end of the session, she asked if she could bring her parents to the next session in an effort to gain their support and to help them understand what she is going through. You agreed to her request and scheduled an appointment to meet with the client and her parents.    At the start of today's session, you introduce yourself to her parents and explain your role in helping their daughter. The client's mother tearfully shares that she had no idea her daughter was struggling so much and that she wishes she had picked up on the signs sooner. The stepfather appears quiet and reserved. You help guide a conversation between the client and her parents about her eating disorder and symptoms that she is experiencing. The client shares her fears, triggers, and struggles around food. Her stepfather speaks up and says, ""I've heard enough. This is just ridiculous. You should just be able to eat, like everyone else. Your generation has gone 'soft' and started making up problems. There are people out there who don't have any food. When I was growing up, we had nothing. Your behavior is disrespectful."" As he is talking, the client's mother is quiet and visibly uncomfortable. The client interjects, ""Are you kidding? I'm the one who's being disrespectful?"" She looks toward you and says, ""When I'm home, he cooks these extravagant meals and refuses to let me leave the table until I've eaten what he's served me because it's 'wasteful to throw away food.' It's abuse! I feel like a captive when I'm at home."" She looks back at her stepfather and says, ""All I'm asking is that you understand what I'm going through and try to be a little more supportive."" The stepfather's face turns red with anger, and he gets up to leave the room. You intervene and ask him to stay, offering a suggestion that you all take a few moments to reflect on what each person has shared before continuing the conversation. While the stepfather takes a break, you encourage the mother to open up and express her feelings. She reveals that she is scared of not being able to help her daughter and feels helpless in understanding how to come together as a family. You discuss ways that she can be supportive and provide an empathetic environment for her daughter.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","Based on the interactions you observe in this session and the client's family history, what new objective would you consider incorporating into the treatment plan?",Addressing client anger issues,Identifying alternative ways of coping with family stress,Developing effective communication strategies for managing difficult conversations,Exploring ways in which the client can adjust to the requests of others,"(A): Addressing client anger issues
(B): Identifying alternative ways of coping with family stress
(C): Developing effective communication strategies for managing difficult conversations
(D): Exploring ways in which the client can adjust to the requests of others",Developing effective communication strategies for managing difficult conversations,C,"This objective is important because it encourages the client and her family to express their feelings in a constructive way, allowing them to come together in support of the client's health and well-being. This will help reduce tension and foster more positive relationships among family members. Additionally, it can provide the client with tools for managing conversations that may trigger negative emotions or behaviors. Therefore, the correct answer is (C)",treatment planning
380, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,Theodore made positive changes in a short amount of time because?,The goals were attainable,Both b and c,The goals were made by Theodore,The goals were agreed upon by Theodore and the counselor,"(A): The goals were attainable
(B): Both b and c
(C): The goals were made by Theodore
(D): The goals were agreed upon by Theodore and the counselor",Both b and c,B,"It is evident that Theodore made a tremendous amount of progress in a short amount of time. Since the goals were made by Theodore, he was able to focus on something he was motivated to work on. Although some goals may seem small and short term, early successes build confidence in the ability to change. Whether or not a counselor agrees with a goal does not determine the likelihood for success. A counselor can discuss possible outcomes or barriers, but ultimately, the goal setting is up to the client. Therefore, the correct answer is (D)",counseling skills and interventions
381, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,A theoretical approach that may work for Darrel is?,Person-Centered therapy,Family systems therapy,Psychoanalysis,Cognitive Behavioral therapy,"(A): Person-Centered therapy
(B): Family systems therapy
(C): Psychoanalysis
(D): Cognitive Behavioral therapy",Cognitive Behavioral therapy,D,"Cognitive behavioral therapy provides a structured, focus-active approach which seems congruent with Darrel's request to learn coping skills and assertiveness training. A psychoanalytic or person-centered approach would be too passive and long term. Family Systems therapy focuses on dysfunctional family relationship problems which are not evident currently. Therefore, the correct answer is (C)",counseling skills and interventions
382,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community.  The client has met his treatment plan goals, is pleased with his progress, and is ready to end therapy. The client and his parents have also made therapeutic gains in family therapy; however, his parents are not prepared to end treatment and would like to keep seeing you without the client","The client has met his treatment plan goals, is pleased with his progress, and is ready to end therapy. The client and his parents have also made therapeutic gains in family therapy; however, his parents are not prepared to end treatment and would like to keep seeing you without the client. After providing pretermination counseling, how should you proceed?",Encourage the client to continue therapy and continue working with all parties.,Terminate with all parties after referring the parents to another provider.,Terminate with all parties.,Terminate with the client and continue working with the parents.,"(A): Encourage the client to continue therapy and continue working with all parties.
(B): Terminate with all parties after referring the parents to another provider.
(C): Terminate with all parties.
(D): Terminate with the client and continue working with the parents.",Terminate with all parties.,C,"After providing pretermination counseling, you should terminate with all parties. Per the ACA Code of Ethics (2014), “Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling” Termination with clients is an ongoing process that begins with informed consent at the outset of treatment. Since the client has met his treatment goals, he no longer needs assistance. Regarding multiple roles, the ACA Code of Ethics (2014) states, “When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. […] Counselors provide pretermination counseling and recommend other service providers when necessary” Since the identified client’s goals have been met, the counselor should continue with pretermination counseling and go forward with the planned termination. The parents would not require an outside referral because treatment plan goals have been met. Church and community connections also serve as ongoing support for the family. Therefore, the correct answer is (A)",professional practice and ethics
383,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","You noted the client stating that he hoped his wife would leave him. From a psychoanalytic perspective, what underlying theme does this comment suggest is prevalent in his thought process?",Fear of abandonment or rejection,Unresolved grief from past relationships and losses,Sense of helplessness and desperation regarding his marriage,An approach-avoidance syndrome,"(A): Fear of abandonment or rejection
(B): Unresolved grief from past relationships and losses
(C): Sense of helplessness and desperation regarding his marriage
(D): An approach-avoidance syndrome",Sense of helplessness and desperation regarding his marriage,C,"From a psychoanalytic perspective, Alexei's statement suggests an underlying sense of helplessness and desperation regarding his marriage. His desire for his wife to leave him reflects a deep-seated wish to escape the power imbalance in the relationship, where he feels powerless and unable to effectively manage her anger or criticism. This is likely linked to his feelings of inadequacy and worthlessness, which are likely rooted in other early experiences. Therefore, the correct answer is (D)",counseling skills and interventions
384,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.  Eighth session The client and his mother arrive for today's session. You begin by meeting with the client alone and plan to speak with his mother afterwards. You ask the client how he has been doing since last week. He is quiet and shrugs his shoulders. You take a moment to notice his non-verbal cues and then gently ask him, ""It looks like something is on your mind. Do you want to tell me about it?"" He hesitates for a moment and then says, ""I don't know. My mom told me that I have to stop playing video games so much. She said it's getting in the way of my homework. But I don't have any friends and video games are the only thing that makes me feel better. It's not fair. My mom gets to do whatever she wants."" You listen attentively and validate his feelings. You explain to him that it is important to have a balance between recreational activities and taking care of responsibilities, like doing your homework. You say, ""Your mom has a job, right? Sometimes she has to take care of things like going to work or paying bills, and it's the same when we have responsibilities at school. It takes time and effort, but if we do it, then it can free up some time for fun activities like playing video games."" He shrugs and says, ""Yeah, I guess.""    You continue the session by discussing his behavior in school and ask him if he can think of any positive experiences he has had since the last session. He thinks for a moment, then starts to shout excitedly, ""Yes! There was something!"" You intervene by giving him a choice of writing down his feelings or starting over with a quieter tone. He stops, takes two breaths, then proceeds to tell you about his experience in the school playground, where he managed to stay calm when he was provoked by a classmate. He said that his teacher was watching and praised him for staying calm. She gave him a sticker and told him that he could choose the game they would play at recess. You congratulate him on his success and praise him for his efforts.    After you conclude the session with him, you invite his mother to your office and direct the client to wait in your waiting room. You talk to his mother to determine how her home parent training is going and review the client's treatment plan with her. His mother states that when she tried to set boundaries on gaming time, he had a ""melt down"". You suggest that she could consider increasing the amount of time he can play his video games in increments if he meets certain goals, such as completing all of his homework or cleaning up his room. She agrees to try this during the upcoming week. She also mentions that her son continues to struggle socially. When she told him that he could invite a friend over for pizza, he said, ""What friend? Making friends is dumb. Who needs them anyway?""    Following the session, you receive a phone call from the client's father who states that he has recently reconnected with his family. He says, ""My wife told me that you've been working with my son. I know he's got some issues. I'm trying to get back in his life and make things right. What should I do?""","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",What statement is strength-based to empower the client to continue to achieve his goals?,"""I'm proud of you for being able to stay calm in the playground. Showing that kind of self-control takes practice and effort, so keep up the terrific work.""","""I know you're feeling frustrated. If you continue to work hard on staying calm when you feel angry, your mom will let you have more time to play video games.""","""It's great that your teacher noticed that you have been practicing staying calm. I bet she's really proud of you!""","""Your mom told me that you're having some trouble following her rules for video gaming. Can you think of another activity that you like to do instead?""","(A): ""I'm proud of you for being able to stay calm in the playground. Showing that kind of self-control takes practice and effort, so keep up the terrific work.""
(B): ""I know you're feeling frustrated. If you continue to work hard on staying calm when you feel angry, your mom will let you have more time to play video games.""
(C): ""It's great that your teacher noticed that you have been practicing staying calm. I bet she's really proud of you!""
(D): ""Your mom told me that you're having some trouble following her rules for video gaming. Can you think of another activity that you like to do instead?""","""I'm proud of you for being able to stay calm in the playground. Showing that kind of self-control takes practice and effort, so keep up the terrific work.""",A,"This response acknowledges the progress he has made and encourages him to keep going. Therefore, the correct answer is (C)",counseling skills and interventions
385,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Using the information provided, which of the following would not be the best choice for determining the client's current status and potential mental health needs?",Structured Interview for Adult ADHD,Beck's Depression Inventory-II (BDI-II),Yale-Brown Obsessive Compulsive Scale (YBOC),Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),"(A): Structured Interview for Adult ADHD
(B): Beck's Depression Inventory-II (BDI-II)
(C): Yale-Brown Obsessive Compulsive Scale (YBOC)
(D): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)",Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),D,"The MMPI-2 is used to assess personality traits and psychopathology and has over 500 questions at an 8th grade reading level. Because the client states that she had reading difficulties for years prior to quitting school in 10th grade, this would be the least helpful assessment for this client. The BDI-II measures the client's current level of depression, which is often correlated with symptoms of hoarding. The potential for this client to be experiencing a hoarding disorder is noted in the number of animals she keeps, the amount of vehicles, and other items kept without letting them go. Additionally, hoarding is often related to OCD and ADHD, making the YBOC and Structured Interview for Adult ADHD tests to consider for this client. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
386, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.",The client reports having several concerns about the antidepressants she has been prescribed by her psychiatrist and asks for your help in switching medications or modifying her dosage. Which of the following is the best choice for responding to the client's concerns?,"Before or after using techniques described in answer c, refer her back to her psychiatrist to discuss her medication changes.",Offer alternative solutions for different medicinal regimens that are not known to have the same side effects.,Validate the client's feelings and lead client into further discussion about symptoms through Socratic questioning.,Confront deflection from addressing core issues and re-direct her to discussing negative core beliefs.,"(A): Before or after using techniques described in answer c, refer her back to her psychiatrist to discuss her medication changes.
(B): Offer alternative solutions for different medicinal regimens that are not known to have the same side effects.
(C): Validate the client's feelings and lead client into further discussion about symptoms through Socratic questioning.
(D): Confront deflection from addressing core issues and re-direct her to discussing negative core beliefs.","Before or after using techniques described in answer c, refer her back to her psychiatrist to discuss her medication changes.",A,"Only psychiatrists, registered mental health nurse practitioners, and in some cases primary care physicians are qualified to make recommendations or adjustments to a client's mental health medications. While it is preferrable for a counselor to have knowledge of psychiatric medications and their effects, it is outside of the scope of practice and must be deferred to the appropriate professional. The approach in answer b) does not adequately validate the client's psychiatric or medical problem, which should be prioritized initially over cognitive behavioral therapy (CBT) approaches until a client has stabilized. Using these techniques will be optimally effective in conjunction with the correct medication and in later stages of treatment once the therapeutic relationship has been more established. It is most often the case that a client demonstrates the need for CBT to show improvement; but the approach in answer b) is also needlessly confrontational during an intake session, which may disrupt the trust-building and information gathering phase. In this case, the client has already been working with the agency's Psychiatrist, therefore it would be best practice to have her discuss with her doctor directly. Neglecting to address the client's reported issues with her psychiatric medications can also be deemed a liability and thus it is important to follow up with the client to ensure her needs are being addressed despite the counselor's opinion that the client has preoccupation with the psychiatric portion of her care. Therefore, the correct answer is (D)",counseling skills and interventions
387, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",Avery has a history of multiple medication switches with his psychiatrist. Which of the following steps would not be necessary to do for your treatment planning?,Inquire about which medications he was on and their effectiveness,Provide education on stimulants and other prescriptive regimens,Ask the parents to provide a copy of Avery's Psychiatric records,Help the parents identify and explore patterns of behavior and root causes,"(A): Inquire about which medications he was on and their effectiveness
(B): Provide education on stimulants and other prescriptive regimens
(C): Ask the parents to provide a copy of Avery's Psychiatric records
(D): Help the parents identify and explore patterns of behavior and root causes",Ask the parents to provide a copy of Avery's Psychiatric records,C,"Answers b) through d) are all appropriate ways to better understand Avery's journey with mental health medications and addressing each of these items can support the parents in their decision making going forward. While you can view the records of other providers with parental consent of your minor client (whether the parents provide them to you, or you submit a release of information and request them from the provider directly) it is not necessary for your treatment planning considerations. Therefore, the correct answer is (A)",professional practice and ethics
388,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.  10th session You have been seeing Gregory for therapy every week for the past three months. You have worked to improve the parent-child relationship and incorporated parent-management training into his treatment plan. You have taught Gregory's mother techniques to improve his behavior and support his emotional functioning. Also included in Gregory's treatment plan is improving impulse control, learning problem-solving skills, and improving social skills. You have used CBT interventions, structured activities, games, and role-playing exercises with Gregory to achieve these goals.    Today, Gregory begins the session by taking a paper from his backpack and handing it to you. You see that he received a high grade on his mid-term in Global Studies. You praise him for his hard work. Then, you ask him how it felt to get his grades back up. There is a long silence. Gregory is fidgeting with the string on his backpack. He turns, looks out the window, and whispers, ""Good, I guess."" You notice the client has tears in his eyes. You draw his attention to his behavior and affect and ask, ""Why are you upset after being successful with your exam?"" He shrugs his shoulders, looks at you, says, ""Would you stop asking me so many questions?"" and walks out of the office. You follow him into the waiting room and hear him tell his mom, ""I'll be in the car."" His mom looks confused. You say to her, ""Is something going on or did something happen with Gregory that I should know about? He seemed upset after showing me his good exam grades."" She thinks for a moment and tells you that he found a box of old family pictures and has been going through them. She wonders if this is related to his reaction today.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.","Given your overall understanding of the client's situation, what is the best adjunct service to suggest at this time?",Group therapy,Grief support group,Family therapy,Problem-solving skills training,"(A): Group therapy
(B): Grief support group
(C): Family therapy
(D): Problem-solving skills training",Family therapy,C,"Considering the current family dynamics, family therapy may be useful to address multiple issues that may be impacting Gregory and the family as a whole. Therefore, the correct answer is (B)",treatment planning
389,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.  Fifth session It has been a month and a half since you first met with the client and she has rescheduled multiple therapy appointments, continually citing a busy work schedule. The last time you met with her, she told you that the judge sentenced her to six months probation, provided that she follow through with Alcoholic Anonymous meetings and counseling sessions. She was also required to do 60 hours of community service. Though she was relieved to have the sentencing behind her, she remarked that she still felt shame and humiliation at having gone down that path. During that counseling session, she communicated to you that she tried to go one day without drinking but couldn't do it. She described the idea of quitting drinking as ""impossible"" because ""I have never been strong enough."" You explored the client's motivations and concerns about changing her behavior. You explained to her that while it was normal to feel overwhelmed by the thought of making changes, there were strategies that she could utilize in order to build a support system and make progress towards sobriety.    Based on the client's behavior, you do not believe that outpatient treatment is the best fit for the client at this time, and you plan to discuss alternate options with her today. She is scheduled for an afternoon session but does not show. When you attempt to call her, her phone goes directly to voicemail. You continue to wait in your office even though the client does not respond to your calls or appear for the session. You are concerned about her because although she has rescheduled appointments before, she has always done so in advance and has never been a ""no show."" You take the appropriate ethical actions to check on her.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","In light of the client's admissions to you, as well as her regularly missing therapy, which recommendation would you make to ensure that the client's level of care matches her current needs?",Recommend participation in SMART Recovery,Refer the client to a Rational Recovery Program,Recommend to the court that she be court-ordered into residential care.,Refer the client to an alcohol and mental health rehabilitation center,"(A): Recommend participation in SMART Recovery
(B): Refer the client to a Rational Recovery Program
(C): Recommend to the court that she be court-ordered into residential care.
(D): Refer the client to an alcohol and mental health rehabilitation center",Refer the client to an alcohol and mental health rehabilitation center,D,"An alcohol and mental health rehabilitation center is an on-site detox with twenty-four hour supervision support. This setting provides evidence-based treatment programs customized to the client's co-occurring mental health needs. Therefore, the correct answer is (A)",professional practice and ethics
390,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ","What do the terms circumstantiality, tangentiality, and coherence reference when conducting a Mental Status Exam?",Speech,Perception,Affect,Thought process,"(A): Speech
(B): Perception
(C): Affect
(D): Thought process",Thought process,D,"Circumstantiality, tangentiality, and coherence are referencing thought process. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
391,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",What is the best assessment instrument for Oppositional Defiant Disorder?,Eyberg Child Behavior Inventory,Child Behavior Checklist (CBCL),New York Teacher Rating Scale for Disruptive and Antisocial Behavior,The adolescent version of Home and School Situation Questionnaires (AHSQ),"(A): Eyberg Child Behavior Inventory
(B): Child Behavior Checklist (CBCL)
(C): New York Teacher Rating Scale for Disruptive and Antisocial Behavior
(D): The adolescent version of Home and School Situation Questionnaires (AHSQ)",The adolescent version of Home and School Situation Questionnaires (AHSQ),D,"Of the options, the AHSQ is the best assessment tool for ODD as it assesses the child in multiple settings. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
392,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.  Eighth session It has been seven weeks since the client presented for the initial interview. Today, the client returns to your office for his weekly session. He admits that he has not been following through with any of the activities you have assigned as part of his systematic desensitization plan, and he continues to feels overwhelmed by anxiety. His facial expressions reveal a sense of defeat and disappointment as he shares his struggles with making progress. He says, ""I just want to be a normal guy. What's wrong with me?"" The client expresses feeling overwhelmed with fear and shame at being unable to make any changes. He asks if you know of anyone else who has experienced social anxiety before and if there is any hope for him to get better. You normalize his experience and briefly share a story about being afraid to wear glasses in high school out of fear that your classmates would make fun of you. You then explain to him that even though it may feel like he is alone in his experience and feels discouraged, recovery is possible. You emphasize the importance of being patient with himself and expressing self-compassion as he works through the process.    During the session, the client also mentions that his parents are having a difficult time in their relationship which has been causing additional distress for him. You explain that this could cause extra feelings of worry and insecurity, even when he is away from them. He acknowledges the connection between his parents’ relationship dynamics and his own struggles with anxiety. In order to address the additional stressors created by the distress in the client's parents' relationship, you explore ways he can work on managing his own emotions and reactions. You explain that building self-awareness of his feelings and responses may help empower him to have greater control over his anxiety symptoms. You discuss mindful breathing and visualization techniques. Afterwards, you provide examples of cognitive reappraisal strategies that can be used to challenge any irrational beliefs related to fear of failure or embarrassment that might be driving his avoidance behaviors. You explain the importance of consistently doing the practice in order for it to be effective and positive changes can be expected with consistent effort. You also give the client a homework assignment to read about social anxiety.    Toward the end of the session, you summarize what you have discussed during today's session, and you address his feelings of disappointment in his perceived lack of progress by saying, ""I understand your frustration. It can seem like things are not changing but in reality, even small changes are a sign of progress. The most important thing for you to remember is that it takes time and effort to learn how to manage your anxiety and make meaningful change in your life. As you continue working on the strategies we have discussed, I want you to recognize any successes or moments of improvement as they occur; no matter how small they may be. This will help keep you motivated and encourage further growth.""","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",What treatment plan objective are you seeking to accomplish by discussing the use of mindful breathing and visualization techniques with the client?,The client will learn and implement calming strategies when experiencing anxiety,The client will identify 3 triggers for anxiety and learn coping skills to decrease distress,The client will develop a sense of self-compassion when working through the therapeutic process,The client will identify and challenge irrational beliefs that fuel anxiety-related avoidance behaviors,"(A): The client will learn and implement calming strategies when experiencing anxiety
(B): The client will identify 3 triggers for anxiety and learn coping skills to decrease distress
(C): The client will develop a sense of self-compassion when working through the therapeutic process
(D): The client will identify and challenge irrational beliefs that fuel anxiety-related avoidance behaviors",The client will learn and implement calming strategies when experiencing anxiety,A,"This answer accurately reflects the goal of discussing mindful breathing and visualization techniques with a client, which is to help them become more aware of their emotions, physical sensations, and thoughts in order to better manage anxious and intrusive feelings. By developing this mindfulness and awareness, clients can begin to explore their reactions to anxiety-provoking situations in a safe space. Therefore, the correct answer is (A)",treatment planning
393,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.",aged. Family History: The client reports that she is close with her parents but that they often have high expectations of her and that she worries about disappointing them. The client has an older brother who is 25 and is a lawyer. The client says some of the pressure is wanting to be as successful as her brother because she thinks her parents are really proud of him,"All of the following are short-term goals for treatment for the first month of therapy, EXCEPT:",Processing aspects of the client’s relationship with her parents,Implementing calming and coping strategies for panic symptoms,Providing psychoeducation on cognitive reframing,Reducing the frequency and intensity of anxiety and panic attacks,"(A): Processing aspects of the client’s relationship with her parents
(B): Implementing calming and coping strategies for panic symptoms
(C): Providing psychoeducation on cognitive reframing
(D): Reducing the frequency and intensity of anxiety and panic attacks",Reducing the frequency and intensity of anxiety and panic attacks,D,"A panic attack is a triggered fight-or-flight response, and this response takes time to reduce when triggered. Reducing the frequency and intensity of panic attacks is a longer-term goal because some psychoeducation and practice with coping skills need to occur first. At this point, the client would be prepared to learn and implement coping skills and cognitive reframing. It would also be helpful for the client to begin processing the thoughts, feelings, and experiences related to her relationship with her parents. Therefore, the correct answer is (C)",treatment planning
394,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","Given the following diagnostic cues, which specific information or observed symptoms would most strongly align with and support a definitive diagnosis of Anorexia Nervosa, Restricting Type?",Low body weight and poor body image,Use of compensatory behavior to prevent weight gain,Interpersonal relationship difficulties,Eating until feeling uncomfortably full,"(A): Low body weight and poor body image
(B): Use of compensatory behavior to prevent weight gain
(C): Interpersonal relationship difficulties
(D): Eating until feeling uncomfortably full",Low body weight and poor body image,A,"Individuals with Anorexia Nervosa present as underweight and have a poor body image. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
395,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies",Which of the following is true of factors related to social anxiety?,Postevent rumination helps accurately evaluate feared outcomes.,Individuals with social anxiety underestimate how negatively others judge them.,Relaxation and other safety behaviors are helpful for managing social anxiety.,"In feared social situations, avoidance behaviors help maintain anxiety.","(A): Postevent rumination helps accurately evaluate feared outcomes.
(B): Individuals with social anxiety underestimate how negatively others judge them.
(C): Relaxation and other safety behaviors are helpful for managing social anxiety.
(D): In feared social situations, avoidance behaviors help maintain anxiety.","In feared social situations, avoidance behaviors help maintain anxiety.",D,"Individuals with anxiety disorder typically try to manage anxiety by engaging in avoidance behaviors, such as not making eye contact or not participating in conversations. Avoidance creates a positive feedback loop that reinforces anxiety and leads to additional self-defeating thoughts and behaviors. Relaxation is not an example of a safety behavior. Relaxation techniques are helpful for the long-term management of anxiety, whereas safety behaviors are not. Safety behaviors are used with and without avoidance behaviors. Safety behaviors include things used to protect individuals from perceived “catastrophic” consequences and include inappropriate giggling or stereotypical movements when performing. Like avoidance behaviors, safety behaviors are not effective for the long-term management of social anxiety. Individuals with social anxiety tend to overestimate rather than underestimate how negatively others judge them. Finally, postevent rumination, a cognitive factor associated with social anxiety, leads to inaccurate evaluations of feared outcomes. Postevent rumination occurs when aspects of the encounter are repeatedly mentally reviewed, thus fueling anxiety and confirming negative perceptions. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
396,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.",Which of the following interventions would be the most effective in helping the client with her anxiety about the holidays?,Have the client invite her friend to a counseling session for better communication.,Teach the client a grounding technique for when her anger overwhelms her.,Provide the client with a book on setting boundaries.,"Role play conversations between the client, her in-laws, and her friend.","(A): Have the client invite her friend to a counseling session for better communication.
(B): Teach the client a grounding technique for when her anger overwhelms her.
(C): Provide the client with a book on setting boundaries.
(D): Role play conversations between the client, her in-laws, and her friend.","Role play conversations between the client, her in-laws, and her friend.",D,"Roleplay provides an opportunity for the client to observe the counselor communicating in a way that models the ideas that the client wishes to communicate to others. By playing the role of the in-laws and friend, the client can listen to new ways of responding to those individuals so that she can feel comfortable imitating the counselor in actual conversations. Providing the client with a book on boundaries can be very helpful, if the client follows through with the reading. Clients do not always complete homework, so assigning a book to read may not provide the outcome that the counselor had hoped. Having the client invite her friend to a session may or may not be effective. While it can provide an opportunity for the client to feel safe confronting her friend, her friend may feel uncomfortable and a rupture in the relationship may occur. Teaching the client a grounding technique when her anger overwhelms her is a good intervention to use when the client's emotions are out of control. In most situations, it is best to help clients be proactive in working on their issues rather than concentrating on reactive remedies. Therefore, the correct answer is (C)",counseling skills and interventions
397,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ",Which of the following assessments is most appropriate to assess suicidality and plan for treatment around suicide risk?,The Behavior Assessment System for Children (BASC),The Beck Depressive Inventory-II (BDI-II),The Columbia Suicide Severity Rating Scale (CSSRS),Collaborative Assessment and Management of Suicidality (CAMS),"(A): The Behavior Assessment System for Children (BASC)
(B): The Beck Depressive Inventory-II (BDI-II)
(C): The Columbia Suicide Severity Rating Scale (CSSRS)
(D): Collaborative Assessment and Management of Suicidality (CAMS)",Collaborative Assessment and Management of Suicidality (CAMS),D,"The CAMS is considered to be the best tool to assess suicidality and plan treatment around suicide risk. The collaborative nature of the CAMS allows extensive coordination of treatment between the client and therapist, which is important for this client. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
398, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.",Which of the following is not part of the termination process?,Review company policies for uses and limits of social media,Provide contact information in case the client or her mother have questions for you,Provide the new clinician with a copy of your notes,Introduce the client and her mother to the clinician who will be working with them,"(A): Review company policies for uses and limits of social media
(B): Provide contact information in case the client or her mother have questions for you
(C): Provide the new clinician with a copy of your notes
(D): Introduce the client and her mother to the clinician who will be working with them",Provide contact information in case the client or her mother have questions for you,B,"Termination is often as hard on counselors as it is on clients. However, the counselor is responsible for terminating ethically, legally, and professionally. Relationships with clients after counseling are discouraged by the ACA Code of Ethics. The counselor should provide only contact information for the new clinician and for the agency as the current counselor will no longer be involved with this client. It will be helpful to use some of the current session to introduce the new clinician and help the client and her mother begin building a relationship with that counselor. Reviewing company policies about social media is important as the counselor should not accept or allow the client access or expectations of access to the counselor through social media. It is appropriate for the retiring counselor to provide a copy of notes to the new clinician to facilitate continuity of treatment. Therefore, the correct answer is (B)",treatment planning
399,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week.  You are using the rational emotive behavior therapy ABC model with the client during this session. You want to challenge the client’s belief that “my parents don’t like me” following their punishment of him",You are using the rational emotive behavior therapy ABC model with the client during this session. You want to challenge the client’s belief that “my parents don’t like me” following their punishment of him. All of the following statements would be a disputation of that belief EXCEPT:,"“My parents do like me, and that is why they’re punishing me.”","“My parents don’t want me to be mean, so they made me take time to calm down.”","“My parents don’t like me right now, so they made me take time to calm down.”","“My parents don’t like what I’m doing, so they punished me.”","(A): “My parents do like me, and that is why they’re punishing me.”
(B): “My parents don’t want me to be mean, so they made me take time to calm down.”
(C): “My parents don’t like me right now, so they made me take time to calm down.”
(D): “My parents don’t like what I’m doing, so they punished me.”","“My parents don’t like me right now, so they made me take time to calm down.”",C,"The purpose of disrupting beliefs is to challenge thoughts that are harmful or unhelpful. The answer that states “my parents don’t like me right now, so they made me take time to calm down” is still unhelpful because it validates that the client is not liked by his parents. The other options promote the idea that the parents care about him and want him to do and feel better. Therefore, the correct answer is (D)",counseling skills and interventions
400,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What potential positive or negative effects could the client's profound sense of inferiority and reliance on her boyfriend have on her recovery process?,"The client's emotions of inferiority and dependency would provide motivation for her to persist in therapy, thus facilitating her recovery process.","The client's feelings of inferiority and dependency could motivate her to work on strengthening her bond with her boyfriend, potentially expediting her recovery journey.","The client's experience of inferiority and dependency could compel her to pursue self-reliance and independence, thereby accelerating her recovery process.","The client's experience of inferiority and dependence may impede her recovery as it could discourage her from seeking support from alternative avenues, thus intensifying her feelings of isolation and loneliness.","(A): The client's emotions of inferiority and dependency would provide motivation for her to persist in therapy, thus facilitating her recovery process.
(B): The client's feelings of inferiority and dependency could motivate her to work on strengthening her bond with her boyfriend, potentially expediting her recovery journey.
(C): The client's experience of inferiority and dependency could compel her to pursue self-reliance and independence, thereby accelerating her recovery process.
(D): The client's experience of inferiority and dependence may impede her recovery as it could discourage her from seeking support from alternative avenues, thus intensifying her feelings of isolation and loneliness.","The client's experience of inferiority and dependence may impede her recovery as it could discourage her from seeking support from alternative avenues, thus intensifying her feelings of isolation and loneliness.",D,"Feelings of inferiority and dependency can cause an individual to have a narrow perspective on who or what can provide support or relief. In this case, the client's heavy reliance on her boyfriend for validation might deter her from seeking or accepting help from others, thereby leaving her emotionally isolated and increasing her risk. Therefore, the correct answer is (A)",counseling skills and interventions
401,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated.  Following this session, you determine that the client is not benefiting from therapy with you because he has used inhalants since at least your third week of sessions and almost daily since then","Following this session, you determine that the client is not benefiting from therapy with you because he has used inhalants since at least your third week of sessions and almost daily since then. Which of the following would be the most appropriate intervention for this client based on his recent inhalant use?",Case management from a local government agency,Psychiatric hospitalization,Referral to another counselor,Inpatient drug rehabilitation,"(A): Case management from a local government agency
(B): Psychiatric hospitalization
(C): Referral to another counselor
(D): Inpatient drug rehabilitation",Inpatient drug rehabilitation,D,"The client continues to use inhalants regularly despite counseling, and it is causing harm to his relationships and putting him and others at risk of harm. An inpatient drug rehabilitation facility might be a more appropriate level of care. A referral to another counselor would likely produce the same results because the counselor can only provide counseling twice weekly and cannot monitor or support him between sessions as well as an inpatient facility could. Psychiatric hospitalization may be helpful to stabilize the client quickly, but it would not provide the therapeutic level of support that the client needs to reestablish and maintain sobriety. Case management might be helpful; however, case management connects the client to services and supports functioning and this takes some time to set up and provide the funded services. The client needs more immediate support to keep him from causing further harm to his relationships and to decrease the risk that the client might pose to himself and others. Therefore, the correct answer is (C)",treatment planning
402,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following is not a symptom of post-traumatic stress disorder?,Derealization,Dissociative flashbacks,Depersonalization,"Dissociative amnesia for everyday, non-traumatic events","(A): Derealization
(B): Dissociative flashbacks
(C): Depersonalization
(D): Dissociative amnesia for everyday, non-traumatic events","Dissociative amnesia for everyday, non-traumatic events",D,"Dissociative amnesia for everyday, non-traumatic events is a symptom of Dissociative Identity Disorder (DID) and not of PTSD. Individuals may be diagnosed with DID and PTSD, but the two are different disorders. Both PTSD and DID often include symptoms of dissociative flashbacks in which the individual relives the traumatic event with a reduced awareness of the present. However, PTSD includes symptoms of depersonalization, in which the individual experiences feeling that they are not real; and derealization, in which the individual experiences the world around them as not real. DID does not include these two symptoms. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
403,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.  Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, ""On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life."" The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, ""Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!""    You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now.    At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her.",,"You respond to the client's statement of feeling hurt by saying, ""I can see why you are feeling hurt. Healing takes time, and it's okay to feel that way. It's important that you recognize that even though you are hurting right now, you have made great progress."" What did you do here?",Used constructive confrontation,Used an open-ended question,Reflection of meaning,Used listening/attending and reflection skills,"(A): Used constructive confrontation
(B): Used an open-ended question
(C): Reflection of meaning
(D): Used listening/attending and reflection skills",Used listening/attending and reflection skills,D,"You used skills which made the client feel heard while reflecting on how far she has come in the therapeutic process while simultaneously validating her feelings. Therefore, the correct answer is (D)",counseling skills and interventions
404,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises.  Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable.    You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times.    After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client.  Ninth session The client's parents were elated to see their daughter make significant progress in her reading at school. After careful consideration and collaboration between you, the client, her teachers, and the paraprofessional, the team has all devised a treatment plan tailored specifically to her needs. Incorporating a small group setting provided the client with the individualized attention she needed to become successful in her reading skills.    As the session came to an end today, it was clear that both the client and her parents were satisfied with the results of their hard work. To ensure that they felt comfortable moving forward and everybody was on the same page, you asked them, ""What I hear you saying is that you feel as though your daughter has met her educational goals and has the support to continue to succeed? Is that correct?"" Both of them smiled knowingly and nodded affirmatively.    With a sense of closure now achieved by this family team, the parents left feeling confident about continuing on this path towards helping their daughter reach success with reading deficits. Together they had created a practical plan which could be adapted as necessary along the way, one which would pave a brighter future for the client."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What action would be irrelevant as part of the termination process?,Ensuring the IEP is effective for the student,Check-in frequently with the client's parents,Discussing the client's progress with the principal,Following up with the client's teachers,"(A): Ensuring the IEP is effective for the student
(B): Check-in frequently with the client's parents
(C): Discussing the client's progress with the principal
(D): Following up with the client's teachers",Discussing the client's progress with the principal,C,"Connecting with the principal to discuss students' academic success is irrelevant as part of the termination process. Instead, you would discuss the client's progress with teachers, parents, and school psychologists. Therefore, the correct answer is (D)",professional practice and ethics
405,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",Which of the following areas would be addressed during a biopsychosocial interview?,"Cognition, thought content, insight","Emotional history, appearance, mood","Problems during pregnancy, sensorium","Presenting problem, duration, family of origin","(A): Cognition, thought content, insight
(B): Emotional history, appearance, mood
(C): Problems during pregnancy, sensorium
(D): Presenting problem, duration, family of origin","Presenting problem, duration, family of origin",D,"Presenting problem, duration, and family of origin are all areas on a biopsychosocial intake. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
406, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,The memory deficit which Sandy experienced is result of?,Sedative withdrawal,Alcohol withdrawal,Alcohol poisoning,Psychosis,"(A): Sedative withdrawal
(B): Alcohol withdrawal
(C): Alcohol poisoning
(D): Psychosis",Alcohol withdrawal,B,"Sandy is showing signs of alcohol withdrawal as evidenced by disorientation of time and place, vivid hallucinations of fast-moving animals and perspiration, fever and rapid heartbeat. Alcohol poisoning may cause amnesia or mental confusion and is accompanied by physical symptoms such as difficulty remaining conscious, vomiting, seizure, trouble breathing, and slow heart rate. Psychosis and sedative withdrawal are ruled out since symptoms are caused by alcohol. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
407,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice.  You desire to support both individuals",You desire to support both individuals. Which is the most ethical intervention to support the couple?,"Meet with the wife and then meet with the husband in a separate, empty office in the practice to maintain confidentiality.",Encourage the wife to come to the lobby to process the situation with the husband because the door is closed to the practice and no one else is present.,Inform the husband of what the wife feels about him leaving because they are both clients and have access to information and no one else is present in the lobby.,Meet with the wife and then meet with the husband in the lobby because the practice door is closed and no one else is present in the practice setting.,"(A): Meet with the wife and then meet with the husband in a separate, empty office in the practice to maintain confidentiality.
(B): Encourage the wife to come to the lobby to process the situation with the husband because the door is closed to the practice and no one else is present.
(C): Inform the husband of what the wife feels about him leaving because they are both clients and have access to information and no one else is present in the lobby.
(D): Meet with the wife and then meet with the husband in the lobby because the practice door is closed and no one else is present in the practice setting.","Meet with the wife and then meet with the husband in a separate, empty office in the practice to maintain confidentiality.",A,"It would be most ethical to meet with the husband in a separate, empty office in the practice following the meeting with the wife. You want to protect both individuals’ right to confidentiality, and you do not know whether the wife would be listening in on your conversation with the husband in the lobby. Because both individuals are clients, it is important to ensure that they each have a safe space to express themselves. You should provide this safety by using separate spaces for self-expression prior to returning to the joint session. Therefore, the correct answer is (C)",professional practice and ethics
408, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.","After the client has responded affirmatively to your last statement, which of the following would be the most appropriate to ask?",Is there a way that you can send your parents money and still have time to make your choices?,What scares you the most about not sending your parents money right now?,Is this something you would like to talk about together?,I wonder if it would help if we talked about some ways that you can work through this.,"(A): Is there a way that you can send your parents money and still have time to make your choices?
(B): What scares you the most about not sending your parents money right now?
(C): Is this something you would like to talk about together?
(D): I wonder if it would help if we talked about some ways that you can work through this.",Is this something you would like to talk about together?,C,"Asking the client if this is something that she wants to talk about with you is the most appropriate question. The counselor must demonstrate respect for the client and her culture. Cultural beliefs about discussing family matters with strangers vary. This client's original intent for counseling was to seek career help, not discuss family issues. It would be necessary for the counselor to allow the client to determine what topics will be discussed in sessions. Asking the client what scares her most makes the assumption that she wishes to discuss her family dilemma more deeply (as noted above) and that she feels scared. It is important for counselors to allow clients to identify their emotions rather than have the counselor assign emotions based on the counselor's own feelings. Asking the client if she can both send money and have time to choose a career demonstrates the counselor's countertransference and need to fix the client's problem, rather than allowing the client to choose her own solutions. Response d is less obtrusive but still does not take the client's culture into account nor allows the client to decide if this will be a topic of counseling. As well, the statement demonstrates the counselor's lack of awareness of her own need to fix the problem. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
409,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","   bile. Family History: The client has two younger brothers who are 6 and 7 years old. The client often engages in physical fights and arguments with his younger siblings and often will break or steal their toys. The client takes advantage of his 6-year-old sibling by conning him out of items and activities by convincing him that a certain trade or decision is better for him, when it is usually better for the client. The client’s parents report that these behaviors occur at school and that the client does not have any friends as far as they are aware. The client’s parents state that the client is adopted and that he was in foster care from when he was 2 until he was 4 years old. The client’s parents state that his basic needs were neglected because his birth mother was heavily using drugs","All of the following are part of the Mental Status Exam (MSE), EXCEPT:",Thought process,Insight,Memory,Diagnosis,"(A): Thought process
(B): Insight
(C): Memory
(D): Diagnosis",Diagnosis,D,"The MSE examines behavior and functioning during the present session. The client’s thought process (eg, coherent, grandiose, fleeting ideas, or delusional), insight, and memory are all part of MSE testing. You assess the client’s thought process throughout the session by noting his ability to communicate thoughts and feelings and to stay on topic during the session. Insight is the client’s awareness of the impact of mental health on functioning. This can be assessed by noticing if the client can identify if his behavior is problematic at home and in the school setting. Memory is assessed by noting if the client is able to recall events and remember what was talked about in this and previous sessions. Diagnosis is not part of the MSE. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
410,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",What question would best help you to evaluate the client's current level of functioning?,"""Do you attend a place of worship?""","""Do you volunteer in the community?""","""Do you spend excessive time on social media?""","""Can you describe the quality of your marital relationship?""","(A): ""Do you attend a place of worship?""
(B): ""Do you volunteer in the community?""
(C): ""Do you spend excessive time on social media?""
(D): ""Can you describe the quality of your marital relationship?""","""Can you describe the quality of your marital relationship?""",D,"Assessing the client's relationship with his wife will provide you with information about his mental functioning. This question will specifically help elicit information about relational functioning, which is a subset of a client's overall mental functioning. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
411,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.",Which of the following DSM-5 categories is most likely being represented by the client's currently expressed symptoms?,Anxiety Disorders,Bipolar and Related Disorders,Trauma- and Stressor-Related Disorders,Depressive Disorders,"(A): Anxiety Disorders
(B): Bipolar and Related Disorders
(C): Trauma- and Stressor-Related Disorders
(D): Depressive Disorders",Anxiety Disorders,A,"The client's current symptoms are most closely related to anxiety disorders, such as general anxiety, which includes symptoms of irritability, sleep disturbance, and worry. The client expresses some mild unhappiness, but this is occasional so does not meet the criteria for depressive disorders. While she has a history of postpartum depression, there is no evidence that she has experienced depression outside of those times. The client exhibits no manic symptoms such as risky behavior, inflated self-esteem, or racing thoughts. Additionally, the client has not reported any traumatic exposure, nor do her expressed symptoms include flashbacks, nightmares, or avoidance. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
412,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.  Eighth session The client has been seeing you once a week for the last two months. Today, he appears calm, and his thoughts are coherent. The client tells you that he has not completely abstained from alcohol, but his use has significantly decreased. He reports that he went to a virtual AA meeting but did not find it helpful, so he signed off. The client opens up and states, ""I think one of the reasons I am anxious is because I am having an affair. Ever since my wife hurt her back, we have not been intimate."" The client's speech becomes more rapid, and he begins to lose eye contact as he discloses the details of his affair to you. Your client tells you, ""I'm not happy with my wife, either sexually or emotionally. The new woman I'm seeing understands me, and I don't want to drink when I'm around her. She helps me forget everything that causes me stress."" In response to your client focusing on the positives of his affair, you engage the client in a discussion to explore the issue from other perspectives. You ask questions like, ""What do you think would happen if your wife found out about your affair?"" Your client pauses for a moment and looks down, and then says, ""I'm not sure. I care about my wife, but I don't know if she will ever be able to understand me in the way that this other woman does. I feel like I'm trapped."" You listen empathically as your client expresses his feelings of anxiety, despair and confusion. You provide clarification when necessary and strive to help your client gain insight into his thoughts and behaviors.    In the session, you explore the client's anxiety and how it has been related to his affair. You address underlying issues that may be contributing to the anxiety such as unresolved feelings of guilt or fear of being discovered. You emphasize that anxiety is often a sign of trying to avoid uncomfortable emotions and situations, but acknowledging them can help him understand anxiety in a different way. You also talk about the role alcohol has played in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to incorporating strategies to address these issues in his treatment plan, such as scheduling regular self-care activities and exploring the relationship between his thoughts and behaviors. Toward the end of this session, the client appears calmer and confident in his ability to make positive changes. As you are wrapping up the session, the client confides to you that ever since he started having an affair, he has found himself sexually attracted to his daughter. He says, ""It's just kind of exciting to peek in the bathroom and watch her in the bathtub. But I would never touch her! It's just a passing thought. I know that I need to stop. The thrill of my affair is satisfying enough.""","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",How do you proceed when the client confides in you at the end of the session about his recent thoughts and behavior toward his daughter?,Suggest a joint session with him and his wife in order to further assess the situation,Document his disclosure in his therapy record as a topic to discuss during the next session,Explore his sexual tension as an expression of anxiety resulting from having an affair,Notify the appropriate legal authorities about the client's behavior,"(A): Suggest a joint session with him and his wife in order to further assess the situation
(B): Document his disclosure in his therapy record as a topic to discuss during the next session
(C): Explore his sexual tension as an expression of anxiety resulting from having an affair
(D): Notify the appropriate legal authorities about the client's behavior",Notify the appropriate legal authorities about the client's behavior,D,"The client has disclosed that he is sexually attracted to his daughter (who is a minor) and has been watching her in the bathroom without her knowledge or consent. In the event that a client reports inappropriate behavior with a child, therapists must immediately notify the appropriate legal authorities to ensure safety of the minor. Therefore, the correct answer is (D)",professional practice and ethics
413, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",You ask how Jonny has been feeling living in the dorms for years on his own. He becomes emotional and admits he misses when his mom took care of him. What approach should you take to have Jonny elaborate?,Share anecdotes in congruence so he feels connected.,Lean in closer with a quiet smile and maintain eye contact.,"""I'm so sorry, Jonathan"" and hand him a box of tissues.",Ask if he wants to call his mom in session.,"(A): Share anecdotes in congruence so he feels connected.
(B): Lean in closer with a quiet smile and maintain eye contact.
(C): ""I'm so sorry, Jonathan"" and hand him a box of tissues.
(D): Ask if he wants to call his mom in session.",Lean in closer with a quiet smile and maintain eye contact.,B,"This skill offers Jonathan to continue sharing in his own timing without feeling pressured, which is the priority of counseling. Self-disclosure or calling his mother are not necessary here and apologizing as if Jonny is a victim of having feelings while providing tissues which can signify ""wipe the tears away"" is not the best approach in encouraging Jonny to elaborate as it changes the focus from his train of thought to believing his memories or feelings are inherently ""sad"". Therefore, the correct answer is (D)",counseling skills and interventions
414,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",What would you say to demonstrate an accurate reflection of the client's feelings?,"""I'm hearing that it seems like you're feeling a bit overwhelmed and out of control.""","""I'm hearing that you're feeling really angry and resentful.""","""I'm hearing that you feel helpless and frustrated with your family situation.""","""I'm hearing that you're feeling a little bit sad and lost.""","(A): ""I'm hearing that it seems like you're feeling a bit overwhelmed and out of control.""
(B): ""I'm hearing that you're feeling really angry and resentful.""
(C): ""I'm hearing that you feel helpless and frustrated with your family situation.""
(D): ""I'm hearing that you're feeling a little bit sad and lost.""","""I'm hearing that you feel helpless and frustrated with your family situation.""",C,"The client has mentioned feeling ""miserable,"" wanting to never have been adopted, and being ""very mean"" to her. She is also overwhelmed by her parents' bickering and does not feel like she can turn to anyone for help. This answer reflects a combination of helplessness and frustration in her family situation. Therefore, the correct answer is (C)",counseling skills and interventions
415,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Which of the following is the most effective approach when working with a client who has OCPD?,Remind him to look at others' perspectives,Use a feelings wheel or list with the client to identify his emotions,Use prolonged exposure techniques to help the client delegate tasks,Warn the client that at some point you will behave in a way that upsets him,"(A): Remind him to look at others' perspectives
(B): Use a feelings wheel or list with the client to identify his emotions
(C): Use prolonged exposure techniques to help the client delegate tasks
(D): Warn the client that at some point you will behave in a way that upsets him",Warn the client that at some point you will behave in a way that upsets him,D,"Warning the client that you will eventually behave in a way that upsets him is one of the most important things a therapist can do with a client who has OCPD. The client's tolerance for lack of perfection in others will be triggered when at some point the counselor, like others in the client's life, will behave or say something that violates the client's rigid standards or expectations for perfection. Violating the client's expectation for perfection from the therapist is frequently the cause for OCPD clients to terminate counseling. Forewarning the client of this provides the opportunity to talk about how staying in the therapeutic relationship can help him learn to manage the conflict. Using a feeling wheel or list will not be helpful with the OCPD client because increasing his self-awareness and insight will be needed before he is able to begin working through emotions. Likewise, looking at and understanding others' perspectives may be attempted but the client will eventually need to challenge his own perspectives of his way being the only right one, rather than focusing on others. Prolonged exposure is an effective treatment for OCD, but is not effective in treating OCPD. Therefore, the correct answer is (D)",counseling skills and interventions
416,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","The client discusses how his case manager has gotten him into a shelter and is currently working on securing housing for him. The client processes feelings surrounding the shelter and has begun a detox program for his fentanyl addiction. The client verbalizes that he is experiencing anxiety surrounding being at meetings with the case manager, talking with other residents, reintegrating into a “more normal life,” and worrying about whether he can ever have a relationship with his kids or ex-wife if he gets sober. Through processing, you realize that this anxiety was present prior to drug use and that he has experienced anxiety throughout his life","Based on the transtheoretical model of intentional behavior change, which stage would the client be in if he is beginning to analyze the pros and cons of his current behavior and situation?",Action,Contemplation,Precontemplation,Preparation,"(A): Action
(B): Contemplation
(C): Precontemplation
(D): Preparation",Contemplation,B,"This client is in the contemplation phase of the transtheoretical model of intentional behavior change because he is analyzing the risks and rewards of changing his current situation. The precontemplation phase involves little or no thought about changing current behaviors. The client is not in the stage of taking actions yet. The client has not made a commitment to change and is therefore not yet in the preparation phase. Therefore, the correct answer is (A)",counseling skills and interventions
417,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",What information are you lacking that would be helpful for completing your assessment?,copies of court documents,family history,relationship history,consent to release information from ex-wife,"(A): copies of court documents
(B): family history
(C): relationship history
(D): consent to release information from ex-wife",family history,B,"Family history information would support your increased knowledge and understanding of contributing factors to Davone's presentation, including his upbringing and how this triggers him, family dynamics, possible trauma, even hereditary conditions. Answers b) through d) are not necessary in completing your initial assessment and may not be needed throughout treatment. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
418,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","   k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress.”  You would like your treatment goals to reflect elements of John Krumboltz’s learning theory of career counseling",You would like your treatment goals to reflect elements of John Krumboltz’s learning theory of career counseling. Which assessment instrument would help you accomplish this?,Vocational Preference Inventory,Vocational Interest Inventory,Career Orientations Inventory,Career Beliefs Inventory,"(A): Vocational Preference Inventory
(B): Vocational Interest Inventory
(C): Career Orientations Inventory
(D): Career Beliefs Inventory",Career Beliefs Inventory,D,"The Career Beliefs Inventory is based on John Krumboltz’s learning theory of career counseling. It is designed to identify problematic beliefs that interfere with career decision making, including indecision and high aspirations. The Vocational Preference Inventory is used to identify an individual’s Holland type, which is based on John Holland’s theory of vocational personalities and work environments. The Career Orientations Inventory is used to determine the motives, values, and skills associated with Edgar Schein’s career anchors. The Vocational Interest Inventory is based on Roe’s personality theory of career choice. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
419,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","Based on the client’s diagnosis, what immediate objective would you focus on with this client?",Participate in a group focusing on positive body image.,Identify unhealthy weight control behaviors,Increase the client's understanding of the risks associated with Anorexia Nervosa,Restore healthy eating patterns,"(A): Participate in a group focusing on positive body image.
(B): Identify unhealthy weight control behaviors
(C): Increase the client's understanding of the risks associated with Anorexia Nervosa
(D): Restore healthy eating patterns",Increase the client's understanding of the risks associated with Anorexia Nervosa,C,"The immediate objective that would be most appropriate to focus on first with this client is to increase her understanding of the physical, emotional, and psychological health risks associated with her anorexia nervosa. This could be done by educating her about the disorder, exploring her feelings and beliefs about her body, and discussing how her behavior is impacting her life. Additionally, the counselor could explore the client's motivation to make changes and develop a personalized treatment plan to help her reach her goal. Therefore, the correct answer is (A)",treatment planning
420,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","   vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week","When completing a mental status exam, which one of the following would be the most appropriate term to define this client’s affect?",Constricted,Flat,Blunted,Congruent,"(A): Constricted
(B): Flat
(C): Blunted
(D): Congruent",Congruent,D,"The client’s affect is best described as congruent because he is demonstrating anxious behavior, which is consistent with being in counseling for the first time. Congruence is demonstrated when a client’s verbalized emotions match their body language and expressions. People with constricted affect show evidence of restrained emotion, displaying much less explicit emotion than the typical person. A flat affect is defined by almost no emotional expression even in the presence of strong stimuli. A blunted affect is similar to a flat affect but involves mild expressions of emotion in the presence of strong stimuli. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
421,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","Based on your theoretical orientation, what strategy would be the most efficient in aiding the client to effectively manage their anger?",Allow the client to express his anger without becoming physically threatening.,Offer the client bibliotherapy resources focused on anger management.,Directly present the client with the negative consequences of his behavior,Begin exploring the client’s triggers to anger by analyzing transference.,"(A): Allow the client to express his anger without becoming physically threatening.
(B): Offer the client bibliotherapy resources focused on anger management.
(C): Directly present the client with the negative consequences of his behavior
(D): Begin exploring the client’s triggers to anger by analyzing transference.",Begin exploring the client’s triggers to anger by analyzing transference.,D,"Transference has occurred as the client has responded to you as though you are his wife/mother. Through an analysis of transference, the client can uncover his unconscious emotions, which might be driving his anger in the here-and-now. Therefore, the correct answer is (D)",counseling skills and interventions
422,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","   Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication.  You find several ADHD interventions consistent with EBP and would like to narrow down your search",You find several ADHD interventions consistent with EBP and would like to narrow down your search. Research methodologies with the highest level of evidence include which of the following?,Randomized control trials,Quasiexperimental studies,Correlational research designs,Ex post facto designs,"(A): Randomized control trials
(B): Quasiexperimental studies
(C): Correlational research designs
(D): Ex post facto designs",Randomized control trials,A,"Randomized control or clinical trials (RCTs) are associated with the highest level of evidence. The highest level of evidence (ie, strength) refers to methodologies that are less likely to have biases or confounds. However, experts caution clinicians from using RCTs as the sole determination for EBP because application to clinical practice must also be considered. Correlational research designs, which are less rigorous than RCTs, determine if there is a relationship between two factors. Experimenters conducting quasiexperimental studies manipulate the independent variable but do not randomly assign subjects to a control group or an experimental group. Ex post facto (ie, “after the fact”) designs are quasiexperimental designs involving subjects who are not randomly assigned to groups. Additionally, the experimenter cannot manipulate the independent variable because it was a condition present before the study was conducted. Therefore, the correct answer is (C)",professional practice and ethics
423,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,Which of the following is a projective test that can be administered to Destiny to assess representation of significant relationships?,Sentence Completion Test,Story Stem Assessment Profile,Draw a Family Picture Test,Strengths and Difficulties Questionnaire,"(A): Sentence Completion Test
(B): Story Stem Assessment Profile
(C): Draw a Family Picture Test
(D): Strengths and Difficulties Questionnaire",Draw a Family Picture Test,C,"The Draw-a-Family-Picture-Test is a projective test instrument developed to determine children's attitude, fears, needs, maturity level, stressors, gender tendencies and self-perception in relation to their family and significant others. The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire for individuals aged 3- 16 which measures emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behavior. It is not a projective test. Sentence completion test is appropriate for individuals ages 12 and older so it would not be appropriate for Destiny. The Story Stem Assessment Profile uses a narrative base measure of internal representations for children between the ages of 4 and 11. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
424,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",Which cluster of symptoms is most representative of Oppositional Defiant Disorder?,"Mania, argumentativeness, and vindictiveness","Irritability, depressed mood, and spitefulness","Being annoying, depressed mood, and vindictiveness","Negative mood, argumentative, and vindictiveness","(A): Mania, argumentativeness, and vindictiveness
(B): Irritability, depressed mood, and spitefulness
(C): Being annoying, depressed mood, and vindictiveness
(D): Negative mood, argumentative, and vindictiveness","Negative mood, argumentative, and vindictiveness",D,"This is the most correct cluster grouping for ODD as ALL three of these symptoms are hallmarks of this disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
425,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ","What, if any, ethical issue did you create by responding to the client's parents asking if there are any tools or techniques they could learn from you to work with their son?",No ethical issue was violated by mentioning medication is prescribed for children with ADHD.,A behavioral analyst should be responsible for scheduling and creating a daily routine for the client.,Mentioning that medication is often prescribed for children with ADHD is not within your scope of practice as a therapist.,A qualified dietician should be the only provider mentioning this treatment modality.,"(A): No ethical issue was violated by mentioning medication is prescribed for children with ADHD.
(B): A behavioral analyst should be responsible for scheduling and creating a daily routine for the client.
(C): Mentioning that medication is often prescribed for children with ADHD is not within your scope of practice as a therapist.
(D): A qualified dietician should be the only provider mentioning this treatment modality.",No ethical issue was violated by mentioning medication is prescribed for children with ADHD.,A,"Giving the client's parents options does not create an ethical issue. If you indicated that their son should be on medication, that would be outside the bounds of your clinical practice. Therefore, the correct answer is (B)",professional practice and ethics
426,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","    plan. Family History: The client’s parents are divorced and he lives with his mother and two younger siblings. There is a history of child protective services (CPS) involvement due to reports of domestic violence between his parents. The client witnessed these incidents between that ages of 10 and 12. His parents subsequently divorced and the client has had minimal contact with this father since. The client’s maternal aunt is diagnosed with obsessive-compulsive disorder. His mother previously attended therapy for anxiety and other trauma-related symptoms. The client began experiencing symptoms of body dysmorphic disorder at age 13, with symptoms worsening after starting high school",Which of the client’s following symptoms is NOT listed as a DSM-5-TR diagnostic criterion for body dysmorphic disorder (BDD)?,Occupational distress and impairment primarily due to BDD symptoms,Repetitive mirror checking in response to appearance concerns,"Self-oriented perfectionism regarding performance, appearance, and routine",Appearance-related preoccupation with flaws that others don’t see,"(A): Occupational distress and impairment primarily due to BDD symptoms
(B): Repetitive mirror checking in response to appearance concerns
(C): Self-oriented perfectionism regarding performance, appearance, and routine
(D): Appearance-related preoccupation with flaws that others don’t see","Self-oriented perfectionism regarding performance, appearance, and routine",C,"Of the symptoms listed, self-oriented perfectionism regarding performance, appearance, and routine is not a diagnostic criterion of body dysmorphic disorder. Instead, this rigid perfectionism is a pathological personality trait associated with obsessive-compulsive personality disorder. While there is an element of perfectionism with BDD, it is limited to one’s appearance rather than an aspect of extreme conscientiousness, which insists that all things must be perfect. According to the DSM-5-TR, the diagnostic criteria for BDD include “A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviors (eg, mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (eg, comparing his or her appearance with that of others) in response to the appearance concerns. C The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder (APA, 2022)”. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
427,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,What would be an area to focus on?,Hopelessness,Gender Identity Development,Recommitment,Behavioral Problems,"(A): Hopelessness
(B): Gender Identity Development
(C): Recommitment
(D): Behavioral Problems",Recommitment,C,"Both Tony and Kathleen felt hurt by the other to the point where they questioned the future of their relationship. However, after some exploration they both decided on working things out. Recommitment to the relationship would be an area of focus. Gender identity is not an issue as transvestic disorder is not an indication that one is not happy with the gender with which they were born. Tony and Kathleen have not expressed feelings of hopelessness individually or as a couple system. There are no behavioral issues to be addressed as a couple system. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
428, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",Which of the following is a long-term goal as opposed to a short-term objective?,"Parents set firm, consistent limits and maintain appropriate parent-child boundaries",Parents and the client demonstrate increased knowledge about ADHD and its treatment,Consult with school personnel to implement behavioral classroom management interventions,Complete psychological testing to measure the nature and extent of ADHD,"(A): Parents set firm, consistent limits and maintain appropriate parent-child boundaries
(B): Parents and the client demonstrate increased knowledge about ADHD and its treatment
(C): Consult with school personnel to implement behavioral classroom management interventions
(D): Complete psychological testing to measure the nature and extent of ADHD","Parents set firm, consistent limits and maintain appropriate parent-child boundaries",A,"Working with the parents on developing and maintaining consistent boundaries at home is an important factor in the effectiveness of your treatment of Avery and would be considered a longer-term goal as it will involve several objectives and interventions delivered over the length of your counseling relationship. Answer a) is a short-term objective that would be paramount in this treatment plan for Avery. Answer b) is an intervention underneath the banner of a short-term objective, and answer d) is also a short-term objective, however it is better conducted by a psychologist. Therefore, the correct answer is (C)",treatment planning
429,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.  Seventh session It has been almost two months since you began therapy with the client. You suggested a session in which both she and her mother were present to discuss the client's progress. She presents to today's session with her mother. The client followed up with your referral from a previous session for her to see a psychiatrist and has provided you with a release of information to communicate with her psychiatrist. The client has been prescribed an antidepressant and says she does not feel any notable change yet but the psychiatrist told her it would take a few weeks to know if the medication was working. The mother states that since her daughter started taking the antidepressant, she is sleeping more than usual and struggles to get out of bed. She has been late to school several times. She is also having trouble with motivation. You reflect the client's current state and suggest she establish a daily routine to gain a sense of control in her life. You discuss the importance of making small achievable goals and explain that taking on too much can be overwhelming, so it is more beneficial to focus on one task at a time. The mother begins listing off potential activities that her daughter should take part in. The client closes her eyes and begins to sigh. When you ask her about her reaction, she says, ""See, yet another example of my mom trying to control everything."" The mother responds by saying, ""I'm not trying to control you. Believe it or not, I just want what's best for you!""    Understanding the tension between them, you suggest a compromise. You explain that if the client completes one activity each day, her mother will not pressure her to do more. The client appears hesitant but agrees to try it out. You then turn to the mother, thanking her for being willing to compromise and understanding. You encourage them to be patient with one another and remind them that progress takes time. You suggest they continue to have regular check-ins so that each party is aware of how the other is doing in following through on the agreement. You end the session by summarizing what was discussed, reinforcing the importance of communication between the client and her mother.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ","Using a cognitive-behavioral approach, how would you use reframing to help the client see her mother's ""controlling"" behavior from a different perspective?","""Take this opportunity to take control over your life and show your mother that you are capable of making responsible decisions.""","""I understand the tension between you and your mother. It sounds like you feel she is trying to control everything, and you're overwhelmed by her expectations.""","""It seems clear that your mother's suggestions are aimed at helping you to gain better control, doesn't it?""","""It sounds like your mother is trying to support you and help you make positive changes. Perhaps she has different ideas about how to get there.""","(A): ""Take this opportunity to take control over your life and show your mother that you are capable of making responsible decisions.""
(B): ""I understand the tension between you and your mother. It sounds like you feel she is trying to control everything, and you're overwhelmed by her expectations.""
(C): ""It seems clear that your mother's suggestions are aimed at helping you to gain better control, doesn't it?""
(D): ""It sounds like your mother is trying to support you and help you make positive changes. Perhaps she has different ideas about how to get there.""","""It sounds like your mother is trying to support you and help you make positive changes. Perhaps she has different ideas about how to get there.""",D,"Reframing involves helping the client and her mother to view the situation from a new perspective. Instead of viewing the mother's requests as controlling, the client can instead view them as an expression of care and concern. Therefore, the correct answer is (B)",counseling skills and interventions
430,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past.  You want to demonstrate congruence with the client when she begins to cry, and you feel the urge to sit beside her and put your hand on her shoulder to comfort her","You want to demonstrate congruence with the client when she begins to cry, and you feel the urge to sit beside her and put your hand on her shoulder to comfort her. Which of the following is the most important consideration?","The appropriateness of this action depends on the sexual orientation and identified gender of you and the client, so as to not send the wrong message to the client.","Physical comfort is a typical human reaction, and this can build therapeutic rapport.",You must first consider if you want to comfort the client physically for your own needs or for the client’s needs.,Handshakes are the only appropriate physical touch with a client.,"(A): The appropriateness of this action depends on the sexual orientation and identified gender of you and the client, so as to not send the wrong message to the client.
(B): Physical comfort is a typical human reaction, and this can build therapeutic rapport.
(C): You must first consider if you want to comfort the client physically for your own needs or for the client’s needs.
(D): Handshakes are the only appropriate physical touch with a client.",You must first consider if you want to comfort the client physically for your own needs or for the client’s needs.,C,"It is most important to first consider your own motives for any personal reaction, similar to self-disclosure, because you want to make sure that you are responding for the client’s benefit and not for your own management of emotional response or emotional needs. Although handshakes are generally acceptable, clients may also respond well to other types of physical touch and may benefit from a comforting hand on the shoulder. Sexual orientation and the client’s identified gender are important considerations; however, your motives are the first filter in assessing the benefits of physical touch. Although physical touch is a typical and accepted human response, you should be careful about the impacts of this response. Therefore, the correct answer is (C)",core counseling attributes
431,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.",Which of the following interventions should be taken as you work with the client and his husband to help them resolve their relationship issues?,Focus on conflict resolution skills,Focus on active listening skills,Have each individual set personal goals for change,"Teach them how to use ""I"" statements","(A): Focus on conflict resolution skills
(B): Focus on active listening skills
(C): Have each individual set personal goals for change
(D): Teach them how to use ""I"" statements",Have each individual set personal goals for change,C,"Couple's counseling is most effective if each individual is able to determine their own goal for how they would like to change themselves in the relationship. Individuals are not able to change another person but can facilitate changes within the relationship when focusing on changing themselves. Each of the other interventions are important skills for clients to learn to improve communication and interpersonal relationships but are not as important as setting one's own personal change goal. For example, the use of ""I"" statements when discussing conflicts (eg, ""I feel sad"" vs ""You make me sad"") is an important part of communication, but will be most effective once the individuals have recognized their own issues within the relationship. Therefore, the correct answer is (B)",treatment planning
432,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.",The client appears to have no significant colleagues at work or friends at home. What is the best method to assess the client's support system?,Ask the client to create a diagram of his relationships with colleagues and friends.,Ask the client to describe his relationships with colleagues and friends.,Ask the client to draw a picture representing his relationships.,Ask the client to list all of his colleagues and friends.,"(A): Ask the client to create a diagram of his relationships with colleagues and friends.
(B): Ask the client to describe his relationships with colleagues and friends.
(C): Ask the client to draw a picture representing his relationships.
(D): Ask the client to list all of his colleagues and friends.",Ask the client to create a diagram of his relationships with colleagues and friends.,A,"As indicated, the client has been in art for over a decade. The client's mode of communication is more haptically oriented, so asking him to draw his relationships with colleagues and friends would be the preferred method in assessing his support system. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
433,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.",Which of the following actions will be most challenging when working with this client?,Empathic responding,Developing a safety plan,Setting and maintaining strong boundaries,Using active listening and attending skills,"(A): Empathic responding
(B): Developing a safety plan
(C): Setting and maintaining strong boundaries
(D): Using active listening and attending skills",Setting and maintaining strong boundaries,C,"Counselors who work with clients diagnosed with BPD are often challenged to set and maintain strong personal and professional boundaries with their client. The client's personality patterns include frantic efforts to avoid any imagined abandonment so changes in appointment times, not allowing the client to stay longer than their appointment time, or holding them to therapeutic discussion rather than casual conversation can appear as rejecting the client. Counselors working with this population are challenged to set, explain, and maintain their boundaries, often needing to repeat these to the client or set new boundaries as new circumstances occur with the client. Developing a safety plan for this client is important so that the client has a plan as well as allowing the counselor to maintain boundaries when not in the office or ""on call"". Empathic responding and active listening/attending skills are foundational counseling interventions that are used with all clients and should not be a challenge. Therefore, the correct answer is (B)",counseling skills and interventions
434,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.",ntly. Family History: The client has an older brother who transports the client to appointments and periodically checks in with the client. Hospital records indicate that the client becomes increasingly agitated during visits with his parents. The hospital social worker noted that his father was critical and dismissive toward the client during family therapy. The client’s mother is diagnosed with generalized anxiety disorder and had to quit her job due to the overwhelming burden of the client’s care. The father blames the client for the excessive toll his illness has placed on the family,You administer the Scale for the Assessment of Positive Symptoms (SAPS) to determine the severity of which of the following?,Diminished speech,Avolition,Agitation,Social withdrawal,"(A): Diminished speech
(B): Avolition
(C): Agitation
(D): Social withdrawal",Agitation,C,"The Scale for the Assessment of Positive Symptoms (SAPS) is a standardized testing instrument used to measure the severity of positive symptoms associated with schizophrenia. Positive symptoms include hallucinations, delusions, bizarre behavior, and positive formal thought disorder. Aggressive and agitated behaviors are considered bizarre behavior. Avolition, diminished speech, and social withdrawal are all negative symptoms of schizophrenia. Avolition is characterized by an inability to pursue goal-oriented activities. Diminished speech, or alogia, involves reduced speech output and decreased verbal fluency. Social withdrawal, or asociality, includes limited social interactions or a lack of interest in socializing. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
435,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","   . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation",Which is included in the DSM-5-TR criteria for binge-eating disorder (BED)?,Dietary restrictions between binging to influence body shape,Dissociation during or following binge eating episodes,Marked distress associated with binge eating,"Recurrent compensatory behavior (e.g., purging)","(A): Dietary restrictions between binging to influence body shape
(B): Dissociation during or following binge eating episodes
(C): Marked distress associated with binge eating
(D): Recurrent compensatory behavior (e.g., purging)",Marked distress associated with binge eating,C,"The DSM-5 criteria for BED include marked distress regarding binge eating. Dietary restrictions and recurrent compensatory behaviors are criteria associated with bulimia nervosa. Some individuals report dissociation during or immediately after binge eating, but this is not a criterion for BED. According to the DSM-5, “Binge-eating disorder has recurrent binge eating in common with bulimia nervosa but differs from the latter disorder in some fundamental respects. In terms of clinical presentation, the recurrent inappropriate compensatory behavior (eg, purging, driven exercise) seen in bulimia nervosa is absent in binge-eating disorder. Unlike individuals with bulimia nervosa, individuals with BED typically do not show marked or sustained dietary restrictions designed to influence body weight and shape between binge-eating episodes. They may, however, report frequent attempts at dieting (APA, 2013)”. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
436,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling  Marital Discord Diagnoses:  You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago.  The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of  The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce",The diagnosis of depressive disorder due to another medical condition (migraine headache) can be assigned when the disturbance is caused by which of the following?,The biopsychosocial effects of migraine headache and/or migraine medication,The pathophysiological effects of migraine headache,The psychocultural effects of migraine headache,The physiological effects of migraine medication,"(A): The biopsychosocial effects of migraine headache and/or migraine medication
(B): The pathophysiological effects of migraine headache
(C): The psychocultural effects of migraine headache
(D): The physiological effects of migraine medication",The pathophysiological effects of migraine headache,B,"According to the DSM-5-TR, Criterion B for the diagnosis of depressive disorder due to another medical condition (migraine headache) states that the diagnoses can be made if there is supporting clinical evidence that the psychological disturbance is the direct pathophysiological consequence of another medical condition. When making this determination, the possibility of medication-induced or substance-induced disruption must also be considered, in which case both diagnoses (ie, depressive disorder due to another medical condition and substance/medication-induced depressive disorder) may be given. Lastly, psychological and cultural effects are considerations for all diagnoses and are not stipulated criteria for this diagnosis. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
437, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.","During the second session, you respond quite impulsively, albeit out of concern for Jonny, exclaiming ""Oh, Jonny, you can't quit everything you've worked for because of a boy you just met!"" What mistake have you just made?",Being overly honest in a way that might hurt his feelings,Breaking counselor code of ethics,Sharing your opinion without being asked,Letting your professional guard down,"(A): Being overly honest in a way that might hurt his feelings
(B): Breaking counselor code of ethics
(C): Sharing your opinion without being asked
(D): Letting your professional guard down",Sharing your opinion without being asked,C,"There is nothing unprofessional about being honest with your client or letting your guard down in a discussion about feelings. It also does not break counselor code of ethics to share your opinions with your clients. However, Jonny did not ask you for your input before you provided it, which has now potentially affected the entire course of your session moving forward since he now knows your disapproving perspective on his choices. You are expected to be a safe, non-judgmental advocate for Jonny, a position which you have now compromised. Therefore, the correct answer is (A)",counseling skills and interventions
438,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.  11th session As the session begins, you sit calmly in your office, virtually watching as the client pounds her fists on her desk and speaks angrily. The client informs you that she is ""not happy"" with you as a therapist. ""You therapists are all the same!"" she yells. She accuses you of being responsible for her break-up, saying that her boyfriend left her because she had been hospitalized on your recommendation.    Her facial expressions convey feelings of hurt and disappointment, and you attempt to normalize her reaction. You remain calm, opting to validate the client's feelings rather than respond defensively or deny responsibility for what has happened between the client and her partner.    As the session continues, you take a deep breath and give yourself a moment to gather your thoughts. You recognize that the client's emotional pain and distress have created a lens through which she now views your professional relationship.    Reflecting on the session and past interactions, you remember your concerns that prompted the recommendation for hospitalization. The client had exhibited signs of severe emotional distress and potential self-harm. As a therapist, you prioritized her safety and well-being. You understand her feelings of abandonment from her partner and try to determine who represents both care and potential harm in her life.    However, no matter how much empathy you try to show or how many times you attempt to normalize the client's feelings of anger, she refuses any further discussion on the topic; instead, she declares firmly that she does not want to see you again and abruptly logs out of the session.    You make a note to reach out to the client in a few days to check in on her well-being and see if she's open to discussing her feelings further. Given the intensity of her reaction, it's crucial to ensure that she has a support system during this challenging time. While she might not be receptive to your outreach initially, she needs to know that she is not alone and that help is available should she seek it.    Later, you discuss the situation with your supervisor, seeking guidance on best handling her response and processing your feelings about the matter. The supervisor reminds you that therapeutic relationships can mirror many aspects of clients' other relationships. The anger and feelings of betrayal the client is experiencing could have been elicited by any number of events in her life. The most important thing is to continue offering support while respecting her boundaries.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What is the most likely reason for the client's aggressive and blaming behavior towards the therapist?,The client is aggressive as a coping mechanism base on her background and life experiences,"The client is stuck in the ego ""critical parent state"" in exhibiting her behaviors.",Projection of her frustrations about the breakup,The client is justified in her anger as you are responsible for her breakup.,"(A): The client is aggressive as a coping mechanism base on her background and life experiences
(B): The client is stuck in the ego ""critical parent state"" in exhibiting her behaviors.
(C): Projection of her frustrations about the breakup
(D): The client is justified in her anger as you are responsible for her breakup.",Projection of her frustrations about the breakup,C,"The client's reaction may indicate projection, a psychological defense mechanism where individuals attribute their unacceptable thoughts or feelings to another person. Here, the client might feel intense disappointment and anger due to the breakup and could be projecting these feelings onto the therapist. This could be because accepting her own role in the situation might be too emotionally challenging. Therefore, the correct answer is (B)",counseling skills and interventions
439,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",It is clear after your second session with Mary that she will continue to struggle with debilitating anxiety symptoms until she is willing to address her unresolved grief. How should you approach this?,motivational interviewing process,do not address it unless Mary brings it up herself,caring confrontation out of ethical responsibility,education on the long-term effects of unresolved grief,"(A): motivational interviewing process
(B): do not address it unless Mary brings it up herself
(C): caring confrontation out of ethical responsibility
(D): education on the long-term effects of unresolved grief",motivational interviewing process,A,"Using motivational interviewing in your counseling with Mary will help you address your primary treatment goal with her, but without using a confrontational style that might cause her to be defensive or resistant. MI can provide a non-judgmental, supportive, and client-led environment for a discussion centered around the client's desired change and factors that increase motivation. Waiting for Mary to work on her grief is a different strategy than waiting for an appropriate time to begin MI interventions. It can be empathic to wait for a future session to address her problem, however waiting for Mary indefinitely is not helpful as she has already suffered for four years without improvement to her condition. Providing education on unresolved grief disorders is useful and can be part of the process; but not used as a means for approaching her unwillingness to engage in the topic. Therefore, the correct answer is (D)",counseling skills and interventions
440,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client attends group therapy and is making therapeutic gains. Her overall anxiety has decreased, and she is engaging in more constructive thinking. Today is week 6 out of the 12 scheduled weekly group sessions. The client continues to work on increasing her assertiveness and has become less tentative with self-disclosures. She is pleasant and cooperative but remains eager to please others. Three group participants have formed a subgroup (i\. e., clique) and have excluded others. The client has begun to take social risks, and today she shares about a time when she felt most anxious. You notice the subgroup whispering and laughing after her disclosure. She nervously turns to you to gauge your response.  Your time-limited group is coming to an end","Your time-limited group is coming to an end. During this final phase, you and the group members process key elements EXCEPT which of the following?",Resolving any conflicted relationships,Identifying members in need of a future “booster” session,"Identifying individual changes in anxiety-related beliefs, attitudes, and behaviors",Generalizing the skills learned in group,"(A): Resolving any conflicted relationships
(B): Identifying members in need of a future “booster” session
(C): Identifying individual changes in anxiety-related beliefs, attitudes, and behaviors
(D): Generalizing the skills learned in group",Identifying members in need of a future “booster” session,B,"You attend to all of the key elements listed except identifying members in need of a booster session. According to the American Group Psychotherapy Association (AGPA) Practice Guidelines for Group Psychotherapy (AGPA, nd), factors listed in answer options A, B, and C summarize the responsibilities of group leaders during the final phase of group therapy. Empirical evidence shows that scheduling booster sessions for all group members helps prevent symptom relapse. Identifying candidates in need of a booster session is rarely processed with the group as a whole. Therefore, the correct answer is (D)",counseling skills and interventions
441,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Which list of symptoms most accurately relates to Social Phobia?,"Depressed mood, dissociation, fear of going outside","Avoidant personality, shyness, anhedonia","Inability to make friends, speech problems, explosions of anger","Avoidance disorder, performance anxiety, fear of eating in public","(A): Depressed mood, dissociation, fear of going outside
(B): Avoidant personality, shyness, anhedonia
(C): Inability to make friends, speech problems, explosions of anger
(D): Avoidance disorder, performance anxiety, fear of eating in public","Avoidance disorder, performance anxiety, fear of eating in public",D,"Social anxiety is characterized by intense, irrational fears of one or more social or performance situations in which a person believes they will be scrutinized by others. Exposure to social situations immediately provokes an anxiety response to an excessive or unreasonable degree. A diagnosed person may or may not experience several of the other factors listed in answers a, c or d, but each one of those answers has a combination of factors that indicate a co-occurring disorder other than social phobia alone. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
442,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","    flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya",Which of the following is the most effective form of treatment for bipolar disorders?,Medication management,CBT and medication management,Dialectical behavior therapy,CBT,"(A): Medication management
(B): CBT and medication management
(C): Dialectical behavior therapy
(D): CBT",CBT and medication management,B,"The most effective form of treatment for bipolar disorders is a combination of medication management and psychotherapy (Mayo Foundation, 2021). Medication and CBT together are an effective treatment combination for this lifelong disorder that requires cognitive adjustments that can be supported by medication. Therapy alone, although it can be helpful, is more effective when combined with medication. Medication alone would address the behavioral and cognitive changes needed to create the lasting changes that are not impacted by medication. Dialectical behavior therapy is useful in treating mood disorders and substance use and is not proven to be beneficial for treatment of bipolar disorder. Therefore, the correct answer is (B)",treatment planning
443,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The couple acknowledge some improvement with communication, but they continue to feel significant levels of relationship distress. The client has been asking for what she needs, mainly when she is in pain and functionally limited, but she reports that the husband continues to do little to support her. The husband reiterates that he has a demanding job that depletes his energy and that he has little to give when he gets home at night. The husband’s child has been verbally abusive to the client, and her husband minimizes her concern. The client feels “stuck in the middle” when determining her stepson’s schedule and activities. The client states that her husband’s bitter ex-wife makes her new role as stepparent “nearly impossible.” To help with the postdivorce adjustment and lessen conflict, you provide information on local support groups, parent education programs through family court, and additional educational resources.  The imago intentional dialogue technique with couples consists of three steps","The imago intentional dialogue technique with couples consists of three steps. In step 2, you encourage the message receiver to respond by stating, “You make sense because …” or “I can see where …” This is an example of which of the following?",Empathizing,Attending,Validating,Summarizing,"(A): Empathizing
(B): Attending
(C): Validating
(D): Summarizing",Validating,C,"This is an example of validating. Imago relationship therapy, developed by Dr Harville Hendrix and Dr Helen LaKelly Hunt, uses imago dialogue, or an imago intentional dialogue, which is a technique used with couples to facilitate meaningful dialogue rather than unproductive discussions that fuel criticism, judgment, and contempt. There are three steps to an imago dialogue: (1) mirroring (ie, “what I hear you say is …”), in which the sender’s message is reflected by using methods such as paraphrasing, summarizing, and clarification; (2) validating (ie, “you make sense because …”), which conveys to the sender that the receiver has accurately understood the message and conveys how it made sense to them; and (3) empathizing, (ie, “I imagine this feels …”), which involves processing the message sender’s underlying feelings. Attending is a listening skill used throughout the process. Couples demonstrate attending using eye contact, facing their partner, and remaining focused. Therefore, the correct answer is (D)",counseling skills and interventions
444,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks",Which of the following would be considered a negative attending behavior?,Consistently matching the client’s posture and repeating her statements throughout the session,Leaning forward,Turning your body 30 degrees in relation to the client throughout the session to present a less aggressive posture,Using hand gestures for emphasis,"(A): Consistently matching the client’s posture and repeating her statements throughout the session
(B): Leaning forward
(C): Turning your body 30 degrees in relation to the client throughout the session to present a less aggressive posture
(D): Using hand gestures for emphasis",Consistently matching the client’s posture and repeating her statements throughout the session,A,"Overusing mirroring with your posture and reflection can present as unnatural or manipulative to clients (Sommers-Flanagan & Sommers-Flanagan, 2015) and would therefore be considered a negative attending behavior. Leaning forward, using hand gestures, and turning your body about 30 degrees in relation to the client are typically not a negative experience for the client unless they are excessive. Overturning your body (past 45 degrees), can be considered a negative attending behavior (Sommers-Flanagan & Sommers-Flanagan, 2015). Therefore, the correct answer is (B)",counseling skills and interventions
445,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",her. Family History: The client says that she has a good relationship with her parents. She says that they are encouraging and supportive of her. The client says that she has a younger brother who is 6 years old and an older brother who is 16 years old. The client states that she has a good group of friends and spends time with them regularly.  You noted that the client is withdrawn and appears uncomfortable,,Ask the client what she does for fun.,Ask the client to talk about anything she wants.,Ask about the musical group depicted on the client’s t-shirt.,Ask open-ended questions to provide the client with the opportunity to answer in a way that she chooses to.,"(A): Ask the client what she does for fun.
(B): Ask the client to talk about anything she wants.
(C): Ask about the musical group depicted on the client’s t-shirt.
(D): Ask open-ended questions to provide the client with the opportunity to answer in a way that she chooses to.",Ask open-ended questions to provide the client with the opportunity to answer in a way that she chooses to.,D,"Open-ended questions were not helpful during the intake session; therefore, you need to take a different approach. If you ask the client about the musical group depicted on her t-shirt or what she does for fun, you show interest in the client and what she values, which could lead to building rapport. It can be helpful to open things up and allow the client to identify whatever goals she wants or to start talking about whatever is easiest for her to start talking about. This gives the client control and lets her lead with what she is most comfortable talking about. Therefore, the correct answer is (A)",counseling skills and interventions
446,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. What would be the most likely manifestation of her paresthesia?",Tremors,Paralysis,Numbness,Dysphasia,"(A): Tremors
(B): Paralysis
(C): Numbness
(D): Dysphasia",Numbness,C,"Paresthesia is a type of abnormal skin sensation characterized by tingling, burning, pricking, itching, or numbness. It commonly affects the hands and feet but can occur anywhere on the body. It is caused by damage to nerve endings caused by trauma, medical conditions such as stroke or diabetes, localized pressure on a nerve, vitamin deficiency, or drugs and alcohol use. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
447, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,The name of the activated system central to the neurochemical process underlying addiction is?,None of the above,Mesocorticolimbic pathway,Norepinephrine pathway,Serotonin pathway,"(A): None of the above
(B): Mesocorticolimbic pathway
(C): Norepinephrine pathway
(D): Serotonin pathway",Mesocorticolimbic pathway,B,"The mesocorticolimbic pathway is the sometimes called the ""pleasure pathway"" and is central to the release of dopamine and is activated by drugs. Serotonin pathway stabilizes our mood, feelings of well-being and happiness. The norepinephrine pathway is activated during stressful events and causes our fight or flight response. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
448,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,Elaina has experienced several ACEs which stands for?,Adverse childhood experiences,Adverse community experiences,Avoidant childrearing entities,Ambivalent caregiver experiences,"(A): Adverse childhood experiences
(B): Adverse community experiences
(C): Avoidant childrearing entities
(D): Ambivalent caregiver experiences",Adverse childhood experiences,A,"Adverse childhood experiences (ACEs) are negative experiences throughout the lifespan such as child abuse or caregiver mental illness which can lead to toxic stress. The more ACEs a person experiences, the more likely they are to have mental health and physical complications later in life. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
449,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client is responding well to your therapeutic interventions. School has ended, and her summertime athletic and academic commitments have lessened. The client reports that she is happy to be out of school and spoke again about not fitting in with her peers. She states that there are limited opportunities for sustaining friendships and worries that she will never find a romantic interest. She reports that her mother has suspended her social media account because the client was overly consumed by the number of “likes” that she received for her online posts. You explain that you will be starting a 12-week group of diverse teens who also experience anxiety and would like her to join. She agrees and is eager to participate","The preaffiliation, or forming, stage of group development is characterized by which of the following?",Dependency and inclusion,Structure and trust,Separation,Power and control,"(A): Dependency and inclusion
(B): Structure and trust
(C): Separation
(D): Power and control",Dependency and inclusion,A,"Dependency and inclusion describe the preaffiliation, or forming, stage of group development. This initial phase of group development is marked by apprehension and tentative exploration. The group leader’s involvement is most pronounced during this stage. Healthy time-limited or closed groups have distinct beginning, middle, and end stages (ie, forming, storming, norming, performing, and adjourning). Power and control describe the middle stage of group development. Other descriptors for this stage include storming, counterdependency, and flight. Competition and the struggle for control emerge as the authority of the group leader is challenged during this stage. Structure and trust describe the norming stage, which transpires during the working stage of development. The leader’s role is less pronounced during this stage, and the group members form closer connections. Separation, or adjourning, is associated with the last stage of group development. Therefore, the correct answer is (B)",professional practice and ethics
450,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which of the following policies builds trust specifically when working with couples in counseling?,The counselor's policy on counseling attendance,The counselor's policy on who is responsible for payment,The counselor's policy on information provided to the counselor by one individual without the knowledge of their partner,The counselor's policy on mandated reporting for domestic violence between adults,"(A): The counselor's policy on counseling attendance
(B): The counselor's policy on who is responsible for payment
(C): The counselor's policy on information provided to the counselor by one individual without the knowledge of their partner
(D): The counselor's policy on mandated reporting for domestic violence between adults",The counselor's policy on information provided to the counselor by one individual without the knowledge of their partner,C,"When working with couples, the counselor's policy of holding or not holding secrets must be determined and communicated to the couple in the informed consent. Many counselors choose not to hold secrets for individuals in a couple so as not to become triangulated in the relationship. A counselor's policy on payment responsibility and attendance is communicated to all clients regardless of whether it is couples counseling or individual counseling. Counselors are mandated reporters for suspected abuse of a child, elderly person, or a vulnerable adult, but not of adults who do not meet these criteria. Therefore, the correct answer is (B)",treatment planning
451,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”","Based on the information provided, which of the following diagnoses is most appropriate for the client at this time?",General Anxiety Disorder,Major Depressive Disorder,Anxiety Disorder Due to Another Medical Condition,Somatic Symptom Disorder,"(A): General Anxiety Disorder
(B): Major Depressive Disorder
(C): Anxiety Disorder Due to Another Medical Condition
(D): Somatic Symptom Disorder",Major Depressive Disorder,B,"The client meets six criteria for diagnosis with major depressive disorder. She cries daily (Criterion A1), difficulty sleeping (A4), weight loss without trying (A3), psychomotor agitation observable by others (A5), difficulty concentrating (A8), and feelings of inappropriate guilt for having cancer (A7). The client has been treated for anxiety and names her emotional state as anxiety, but her symptoms most closely indicate depression. She does worry about finances and her health, but these are normal worries given her circumstances and do not qualify as anxiety. For these reasons, she does not qualify for a general anxiety disorder. The client does not meet criteria for an anxiety disorder due to a medical condition because this requires that her medical condition, cancer, is physiologically causing her current physical or emotional symptoms and no evidence is provided to support this. Additionally, the client does not complain of somatic symptoms (most commonly pain) that is debilitating and significantly disrupts the client's life. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
452,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.",Which of the following would be the most effective “homework assignment” for the client before the next session?,Create a wall collage of her son's photos for the home,Write about her son and her feelings in a daily journal,Choose one day a week for family members to discuss the loss,Talk with her husband about her counseling session,"(A): Create a wall collage of her son's photos for the home
(B): Write about her son and her feelings in a daily journal
(C): Choose one day a week for family members to discuss the loss
(D): Talk with her husband about her counseling session",Write about her son and her feelings in a daily journal,B,"Writing in a journal provides space for the client to express her feelings. These can be shared with the counselor if desired. The artwork and family interactions represent ways to require the family to engage with the client's pain, which is not serving the client effectively at this time. Therefore, the correct answer is (C)",treatment planning
453,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","   ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake",,"On more than one occasion, the client has been arrested or had other legal problems because of alcohol use.","The client has continued to consume alcohol, even though it causes difficulties with her family or friends.",Adverse consequences associated with alcohol consumption have increased in severity within the last 6 months.,The client sees or hears things that others do not.,"(A): On more than one occasion, the client has been arrested or had other legal problems because of alcohol use.
(B): The client has continued to consume alcohol, even though it causes difficulties with her family or friends.
(C): Adverse consequences associated with alcohol consumption have increased in severity within the last 6 months.
(D): The client sees or hears things that others do not.","The client has continued to consume alcohol, even though it causes difficulties with her family or friends.",B,"This question addresses the client’s reported symptoms and the diagnostic criteria for Alcohol Use Disorder (AUD). AUD is diagnosed in individuals who meet at least 2 of 11 criteria in the same 12-month period, as outlined in the DSM-5-TR. The client admitted to continuing to consume alcohol even though it was causing family difficulties (eg, divorce, estrangement from her oldest child, and supervised visits with her grandchildren). This criterion is one out of the 11 criteria recognized in the DSM-5-TR. Individuals who see, feel, or hear things that others don’t are symptoms of alcohol-induced psychosis, which the client did not experience. The client did have negative consequences associated with alcohol consumption, and those consequences did increase in severity within the last 6 months; however, that is not a characteristic of AUD. The client’s 3 DUIs would qualify as legal troubles; however, this criterion was recognized in the DSM-IV and not included in the DSM-5 or DSM-5-TR. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
454,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",What do your observations of the client during the initial session suggest in terms of establishing primary treatment goals?,The primary treatment goals should focus on exploring her childhood experiences and how they may be contributing to her current symptoms.,"The primary treatment goals should address thoughts of dying, coping with loss, and her drinking behaviors.",The primary treatment goals should focus on examining the client's past relationships and how they are impacting her current emotional state.,The primary treatment goals should focus on helping the client develop better social skills and increase her social connections.,"(A): The primary treatment goals should focus on exploring her childhood experiences and how they may be contributing to her current symptoms.
(B): The primary treatment goals should address thoughts of dying, coping with loss, and her drinking behaviors.
(C): The primary treatment goals should focus on examining the client's past relationships and how they are impacting her current emotional state.
(D): The primary treatment goals should focus on helping the client develop better social skills and increase her social connections.","The primary treatment goals should address thoughts of dying, coping with loss, and her drinking behaviors.",B,"These issues should be the initial focus of treatment in order to address the client's immediate psychological needs. Therefore, the correct answer is (A)",treatment planning
455,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”",Which of the following will the counselor need to be most aware of when helping this client set treatment length expectations and prognosis?,Skill building through DBT is helpful but cannot create lasting change,Addiction is a cycle that include relapse,Addiction in conjunction with BPD is not treatable,BPD characteristics tend to diminish in late adulthood so therapy may be long-standing,"(A): Skill building through DBT is helpful but cannot create lasting change
(B): Addiction is a cycle that include relapse
(C): Addiction in conjunction with BPD is not treatable
(D): BPD characteristics tend to diminish in late adulthood so therapy may be long-standing",BPD characteristics tend to diminish in late adulthood so therapy may be long-standing,D,"Research shows that clients with BPD tend to experience more distress in young adulthood but may gradually experience fewer symptoms in late adulthood and this can be improved with treatment. Therapy is frequently long-term and may be needed for years to modify ingrained personality characteristics. Skill building with DBT is an effective treatment and some studies show that clients may not qualify for a BPD diagnosis after completing long-term DBT therapy. The addiction cycle does include relapse but this is incidental to BPD. Addiction is often a way that individuals with BPD medicate their distress and is treatable with substance abuse therapy. Therefore, the correct answer is (B)",counseling skills and interventions
456, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.",Which of the following types represent the client's ISA code?,"Intellectual, Structured, Analytic","Investigative, Social, Artistic","Intuitive, Sedentary, Abstract","Inventive, Scientific, Active","(A): Intellectual, Structured, Analytic
(B): Investigative, Social, Artistic
(C): Intuitive, Sedentary, Abstract
(D): Inventive, Scientific, Active","Investigative, Social, Artistic",B,"The Holland RIASEC types are Realistic, Investigative, Artistic, Social, Enterprising, and Conventional. The client's type ISA shows that her personality type is Investigative, Social, and Artistic so a counselor would facilitate exploration of occupations and work environments that meet the ISA, IAS, SIA, SAI, AIS, and ASI codes. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
457, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”",Which of the following is the best approach to help you determine the client's current readiness for counseling?,Use Motivational Interviewing,Use the client's goals as indicators,Use the Motivation Assessment Scale,Use Prochaska and DiClemente's Transtheoretical Model,"(A): Use Motivational Interviewing
(B): Use the client's goals as indicators
(C): Use the Motivation Assessment Scale
(D): Use Prochaska and DiClemente's Transtheoretical Model",Use Prochaska and DiClemente's Transtheoretical Model,D,"Prochaska and DiClemente's Transtheoretical Model includes five stages of change and allows the client and counselor to determine the client's current status in their readiness for change, from precontemplation to maintenance. This allows the counselor to tailor the treatment plan to the stage in which the client currently resides. Motivational Interviewing is an effective way of moving a client into action when they are less motivated to do so or are experiencing resistance. Motivational Interviewing is a good intervention to use after the client's stage of change has been determined. The Motivation Assessment Scale does measure motivation but is used for clients with developmental disabilities. The client's goals may show desires for change but particularly as the client has been in counseling for these same issues in the past, it is not likely that the goals will provide evidence of the client's readiness for change. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
458,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.",You have been working with the client weekly and are meeting with the mother today to discuss interventions that she can use at home. She relays that her husband does not support the diagnosis of ADHD and has reached out to their faith community instead. The mother is conflicted about counseling and explains that it is viewed as a sign of weakness in her community. She continues to voice concern over the school’s lack of diversity and her belief that the client is being treated differently because of his race,Which of the following would help you engage the client’s mother in treatment?,Explore the influence of her biases toward the school’s majority culture.,Denote the incongruence between historical trauma and here-and-now experiences.,Refute the core cultural beliefs surrounding mental health stigma.,Recognize the impact of the intersectional contexts of privilege and marginalization.,"(A): Explore the influence of her biases toward the school’s majority culture.
(B): Denote the incongruence between historical trauma and here-and-now experiences.
(C): Refute the core cultural beliefs surrounding mental health stigma.
(D): Recognize the impact of the intersectional contexts of privilege and marginalization.",Recognize the impact of the intersectional contexts of privilege and marginalization.,D,"Recognizing intersectional contexts of privilege and marginalization would best help engage the mother in treatment. Intersectionality considers each individual’s privileged and marginalized status in terms of all intersecting sociocultural contexts (eg, race, ethnicity, religion, socioeconomic background, education). Culturally responsive therapists consider the client and the counselor’s intersectional identity’s impact on the client’s presenting problem, treatment engagement, and treatment adherence. Validating rather than refuting core cultural beliefs surrounding mental health stigma can enhance the therapeutic relationship. Exploring the influence of the biases toward the school’s majority culture is not conducive to engaging the mother in treatment. Finally, it is essential to validate historical trauma (and not denote its incongruence), particularly the trauma’s connection to here-and-now experiences, values, and assumptions. Therefore, the correct answer is (B)",counseling skills and interventions
459,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.  Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself.    When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress.    Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, ""My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?"" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious.    At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week.  Tenth session You have been working with Michael to develop and practice effective coping skills appropriate to his age. You have been using behavioral modification techniques to decrease his anxiety about being away from his parents. During previous sessions, you suggested that his parents leave your office space for progressively more extended periods. Michael has complied with these requests, although he was initially anxious and agitated. After five weeks, he is now able to tolerate being away from his parents for up to an hour. In today's session, the parents reflect on their son's progress since he started therapy. They believe that he has made a significant improvement. To date, there have only been ""little incidents."" The parents report that two days ago, Michael was reluctant to go to bed without them and had a minor fit. Instead of escalating the situation, they calmly reminded him of the strategies he had learned in therapy such as taking deep breaths when feeling anxious. To their surprise, Michael began using his coping skills and went to bed peacefully. Michael's mother tells you, ""It finally feels like we've turned a corner. I'm so proud of him!"" The parents have also received positive updates from Michael's teachers who say that he is doing much better in school. They report that he has made a new friend and was invited to a sleepover. Michael seems excited about the idea. His parents are not sure how he will handle being away from home overnight, but they are willing to try.    After providing you with an update, the parents leave the room to wait in the waiting room while you talk to Michael. He appears receptive and comfortable with this arrangement. He tells you, ""I kind of feel dumb for being scared. I'm sorry for causing so much trouble."" You respond affirmatively and validate his feelings. Next, you say, ""I remember when you first came to my office with your mom and dad. You were having a lot of trouble being away from them. Do you think that's still a problem for you?"" He shakes his head ""No"" and reports that he is now able to be away from his parents for longer periods of time without feeling scared or upset. You ask him what has been most helpful to him when he starts to feel anxious. He says, ""The counting and breathing stuff you showed me how to do. Also, I think about something fun that I did with my mom and dad, like that time we went to the beach and built a giant sandcastle!"" You tell him how proud you are of his progress and encourage him to keep using the coping strategies he has learned in therapy.    Near the end of the session, you invite Michael's parents back into your office to check in with them about next steps. The parents agree that Michael has made significant progress in tolerating separation and they feel that the treatment has been successful. You offer additional resources for follow-up care and suggest a plan for transitioning out of therapy. Lastly, you thank Michael and his parents for their dedication throughout the course of therapy and let them know that you are available if they have any further questions or concerns.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ","Throughout the sessions with the client, his parents have accompanied him. You have asked one or both to leave the room for progressively longer periods of time as the sessions have progressed. What approach are you using?",Imaginal exposure therapy,Successive approximations,Flooding,Systematic desensitization,"(A): Imaginal exposure therapy
(B): Successive approximations
(C): Flooding
(D): Systematic desensitization",Systematic desensitization,D,"Systematic desensitization is a form of exposure therapy in which the client is gradually exposed to a situation/stimuli he fears. Over time and with repeated exposures, the anxiety about the situation/stimuli is reduced. Therefore, the correct answer is (C)",counseling skills and interventions
460,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",Unfortunately Mary is a no-show for your next virtual session and is unavailable for contact for over 30 days thereafter. You have three missed calls from Evelyn. What should you do?,Discharge Mary from care and ignore the missed call.,Call back and ask if Mary is okay because you are very worried.,Return the call without confirming any information and ask what it is regarding.,Do not return the phone call and continue to wait for Mary to re-contact.,"(A): Discharge Mary from care and ignore the missed call.
(B): Call back and ask if Mary is okay because you are very worried.
(C): Return the call without confirming any information and ask what it is regarding.
(D): Do not return the phone call and continue to wait for Mary to re-contact.",Return the call without confirming any information and ask what it is regarding.,C,"In this case, it is reasonable to assume Mary may be avoiding therapy as is consistent with her mental health diagnoses, but it is also a possibility that Mary is unwell or has befallen harm as she is a lonely senior with unresolved complex grief and has suddenly disappeared. Either way, the phone calls from Evelyn can be returned out of concern for Mary's safety, without breaking confidentiality. For instance, ""Hello Ms Evelyn, I see you called me, and I was returning your call to ask what it was regarding"". Evelyn may tell you directly if there is news involving Mary's status that may change the terms of confidentiality. If she does not, you are within your legal right to maintain your confidential position by replying ""I'm sorry, Ms Evelyn, I am still unable to comment on the status of any clientele I may or may not have, I just wanted to follow up the reason for your call"". Depending on your agency or practice's rules, you may be within your right to discharge Mary from care or wait for her to re-contact. However, the best practice decision would be to follow up if there is any doubt about her safety. Answer b) breaks confidentiality, even if you end up discovering that Mary is not okay. Therefore, the correct answer is (D)",professional practice and ethics
461,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ","Given the client's comments, which treatment goal would you consider working on at this time?",Transitioning from individual to couples therapy,Determining whether or not he should divorce his wife,Creating a plan to file for bankruptcy for his business,Decreasing his drinking and learning to use relaxation techniques when feeling the urge to drink more,"(A): Transitioning from individual to couples therapy
(B): Determining whether or not he should divorce his wife
(C): Creating a plan to file for bankruptcy for his business
(D): Decreasing his drinking and learning to use relaxation techniques when feeling the urge to drink more",Decreasing his drinking and learning to use relaxation techniques when feeling the urge to drink more,D,"This is the correct answer because his drinking is affecting his relationship and his work performance. Therefore, the correct answer is (B)",treatment planning
462,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,At this point the counselor should?,"Tell the mother that since she is the guardian, she can be told session details.",Introduce client confidentiality and privacy rights.,"Encourage Shar to communicate what occurred in the session as they feel comfortable, with their mother.",Share minimal information with the mother.,"(A): Tell the mother that since she is the guardian, she can be told session details.
(B): Introduce client confidentiality and privacy rights.
(C): Encourage Shar to communicate what occurred in the session as they feel comfortable, with their mother.
(D): Share minimal information with the mother.","Encourage Shar to communicate what occurred in the session as they feel comfortable, with their mother.",C,"Working with a minor often brings up issues of confidentiality. The best option out of the choices above is to help facilitate communication between Shar and Nadia. It is unethical to share with Nadia what is said in the counseling sessions unless there are safety concerns. Client confidentiality and privacy rights should be discussed at intake so this should not be the time to first introduce this. Regardless of the mother being the guardian, confidentiality and privacy rights still apply. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
463,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.  Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, ""I can't do this. You tell them."" Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents.    You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, ""We know that something is going on."" He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, ""We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl."" You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her.    The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that ""did this to our daughter."" The initial conversation is difficult, but you provide support as the family talks through their feelings.  Fifth session You have been seeing the client weekly during her lunch break. After their initial shock, her parents have accepted the news and are now focused on helping their daughter. The client told you that they have been discussing the options available to them, such as adoption or parenting the baby. When you met with the client last week, she opened up about how she was feeling physically and emotionally. She told you that although her parents have been supportive, she was still feeling overwhelmed and uncertain about the future. She told her boyfriend about the baby, but he has been distant and unsupportive. Her parents met with the boyfriend's parents and tried to talk about options, but his parents said they did not want to be involved. They said they ""already had too many mouths to feed"" and could not help with the baby.    Today, the client and her mother come to see you for a scheduled appointment. The mother smiles as she pulls out a picture of the baby's sonogram to show you. She says, ""We met with our minister, and the three of us have been praying for guidance as we have been trying to cope with this situation."" They decided that the best option for their daughter and the unborn baby was to find a loving family who would be willing to adopt. The mother explains, ""We want our daughter to focus on her education and not worry about the responsibilities of raising a child right now. We are hoping that by finding a good home, we can provide this baby with a bright future."" As the mother talks, you notice that the client is more relaxed and looks alert and focused. You ask her about how she feels about the decision. She admits that although she still feels overwhelmed, she is also starting to feel more at peace with the idea of adoption. You nod your head in understanding and offer some words of support. Finally, the mother states, ""What we need at this point is for you to reschedule our daughter's classes so that she can continue with schoolwork virtually and also ensure that she gets the rest she needs during her pregnancy."" You assure them that you will work with the school administration to facilitate the client's needs. You end the session with a plan for the client's continued care. You will continue to meet with her as needed and provide additional support.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","Through several professional development opportunities, you have been made aware that there have been changes in your state's legislation as to the types and character of the pregnancy-related resources that you can provide to the client, as an employee of the school system. Even though you have access to many possibly helpful programs, you are unsure what types of adolescent pregnancy resources you can provide. How do you proceed?","Since you have a grasp of the client's psychological frailty, your ethical choice is to provide any and all resources that will support the client.","Given your status as a school employee, you should seek supervision and consultation as your first ethical concern.",You should make a formal request to the school administration as to what materials you can share with the client that are consistent with any changes in legislation.,"In light of the client's needs, you should consult with the client's parents and direct them toward resources that you cannot officially suggest.","(A): Since you have a grasp of the client's psychological frailty, your ethical choice is to provide any and all resources that will support the client.
(B): Given your status as a school employee, you should seek supervision and consultation as your first ethical concern.
(C): You should make a formal request to the school administration as to what materials you can share with the client that are consistent with any changes in legislation.
(D): In light of the client's needs, you should consult with the client's parents and direct them toward resources that you cannot officially suggest.","Given your status as a school employee, you should seek supervision and consultation as your first ethical concern.",B,"If you are unsure of any regulations regarding resources to the client, first seek supervision and consultation. Therefore, the correct answer is (A)",professional practice and ethics
464,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”","After the second session, you now feel better equipped with information to reliably diagnose Davone with a Borderline or Antisocial Personality Disorder. All of the following factors would contribute to this decision, except?","Davone's persistent, inflexible pattern of maladaptive perceptions and interpretations",Davone's pervasive inability to change his behavior without insight,Davone's apparent fear of abandonment and extreme emotional mood swings,Davone's report of trying harder to do better with increased self-esteem,"(A): Davone's persistent, inflexible pattern of maladaptive perceptions and interpretations
(B): Davone's pervasive inability to change his behavior without insight
(C): Davone's apparent fear of abandonment and extreme emotional mood swings
(D): Davone's report of trying harder to do better with increased self-esteem",Davone's report of trying harder to do better with increased self-esteem,D,"Davone has clearly presented with a persistent, inflexible pattern of maladaptive perceptions and interpretations, a pervasive inability to change his behavior without insight, fear of abandonment and extreme emotional mood swings. He also demonstrates lack of remorse for his wrongful actions, abnormalities in his decision-making processes with criminal behavior and has an unclear or shifting self-image. These expressions can point towards further assessing for Borderline or Antisocial Personality Disorder. Davone expressing an increase in self-esteem or recent behavior changes that he has been making to improve upon himself are not factors in the determination of this diagnosis. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
465,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ","What is your rationale for selecting a ""moderate"" specifier for the client's eating disorder?","The ""moderate"" specifier for the client's eating disorder is inaccurate and does not reflect the client's compensatory behaviors.",He engages in an average of 8-13 episodes of compensatory behavior per week to prevent weight gain.,He engages in an average of 4-7 episodes of compensatory behavior per week to prevent weight gain.,He engages in an average of 1-3 episodes of compensatory behavior per week to prevent weight gain.,"(A): The ""moderate"" specifier for the client's eating disorder is inaccurate and does not reflect the client's compensatory behaviors.
(B): He engages in an average of 8-13 episodes of compensatory behavior per week to prevent weight gain.
(C): He engages in an average of 4-7 episodes of compensatory behavior per week to prevent weight gain.
(D): He engages in an average of 1-3 episodes of compensatory behavior per week to prevent weight gain.",He engages in an average of 4-7 episodes of compensatory behavior per week to prevent weight gain.,C,"The moderate specifier is used when the client engages in an average of 4-7 episodes of compensatory behavior per week to prevent weight gain. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
466,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.  Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is ""officially sleeping in the spare bedroom"" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, ""We don't talk anymore. He just berates me all the time, and that hurts a lot."" As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, ""She's a mess. I don't know what to say.""    You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed.    Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship.  Seventh session You met previously with each partner separately. They shared their perspectives with you about their relationship. The husband told you that he was reluctant to stay with his wife. The wife described feelings of worthlessness and loneliness. Today, the husband arrives for their couples session ten minutes after the wife, as they are driving in separate cars. The husband states that he is bored at home and is tired of his wife ""nagging"" him. The wife rolls her eyes and expresses that she will never be a priority, and the husband blames her for everything that goes wrong. The wife is now staying at her friend's house, and the husband is relieved that she is gone. You talk to the couple about their perceived outcomes in therapy and what they hope to accomplish going forward.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ","You state to the husband, ""You say you are bored at home and are tired of your wife's constant nagging. You're also relieved that she is not staying with you right now. Is that right?"" What skill are you demonstrating with this response?",Reflecting meaning,Summarizing,Reflecting feelings,Encouraging,"(A): Reflecting meaning
(B): Summarizing
(C): Reflecting feelings
(D): Encouraging",Summarizing,B,"Summarization in therapy is the process of recapping and synthesizing a client's story or experiences. This involves actively listening to the client, reflecting on what has been said, and then providing a summary of those thoughts and feelings to ensure understanding between the therapist and client. Therefore, the correct answer is (A)",counseling skills and interventions
467,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ",What do you address first with this couple during the intake?,The wife's weight issues,The possibility of an extramarital affair,The husband's sexual issues,The couple's objectives for therapy,"(A): The wife's weight issues
(B): The possibility of an extramarital affair
(C): The husband's sexual issues
(D): The couple's objectives for therapy",The couple's objectives for therapy,D,"The couple is experiencing distress in their relationship, possibly due to sexual dysfunction. It is important that you understand what they want to gain from therapy. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
468,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What step is relevant when arranging a one-on-one aid for the client?,Review the client's family history of developmental delays,Obtain informed consent from the client's mother,Consult the client's past providers to determine eligibility,"Begin ""deconstructing the problem"" with the client's mother","(A): Review the client's family history of developmental delays
(B): Obtain informed consent from the client's mother
(C): Consult the client's past providers to determine eligibility
(D): Begin ""deconstructing the problem"" with the client's mother",Obtain informed consent from the client's mother,B,"This is the only relevant step in the actual process to arrange for this client's one-on-one aid. Therefore, the correct answer is (C)",professional practice and ethics
469,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher.  Ninth session The client, his parents, and the math teacher present to your office. The teacher reports that the client seems to be achieving academic success with the addition of having a separate location for tests and extra time to complete assignments. The parents state they see improvement at home after deciding to put him on Ritalin. They are smiling as they report that their son seems to have entered a ""new phase."" His progress is evident in his increased engagement in the classroom and his improved academic performance. He is able to follow instructions and complete assignments in a timely manner, and is better able to interact with his peers. His attitude towards class participation has improved and he is able to self-regulate his emotions better. He has also expressed an increased level of self-esteem and self-efficacy in math class. Overall, the client has demonstrated improved functioning in the academic arena and the addition of Ritalin has helped him to become more alert and focused. The client appears content and keeps asking if it is time to go back to class yet.    To further ensure successful progress and to provide additional support for the client, you suggest that the teacher and parents have consistent and frequent communication about the client’s academic progress. You recommend that the teacher provide regular feedback and encouragement to the client, and you suggest that the parents continue to provide a structured and supportive environment at home. Additionally, you discuss potential academic supports that the parents may consider to help the client maintain his academic progress. Finally, you suggest that the client continue to utilize his self-regulation strategies and other coping skills to manage any anxiety or other challenging emotions related to math class."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",What additional educational resource would you suggest for the client in this new phase of his treatment?,Math Team,Youth group at church,Gym,Tutoring,"(A): Math Team
(B): Youth group at church
(C): Gym
(D): Tutoring",Tutoring,D,"Now that the client is more focused and has an IEP, this may be a good time for extra help in math to work on those areas where he is falling behind. Therefore, the correct answer is (C)",treatment planning
470,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",How would you use cognitive-behavioral therapy (CBT) to address the client’s feelings of not belonging?,Explore the client's need to belong,Use scaling questions to identify exceptions to feelings of not belonging,Identifying her self-talk that promotes social isolation,Help the client deal with her tendency to overgeneralization,"(A): Explore the client's need to belong
(B): Use scaling questions to identify exceptions to feelings of not belonging
(C): Identifying her self-talk that promotes social isolation
(D): Help the client deal with her tendency to overgeneralization",Identifying her self-talk that promotes social isolation,C,"CBT focuses on identifying and challenging the client’s negative self-talk and thought patterns in order to help them gain insight into how these thoughts are impacting their behavior. In this case, you would focus on helping the client identify her negative self-talk that is promoting social isolation and challenge those beliefs. By doing this, the client can gain insight into how these thought patterns are contributing to her feelings of not belonging and help her identify alternatives that will lead to healthier coping strategies. Therefore, the correct answer is (A)",counseling skills and interventions
471,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.  Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a ""new chance at living."" She further discloses that she recently met a ""wonderful man."" They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that ""he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me."" She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different.    From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. ""He's always around when I need him,"" she explains, ""And he listens to me and takes what I say seriously."" The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, ""If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared.""    You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",In what way would you best assess the client's progress and ongoing needs during the therapeutic process?,Ask the client to keep a comprehensive journal of actions and feelings.,Implement check-ins and review goals for therapy regularly.,Elicit information from the client's self-report during sessions.,Have the client take a survey or questionnaire.,"(A): Ask the client to keep a comprehensive journal of actions and feelings.
(B): Implement check-ins and review goals for therapy regularly.
(C): Elicit information from the client's self-report during sessions.
(D): Have the client take a survey or questionnaire.",Implement check-ins and review goals for therapy regularly.,B,"To assess the client's progress and ongoing needs during the therapeutic process, you can implement regular check-ins throughout sessions to explore any new thoughts or feelings that have arisen, as well as ask questions about how she is managing her relationship with her partner. Additionally, you can review goals for therapy regularly to ensure the client is on track for achieving her desired outcomes. Therefore, the correct answer is (D)",treatment planning
472,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","    History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork.  You help the client create self-affirmations to counter the anxiety that she experiences during job interviews","You help the client create self-affirmations to counter the anxiety that she experiences during job interviews. According to self-affirmation theory, what is the first step to developing these mental processes?",Replace a crossed transaction with a complementary transaction.,Identify a significant core value.,Identify the activating event.,Model unconditional positive regard.,"(A): Replace a crossed transaction with a complementary transaction.
(B): Identify a significant core value.
(C): Identify the activating event.
(D): Model unconditional positive regard.",Identify a significant core value.,B,"The first step in developing self-affirmations is to identify a significant core value. Core values are stable beliefs upon which a person acts or aspires to act. Self-affirmations are used to affirm a person’s self-worth. Core values create positive emotional states. Self-affirmation theory is based on the premise that a person’s core values provide a more global view of themselves. When self-affirmations are based on core values, the other parts of a person are reinforced and self-concept is better protected. Individuals engaging in self-affirmations are less likely to attribute negative feedback to the current experience and are less likely to distort information. Identifying the activating event is the first step in CBT. Providing the client with unconditional positive regard rather than modeling it is a person-centered technique. Crossed and complementary transactions are concepts associated with transactional analysis. Therefore, the correct answer is (B)",counseling skills and interventions
473, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,Autumn could be showing symptoms of all of the following except?,Social Anxiety Disorder (Social Phobia),Anorexia Nervosa,Avoidant/Restrictive Food Intake Disorder,Binge Eating Disorder,"(A): Social Anxiety Disorder (Social Phobia)
(B): Anorexia Nervosa
(C): Avoidant/Restrictive Food Intake Disorder
(D): Binge Eating Disorder",Binge Eating Disorder,D,"Autumn is not showing signs of Binge Eating Disorder in where there is ""eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances"". Like Autumn, someone diagnosed with avoidant/restrictive food intake disorder shows significant weight loss. This is also a symptom with Anorexia Nervosa along with a restriction of caloric intake. The counselor may also consider social anxiety disorder (social phobia) because of the avoidance of eating in social situations. Therefore, the correct answer is (D)",treatment planning
474,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",Which of the following motivational interviewing techniques did you use during the session to encourage the client to consider pursuing the teaching opportunity?,Reframing,Emphasizing autonomy,Double-sided reflection,Affirmation,"(A): Reframing
(B): Emphasizing autonomy
(C): Double-sided reflection
(D): Affirmation",Reframing,A,"Reframing in the context of motivational interviewing is a technique used to help clients see a situation from a different perspective. During the session, the client told you that she still loves ballet but thinks it will be painful to watch other children fulfill the dreams she can no longer pursue. You responded with a different perspective by suggesting that teaching ballet could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. Therefore, the correct answer is (C)",counseling skills and interventions
475,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.",What is one of the three symptoms that must be experienced in order to diagnose Erectile Disorder?,Increase in premature ejaculation,Decrease in erectile rigidity,Duration of 3 months,Decrease in ability to climax,"(A): Increase in premature ejaculation
(B): Decrease in erectile rigidity
(C): Duration of 3 months
(D): Decrease in ability to climax",Decrease in erectile rigidity,B,"This is the correct answer because it is one of the symptoms in Criteria A that determines the diagnosis of Erectile Disorder. This symptom indicates the client may obtain an erection, but then the penis becomes flaccid. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
476,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","You work with the client and their parents to help the parents understand how the client conceptualizes their gender identity. You use the client’s self-identified, gender-affirming pronouns and praise the client for taking a brave first step. The client’s mother is fearful and anxious, particularly when thinking about the client’s safety. The client’s father expresses an overall lack of understanding and thinks it could be a phase. You recognize the father’s efforts to understand and help the client explain the distressing emotions associated with coming to terms with their gender identity, including an increase in severity since the onset of adolescence. The father states that he is unsure if he can accept the client’s transgender identity but says that he is committed to the counseling process.  The client is discouraged by their father’s lack of acceptance",The client is discouraged by their father’s lack of acceptance. Which of the following can you use to reconceptualize the client’s perception by shifting their viewpoint?,Reframing,Joining,Linking,Restructuring,"(A): Reframing
(B): Joining
(C): Linking
(D): Restructuring",Reframing,A,"Reframing is used to help the client reconceptualize the problem and allow them to shift their perspective. In this situation, a reframe would emphasize the father’s commitment to counseling and his desire to understand as a possible indication of love and acceptance. Restructuring is used in family therapy when counselors intentionally unbalance the family’s homeostasis to facilitate transformation and improve interactions and functioning. Linking is a group therapy technique employed by group leaders to help members connect with one another. Joining is a family systems technique that refers to the counselor taking a leadership position within the family system. In structural family therapy, joining also involves blending, tracking, and mimesis. Therefore, the correct answer is (C)",counseling skills and interventions
477,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”","Regarding anger management, what exercises should Davone practice before next session to remain calm throughout the week?",physical expressive therapy using punching bags in the gym,journal writing to members of his family,release of negative energy through use of crystals,watch humorous videos and practice deep breathing in between laughter,"(A): physical expressive therapy using punching bags in the gym
(B): journal writing to members of his family
(C): release of negative energy through use of crystals
(D): watch humorous videos and practice deep breathing in between laughter",watch humorous videos and practice deep breathing in between laughter,D,"Using humor to release tension has been effective for men needing anger management, therefore combining deep breathing strategies with this activity can greatly calm anger and help Davone practice mindfulness. Exercise is a great solution to relieving stress, but it is not recommended to channel fueled emotions by engaging physical motions of aggression as it has been proven in scientific studies to heighten aggressiveness when angry. The use of holistic or crystal therapies are interventions to be delivered at the discretion of the therapist however are not evidence-based and should only be considered with clients who are already familiar with the practices or requesting to learn more about them. Although journaling is a healthy exercise in helping Davone reflect and relieve himself of things he wants to communicate, engaging in cognitive and emotional content through focusing on his reasons for anger may only serve to heighten his distress. Therefore, the correct answer is (C)",counseling skills and interventions
478,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.",,What is the most important action to take based on the client's statements during today's session?,Encourage the client to tell her husband she knows he is dating,Involuntary hospitalization,Develop a safety plan,Conduct a risk assessment,"(A): Encourage the client to tell her husband she knows he is dating
(B): Involuntary hospitalization
(C): Develop a safety plan
(D): Conduct a risk assessment",Conduct a risk assessment,D,"The client alludes to death and other feelings which could be problematic. Conducting a risk assessment will give you a better idea of where the client is, especially regarding whether she is thinking about suicide or if she intends to harm herself. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
479,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.  Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.",Which treatments have been shown to be effective in treating clients with NCDs?,Electro-Convulsive Therapy (ECT),Dynamic Supportive Therapy (DST),Exposure and Response Prevention (ERP),Mindfulness-Based Stress Reduction (MBSR),"(A): Electro-Convulsive Therapy (ECT)
(B): Dynamic Supportive Therapy (DST)
(C): Exposure and Response Prevention (ERP)
(D): Mindfulness-Based Stress Reduction (MBSR)",Mindfulness-Based Stress Reduction (MBSR),D,"MBSR is inexpensive, easy to teach, and relatively simple to practice. Therefore, the correct answer is (C)",counseling skills and interventions
480,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.  10th session You have been seeing Gregory for therapy every week for the past three months. You have worked to improve the parent-child relationship and incorporated parent-management training into his treatment plan. You have taught Gregory's mother techniques to improve his behavior and support his emotional functioning. Also included in Gregory's treatment plan is improving impulse control, learning problem-solving skills, and improving social skills. You have used CBT interventions, structured activities, games, and role-playing exercises with Gregory to achieve these goals.    Today, Gregory begins the session by taking a paper from his backpack and handing it to you. You see that he received a high grade on his mid-term in Global Studies. You praise him for his hard work. Then, you ask him how it felt to get his grades back up. There is a long silence. Gregory is fidgeting with the string on his backpack. He turns, looks out the window, and whispers, ""Good, I guess."" You notice the client has tears in his eyes. You draw his attention to his behavior and affect and ask, ""Why are you upset after being successful with your exam?"" He shrugs his shoulders, looks at you, says, ""Would you stop asking me so many questions?"" and walks out of the office. You follow him into the waiting room and hear him tell his mom, ""I'll be in the car."" His mom looks confused. You say to her, ""Is something going on or did something happen with Gregory that I should know about? He seemed upset after showing me his good exam grades."" She thinks for a moment and tells you that he found a box of old family pictures and has been going through them. She wonders if this is related to his reaction today.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.","Given Gregory's behavior in the session and his mother's disclosure, what topic may need further exploration in the next session?",Bullying at school,Unprocessed grief,Sibling rivalry,Nicotine withdrawal,"(A): Bullying at school
(B): Unprocessed grief
(C): Sibling rivalry
(D): Nicotine withdrawal",Unprocessed grief,B,"Gregory's emotional response was incongruent with improved functioning in school performance. Given what his mother told you, his angry response could be a secondary emotion tied to unprocessed grief related to his father's death. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
481,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ","If you are going to bill a third party insurance company, what information do you need to share with the parents regarding their daughter’s therapy records?",The insurance company will have access to records that the parents have released.,The insurance company will have full access to the client's therapy records without any restrictions.,The insurance company will have limited access to her records to conduct a utilization review.,"The insurance company will have access to a separate, redacted narrative produced by the therapist and the client.","(A): The insurance company will have access to records that the parents have released.
(B): The insurance company will have full access to the client's therapy records without any restrictions.
(C): The insurance company will have limited access to her records to conduct a utilization review.
(D): The insurance company will have access to a separate, redacted narrative produced by the therapist and the client.",The insurance company will have limited access to her records to conduct a utilization review.,C,"While therapy records may be shared with third party insurers, there are still professional and legal limitations on how much information can be released and what it can be used for. Therefore, the correct answer is (B)",professional practice and ethics
482,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,Which of the following interventions would NOT help Michael recognize a situation and an urge before a tic arises?,Cognitive behavioral therapy,Psychoeducation,Insight-oriented therapy,Neuroleptics,"(A): Cognitive behavioral therapy
(B): Psychoeducation
(C): Insight-oriented therapy
(D): Neuroleptics",Insight-oriented therapy,C,"Insight-oriented therapy would not be an appropriate modality. This modality helps to identify unconscious motivation in behavior. Neuroleptics, also known as antipsychotic medication, has been shown to reduce tics. CBT can help the individual recognize the urge before the tic and identify situations prior. Psychoeducation can be used to help the person learn things that may alleviate or worsen symptoms. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
483,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,Which of the following statements about panic and anxiety is not accurate?,Panic attacks usually subside within 20 to 30 minutes.,Anxiety does not have an abrupt onset.,In a panic attack the symptoms develop abruptly.,Anxiety symptoms are always intense.,"(A): Panic attacks usually subside within 20 to 30 minutes.
(B): Anxiety does not have an abrupt onset.
(C): In a panic attack the symptoms develop abruptly.
(D): Anxiety symptoms are always intense.",Anxiety symptoms are always intense.,D,"Anxiety symptoms are not always intense; they can have a range in severity and are typically mild. In addition, the onset is usually not abrupt. Panic attacks have an abrupt onset and usually subside within 20 to 30 minutes. To distinguish between the two, it is important to look at brevity and intensity. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
484, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.",Which of the following counseling interventions will be least helpful in helping her connect to her story?,Using a Feeling Wheel or Feeling List to review the categories and levels of emotions,"Provide psychoeducation about the connection between emotions, thoughts, and behaviors",Use a therapeutic game to help client explore her feelings,Record the client telling her story and pause so she can add thought and emotion details,"(A): Using a Feeling Wheel or Feeling List to review the categories and levels of emotions
(B): Provide psychoeducation about the connection between emotions, thoughts, and behaviors
(C): Use a therapeutic game to help client explore her feelings
(D): Record the client telling her story and pause so she can add thought and emotion details",Using a Feeling Wheel or Feeling List to review the categories and levels of emotions,A,"Therapeutic games, such as the Ungame are often used to help clients begin talking about their feelings. These are usually used with children and adolescents, and it would be unusual to do this with an adult with normal intellectual abilities. As the client has demonstrated willingness to talk with the counselor about her life history, it would be most beneficial to follow a sequential process of introducing the connections between emotions, thoughts, and behaviors, followed by helping the client identify feelings she has experienced. Counselors, with clients' permission, may record or have the client record their narrative so that the recording can be used in session to process thoughts and emotions that underlie or result from the client's actions. Therefore, the correct answer is (C)",counseling skills and interventions
485,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""","After you have reviewed the paperwork from the client, you recognize his last name and realize he is your wife's cousin, although this is your first time meeting him. What would be the most appropriate response in this situation?",Notify the client that you are transferring his case as mandated due to ethical concerns.,Ask the client if he is comfortable continuing with therapy,Consider your ability to remain objective,Discuss the situation with the client and collaboratively come to a decision regarding therapy,"(A): Notify the client that you are transferring his case as mandated due to ethical concerns.
(B): Ask the client if he is comfortable continuing with therapy
(C): Consider your ability to remain objective
(D): Discuss the situation with the client and collaboratively come to a decision regarding therapy",Consider your ability to remain objective,C,"According to the ACA Code of Ethics, ""Counselors are prohibited from engaging in counseling relationships with friends or family members with whom they cannot remain objective"". Therefore, the correct answer is (C)",professional practice and ethics
486,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex."," Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother","According to the American Psychological Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which of the following would be a differential diagnosis for premature ejaculation?",Substance-induced sexual dysfunction,A specific phobia,Generalized anxiety disorder,Bipolar disorder,"(A): Substance-induced sexual dysfunction
(B): A specific phobia
(C): Generalized anxiety disorder
(D): Bipolar disorder",Substance-induced sexual dysfunction,A,"Substance-induced sexual dysfunction is a DSM-5-TR differential diagnosis because substance use can affect sexual functioning. Generalized anxiety disorder covers general anxiety about many topics, but it does not necessarily lead to sexual functioning impairment. Social phobia is about a very specific situation or trigger for anxiety, and, although the client does have anxiety about sex and work, this would not meet the criteria. Bipolar disorder does not have known causes of sexual dysfunction. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
487,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and sits down. Their body language does not appear as uncomfortable as it has in previous sessions because they are sitting a little closer together. You ask both individuals what they need to work on. The wife says that she knows that she needs to rebuild trust, and the husband says that he wants to know more about what happened in the affair before they move forward. The couple report that they tried to engage in sex, but that the husband stopped during intercourse. The husband states that he could not get the idea out of his mind that his wife does not find him attractive because she was with a woman. You ask the husband what it means for their marriage if his wife does not find him attractive, and he states that it means he will not be able to please her. You then ask him what it means for the relationship if he cannot please her, and he responds that it means he cannot be a good husband. You follow up asking what it means if he cannot be a good husband, and he says that they will have a miserable marriage. You support effective communication strategies and empathize with the couple. After the session, the wife comes back to get her coffee that she left and says that she knows that she hurt her husband and is in the wrong, so she will do whatever her husband needs to rebuild trust.  The Gottman Method focuses on having five positive interactions to every one negative interaction",The Gottman Method focuses on having five positive interactions to every one negative interaction. Which of the following statements uses the Gottman Method approach of the positive-to-negative ratio?,Focus on small acts of love often,Take breaks in an argument to ensure that you mean what you say.,Communicate early and often to manage conflicts before they grow.,Focus on your friendship with each other.,"(A): Focus on small acts of love often
(B): Take breaks in an argument to ensure that you mean what you say.
(C): Communicate early and often to manage conflicts before they grow.
(D): Focus on your friendship with each other.",Focus on small acts of love often,A,"The Gottman Method encourages maintaining more positive than negative interactions by focusing on engaging in small acts of love often to counterbalance negative interactions. Taking breaks during conflict and regulating what you say is important, but these actions do not reflect the Gottman Method of improving positive interactions. Focusing on friendship is helpful, but this comes from engaging in positive interactions often. Communicating and dealing with conflict as it happens prevent the exacerbation of conflicts but are not the focus of the Gottman Method. Therefore, the correct answer is (B)",counseling skills and interventions
488,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.","You and the client meet 4 days after the initial intake session due to truancy because she has missed several days of school. For about half of the session, the client seems to be withdrawn. She asks you what you are required to report, and you remind her of the limits of confidentiality. The client says that she understands, and then says she is going to talk about what happened anyway. She says that her volleyball coach asked to meet with her after practice about 7 months ago and when she entered his office, he asked to look at her right thigh following a fall during practice. She continues to state that when she showed him, he started to touch her genital area from the outside of her pants. She states that she ran out of the room and went home. She explains that after this event she quit the team and told her parents that she did not want to play anymore, but recently she has started to experience distressing memories of the sexual abuse; she refuses to go to school because she would see the man daily; she has difficulty feeling happiness; and she is experiencing feelings of shame, insomnia, and difficulty concentrating. You praise the client for disclosing this information and empathize with her about how hard it must have been to share this experience",All of the following are appropriate short-term treatment goals following the new information presented during the session EXCEPT:,Identify situations that could trigger a trauma response in order to reduce the impact of the sexual assault.,Identify and reduce the symptoms and effects of the sexual assault.,The client will process her feelings of shame associated with the sexual assault.,Process thoughts and feelings regarding the investigation process into the sexual assault.,"(A): Identify situations that could trigger a trauma response in order to reduce the impact of the sexual assault.
(B): Identify and reduce the symptoms and effects of the sexual assault.
(C): The client will process her feelings of shame associated with the sexual assault.
(D): Process thoughts and feelings regarding the investigation process into the sexual assault.",Identify situations that could trigger a trauma response in order to reduce the impact of the sexual assault.,A,"Identifying situations that may trigger a trauma response would likely come later in treatment from processing because the effects of the sexual assault are not fully understood at this point. It is important to begin processing the feeling of shame because this is a feeling the client is experiencing presently. One of the first steps in working through trauma is to process how it affects present functioning; therefore, it would be helpful to assist the client in reducing the sexual assault’s effects on herself. It is also helpful to prepare the client for the investigation because this may be further triggering and occur quickly, and the client would be otherwise unprepared to emotionally manage the situation. Therefore, the correct answer is (D)",treatment planning
489,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,"All of the following areas must be reviewed during the initial interview, except?",Support system,Paperwork from the hospital,Mental status,Family mental health history,"(A): Support system
(B): Paperwork from the hospital
(C): Mental status
(D): Family mental health history",Paperwork from the hospital,B,"Paperwork from past evaluations and hospital stays can be collected later and can be also obtained during the clinical interview and used as confirmation after the interview. Family mental health history can show depression in first degree family members, a risk factor for depression in the patient. Without knowing details of her father's car accident, some car related deaths are intentional. Molly's support system should be assessed and built upon as it is a protective factor when experiencing grief; a mental status exam can discover key areas of risk for suicide or self-harm and help the clinician understand thought processes, assess for auditory or visual hallucinations and gain insight into behaviors and judgment. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
490,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",What is the best way to build rapport with the client?,Assess the client's current level of support,Express empathy and validate the client's feelings,Ask the client to tell you more about his family and their conflicts,Use humor to lighten the mood,"(A): Assess the client's current level of support
(B): Express empathy and validate the client's feelings
(C): Ask the client to tell you more about his family and their conflicts
(D): Use humor to lighten the mood",Express empathy and validate the client's feelings,B,"Building rapport with a client is an important aspect of counseling and therapy. Expressing empathy and validating the client's feelings helps to create a trusting relationship and provides a safe space for the client to open up. Therefore, the correct answer is (C)",counseling skills and interventions
491,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.","Based on the information provided, which of the following diagnoses should the counselor suspect?",Post-Traumatic Stress Disorder (PTSD),Major Depressive Disorder (MDD),Adjustment Disorder (AD),General Anxiety Disorder (GAD),"(A): Post-Traumatic Stress Disorder (PTSD)
(B): Major Depressive Disorder (MDD)
(C): Adjustment Disorder (AD)
(D): General Anxiety Disorder (GAD)",Post-Traumatic Stress Disorder (PTSD),A,"The client has met the first criterion for PTSD in that he was exposed to an actual death, by witnessing the event which happened to a close family member (Criterion A). Additionally, his angry outbursts with little provocation and his difficulty falling asleep meet Criterion E, which requires marked alterations in arousal and reactivity. An adjustment disorder could be expected with significant life changes, but the disturbance of an adjustment disorder cannot encapsulate normal bereavement (Criterion D), nor can the client meet criteria for another mental health disorder (Criterion C). Given the time period of 15 years since the event and the client's positive experiences with family since the event, it would not be appropriate to diagnose an adjustment disorder. The client uses the word ""depression"" to describe periods of ""a couple days"" during the year in which he feels sad and isolates himself. MDD requires that the individual have either a depressed mood, most of the day, nearly every day during a two-week period (Criterion A1); or a loss of interest in almost all activities, most of the day, nearly every day during a two-week period (Criterion A2). The client does not demonstrate these conditions for more than ""a couple days"" so he does not meet criteria for MDD. Finally, the client does not demonstrate evidence of a general anxiety disorder as he describes no excessive worries or fears related to events or activities (Criterion A). Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
492,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",What type of therapy are you employing with your homework assignment for the client?,Gestalt therapy,Play therapy,Bibliotherapy,Behavioral therapy,"(A): Gestalt therapy
(B): Play therapy
(C): Bibliotherapy
(D): Behavioral therapy",Play therapy,B,"Music may be used in play therapy wherein the individual brings meaningful music and discusses it with the therapist. Therefore, the correct answer is (C)",counseling skills and interventions
493,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.",The client reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him. The client says he has attended Metropolitan Community Church (MCC) with his boyfriend and was surprised to hear their messages of acceptance and inclusion. He has stopped going to bars and nightclubs since dating and reports less substance and alcohol misuse. The client states it has been quite some time since he felt like he had no purpose in life,How should the client’s disclosures about dating and attending church affect the direction of therapy?,It allows you to explore if the client has the ego-strength required for dating and finding a new church.,It determines the need for you to help the client establish his own LGBTQIA+ identity.,It causes you to re-evaluate potential risks associated with the client being “out” in the community.,"It helps connect these events to the client’s management of his hopelessness, depression, and social isolation.","(A): It allows you to explore if the client has the ego-strength required for dating and finding a new church.
(B): It determines the need for you to help the client establish his own LGBTQIA+ identity.
(C): It causes you to re-evaluate potential risks associated with the client being “out” in the community.
(D): It helps connect these events to the client’s management of his hopelessness, depression, and social isolation.","It helps connect these events to the client’s management of his hopelessness, depression, and social isolation.",D,"By connecting dating and attending church with the client’s treatment plan goals, you and the client can best determine the direction of therapy. The client is in the mid to late stages of treatment. Evaluating these events in the context of his treatment plan goals will help clarify the client’s readiness for termination. The client already has established his identity as a gay male, making answer A incorrect. Determining the client’s ego-strength could undermine the client’s confidence and self-efficacy, making this option incorrect. Re-evaluating the potential risks associated with being out in the community is also incorrect because the client is already well aware of the risks. Therefore, the correct answer is (B)",counseling skills and interventions
494,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","It has been 1 month since you last saw the client because he has canceled many sessions in a row without explanation. You process attendance with him and then ask him for updates regarding how symptoms have been over the last month. The client says that there were many reasons for cancellations, such as going to dinner with friends, being too tired, and forgetting about the session and making other plans. The client says that he got a new job and states that he is doing much better managing his ADHD symptoms in the new position. You and the client process what was difficult about his last position and then identify that these tasks are not present in the current position. A majority of this session was spent assessing the level of symptomatology experienced over the past month and the client reporting on events that occurred since the last session.  During several sessions, you have noted in your mental status exam that the client demonstrated psychomotor activity","During several sessions, you have noted in your mental status exam that the client demonstrated psychomotor activity. Which of the following might be a common psychomotor activity for someone who has ADHD?",Pacing,Posturing,Fidgeting,Scanning/excessive eye movement,"(A): Pacing
(B): Posturing
(C): Fidgeting
(D): Scanning/excessive eye movement",Fidgeting,C,"Fidgeting is a common psychomotor activity for individuals who have ADHD and many other mental health disorders. This may be hard to assess because sessions are conducted via telehealth. Scanning and excessive eye movement are likely more related to anxiety, paranoia, and other mental health disorders, not ADHD. Posturing is not a typical symptom associated with ADHD. Pacing is typically associated with anxiety disorders, panic attacks, and at times autism spectrum disorders with repetitive behaviors. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
495,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client comes into your office and says hello in a quiet voice and then sits down, slumps his shoulders, and does not make eye contact. You inquire about what you see, and the client says that he has been feeling more depressed over the past week. The client says that he is experiencing low appetite, a down mood, fatigue, and irritability. You empathize with the client and discuss coping skills for depressive symptoms. The client expresses frustration with his church because he worked part-time in the church office until recently when they encouraged him to resign because he is divorced and he is now unable to work in the church because of this. You empathize with the client regarding his situation at church.  The client states, “I don’t understand how a loving God would approve of disqualifying me from working at church because of a decision my wife made.” The client then begins to cry","The client states, “I don’t understand how a loving God would approve of disqualifying me from working at church because of a decision my wife made.” The client then begins to cry. Which of the following responses would be considered an expression of validation?","“If I am understanding you correctly, it sounds like you’re feeling depressed and frustrated following the finalization of the divorce and the church encouraging you to resign.”",“It does sound frustrating to be encouraged to resign when the choice to divorce was not yours. I think it is perfectly understandable to be sad and frustrated about this.”,“It sounds like you are frustrated that the church encouraged you to resign because of a situation that you do not have control over.”,“I can see how that would be frustrating for you because it might feel incongruent with your beliefs.”,"(A): “If I am understanding you correctly, it sounds like you’re feeling depressed and frustrated following the finalization of the divorce and the church encouraging you to resign.”
(B): “It does sound frustrating to be encouraged to resign when the choice to divorce was not yours. I think it is perfectly understandable to be sad and frustrated about this.”
(C): “It sounds like you are frustrated that the church encouraged you to resign because of a situation that you do not have control over.”
(D): “I can see how that would be frustrating for you because it might feel incongruent with your beliefs.”",“It does sound frustrating to be encouraged to resign when the choice to divorce was not yours. I think it is perfectly understandable to be sad and frustrated about this.”,B,"Reflecting the emotion of being frustrated about the resignation and then moving to agreeing that the client’s feelings are understandable is validation because it goes a step past reflection to normalizing his emotions. Understanding that a situation is frustrating aligns more with empathy. Simply acknowledging frustration regarding the situation would just be reflection because you are reflecting his emotion. Expressing understanding about frustration regarding the church situation and depressive symptoms is simply a summarization of what the client has said. Therefore, the correct answer is (B)",counseling skills and interventions
496,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","   e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination.”  Your religious beliefs prohibit you from affirming the gender identity of a 13-year-old",Your religious beliefs prohibit you from affirming the gender identity of a 13-year-old. Which of the following is your best first response?,Conduct a trauma-informed assessment to determine the etiology of the client’s gender identity to help refine the treatment focus.,Use self-reflection and self-assessment to examine the personal biases and stereotypes you may have about transgender individuals.,Self-disclose your misgivings with the mother to help establish a therapeutic alliance.,Refer the client to a counselor who specializes in counseling transgender youths to prevent imposing your personally held values and beliefs.,"(A): Conduct a trauma-informed assessment to determine the etiology of the client’s gender identity to help refine the treatment focus.
(B): Use self-reflection and self-assessment to examine the personal biases and stereotypes you may have about transgender individuals.
(C): Self-disclose your misgivings with the mother to help establish a therapeutic alliance.
(D): Refer the client to a counselor who specializes in counseling transgender youths to prevent imposing your personally held values and beliefs.",Use self-reflection and self-assessment to examine the personal biases and stereotypes you may have about transgender individuals.,B,"Your best first response is to use self-reflection and self-assessment to examine the personal biases and stereotypes you may have about transgender individuals. Per the ACA Code of Ethics, disclosing your misgivings is unethical because it is not aligned with transaffirmative care and can be detrimental to the client. Conducting a trauma-informed assessment is appropriate, particularly for clients who are at risk for or may have experienced victimization or assault. However, providing this assessment to determine the etiology of the client’s gender identity suggests that there is an underlying cause that should be addressed to “fix” or change the “damaged” client. Assessments can be helpful appraisals for gender dysphoria rather than gender identity. Lastly, the ACA Code of Ethics states that counselors must “refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors” It is important to note that, although making values-based referrals is unethical, counselors are ethically responsible for practicing within the boundaries of their professional competence. Therefore, the correct answer is (C)",professional practice and ethics
497,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Shawn asks for help with overcoming interviewing anxiety. You offer to run a mock interview with him and coach him through his presenting fears. He then mentions he saw your agency's job posting for clinical assistant and would like to be considered. What is the most appropriate response?,"""Our counseling strategies must have been effective, so proud of you for asking! I'll tell my clinical director of your interest!""","""Do you really think that is a good idea considering how anxious you already are?""","""Unfortunately, there is a conflict of interest seeing as you are a current client, I'm so sorry!""","""Maybe in a few months when you're better we can see where you would best fit.""","(A): ""Our counseling strategies must have been effective, so proud of you for asking! I'll tell my clinical director of your interest!""
(B): ""Do you really think that is a good idea considering how anxious you already are?""
(C): ""Unfortunately, there is a conflict of interest seeing as you are a current client, I'm so sorry!""
(D): ""Maybe in a few months when you're better we can see where you would best fit.""","""Unfortunately, there is a conflict of interest seeing as you are a current client, I'm so sorry!""",C,"Clearly presenting a boundary line without offering any hope of future opportunity is the most ethical and appropriate response currently for this client. All other responses are either too presumptuous of his future progress (answer c), unethical due to the dual relationship he would have with the agency or irresponsible considering the level of care he currently needs (answer b) and unnecessarily shaming (answer a). Therefore, the correct answer is (D)",professional practice and ethics
498, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,Darrel is showing symptoms of?,Persistent Depressive Disorder,Other specified depressive disorder,Adjustment Disorder with mixed anxiety and depressed mood,Major depressive disorder,"(A): Persistent Depressive Disorder
(B): Other specified depressive disorder
(C): Adjustment Disorder with mixed anxiety and depressed mood
(D): Major depressive disorder",Major depressive disorder,D,"Darrel's symptoms are consistent with Major Depressive Disorder marked by a depressed mood and loss of interest in any activity, weight loss, difficulty sleeping, feelings of worthlessness and inability to concentrate, all causing severe impairment in functioning. Although Daniel's symptoms occurred within three months of a stressful event, his symptoms are beyond those of an adjustment disorder. Additionally, to meet the criteria for persistent depressive disorder, symptoms must have lasted for two years, which they have not. Other specified depressive disorder also cannot be used since Darrel meets the criteria for Major Depressive Disorder. Therefore, the correct answer is (B)",core counseling attributes
499,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family","Which screening and assessment instrument includes the question, “What are the three objects that I asked you to remember a few moments ago?”",Vineland-II,Mini-Mental State Examination (MMSE),Cornell Scale for Depression in Dementia (CSDD),Daily Living Activities 20 (DLA-20),"(A): Vineland-II
(B): Mini-Mental State Examination (MMSE)
(C): Cornell Scale for Depression in Dementia (CSDD)
(D): Daily Living Activities 20 (DLA-20)",Mini-Mental State Examination (MMSE),B,"The MMSE includes the question “What are the three objects that I asked you to remember a few moments ago?” The MMSE is one method used to quantify an individual’s cognitive functioning. In addition to recall, the MMSE assesses orientation, language, mathematical calculation, attention, and motor skills. The CSDD is a screening tool used to help detect symptoms of depression in individuals experiencing dementia. The CSDD measures a broad range of symptoms, including mood, behavioral disturbances, eating, sleeping, and suicidality. The Vineland-II is an assessment tool rather than a screening instrument. The Vineland-II measures several factors, including daily functioning, adaptive functioning, emotional disturbance, and other behavioral health conditions. Finally, the DLA-20 is an assessment instrument measuring multiple domains, including time management, safety, and communication. The DLA-20 is useful for establishing baseline measures and can be used again at various treatment intervals to measure outcomes. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
500,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.  10th session During the last few counseling sessions, you and the client explored ways that she and her husband could better collaborate and communicate in order to manage their respective responsibilities. You worked with the client to develop coping skills to manage her anxiety, including deep breathing exercises and visualization techniques. You also engaged the client in a discussion about how her beliefs and values were influencing her reactions to her family's needs and strategized how to set boundaries and make decisions that honor her values without feeling guilty or overwhelmed. She has been actively using these coping strategies to better manage her emotions and has been more successful in communicating her needs to her husband.    When you meet for today's session, the client appears to be in a positive mood. After a long discussion with her husband and her brothers, everyone finally agreed it would be best to move her mother into an assisted living facility. She says, ""I had the most trouble convincing my youngest brother that assisted living was the best option. I think my sister-in-law was the one who finally helped him to understand why making the switch would give my mother the best chance for a better quality of life."" She goes on to describe it as ""one of the most difficult decisions I've ever made."" You ask her how she is feeling now that the decision has been made, and she tells you, ""a little bit guilty, but mostly relieved."" You affirm her courage and ability to handle such a challenging situation. She tells you that she ""can finally breathe again."" She also believes that she might be able to have a better relationship with her mother with her being in an assisted living facility. The client does not want to resent her mother every day and expresses a desire to try to make the most of the time they have left together. She tells you that she has been going through some old family photo albums and came across a picture of her mother when she was newly married. She says, ""She and my dad looked so happy together. There was a time when she wasn't so critical and demanding."" The client tells you that she has been reflecting on her own experiences as a mother lately and thinking about ""the courage my mother must have had to leave everything that was familiar to her and move to a new country with four kids in tow."" She remarks that this newfound awareness has helped her understand why her mother was so demanding and strong-willed; she now sees that all of these qualities stem from a desire to provide for their family and give them the best possible life.    Toward the end of the session, the client says, “I’m so grateful for everything you have done. You have been a great listener and given me the tools to cope with everything in a healthier way."" You acknowledge her progress and remind her that she has come a long way since the beginning of your counseling sessions.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",What intervention would be most appropriate for the client to sustain her progress with her family?,Mindfulness exercises/stress management,Peer support group consisting of people with similar situations,Psychoeducation regarding helping aging parents,Couples Therapy,"(A): Mindfulness exercises/stress management
(B): Peer support group consisting of people with similar situations
(C): Psychoeducation regarding helping aging parents
(D): Couples Therapy",Peer support group consisting of people with similar situations,B,"Recommending a peer support group would be most appropriate. Peer support groups provide clients with another layer of support beyond what is offered in individual therapy. The client can benefit from and learn from a peer group and use it to augment her individual therapy. Therefore, the correct answer is (B)",treatment planning
501,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,The counselor is not familiar with East Indian culture. It is important for the counselor to approach this by?,Suppressing bias.,a and b,Acknowledging any bias he or she feels.,Learning more about the East Indian cultures.,"(A): Suppressing bias.
(B): a and b
(C): Acknowledging any bias he or she feels.
(D): Learning more about the East Indian cultures.",a and b,B,"Counselors must be culturally competent and be self-aware of any biases that he/she has. Biases occur naturally and can be addressed so they do not affect the therapeutic relationship. Learning about East Indian culture can be beneficial if the counselor also considers the individuality of the client/family as well. Suppressing bias would not be beneficial to the counselor or therapeutic progress. At times counselors may be surprised or embarrassed to acknowledge their biases. However, this is an important part of equity, diversity and inclusion in the counseling process. Therefore, the correct answer is (D)",professional practice and ethics
502,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.","Which of the following should be included in treatment plan goals in addition to ""emotional management""?",communication skills,autism family support group,academic advisement,family interventions,"(A): communication skills
(B): autism family support group
(C): academic advisement
(D): family interventions",communication skills,A,"It is apparent that Taylor is having difficulty communicating her concerns clearly to her family and within her relationship with her boyfriend since she has reported yelling at all of them and is seeking out a counselor to talk to instead. Teaching communication skills would be the most helpful intervention to help Taylor independently handle her own relationship issues. Conducting family interventions is not appropriate when Taylor, who is an adult, is the only one in the family who has requested help. Offering a support group as a resource is always an option to provide your clients but does not have to be a goal within itself; listing attendance to a relevant support group can fall under an objective within the greater goal of communication skills or emotional management. Academic advisement can be addressed by her school and is not necessarily a treatment provided by a mental health counselor. The subject of improvement in concentration relevant to her academic performance may be presented throughout counseling, however. Therefore, the correct answer is (A)",treatment planning
503,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,Sexual arousal from cross dressing is characteristic of?,Transvestic Disorder,Gender Dysphoria,Nonconformity to Gender roles,Depression,"(A): Transvestic Disorder
(B): Gender Dysphoria
(C): Nonconformity to Gender roles
(D): Depression",Transvestic Disorder,A,"Transvestic disorder is characterized by sexual arousal from cross dressing. Nonconformity to gender roles as an openness to atypical gender expressions. Gender dysphoria is a noncongruence with the gender someone is born with. Depression is characterized by sadness and hopelessness. Therefore, the correct answer is (B)",counseling skills and interventions
504,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client comes into your office and says hello in a quiet voice and then sits down, slumps his shoulders, and does not make eye contact. You inquire about what you see, and the client says that he has been feeling more depressed over the past week. The client says that he is experiencing low appetite, a down mood, fatigue, and irritability. You empathize with the client and discuss coping skills for depressive symptoms. The client expresses frustration with his church because he worked part-time in the church office until recently when they encouraged him to resign because he is divorced and he is now unable to work in the church because of this. You empathize with the client regarding his situation at church.  Due to an increase in depressive symptoms, you explore major depressive disorder","Due to an increase in depressive symptoms, you explore major depressive disorder. All of the following are missing criteria for major depressive disorder EXCEPT:",Increased presence of risky behaviors,A 2-week period of depressive symptoms,A change of weight more than 5% in a month,Decreased interest in preferred activities,"(A): Increased presence of risky behaviors
(B): A 2-week period of depressive symptoms
(C): A change of weight more than 5% in a month
(D): Decreased interest in preferred activities",Increased presence of risky behaviors,A,"An increase in risky behaviors would align more with bipolar disorder, which does involve depressive episodes but is not required for major depressive disorder. The client needs at least five symptoms to meet the criteria for major depressive disorder that occur within a 2-week depressive episode, which include a change in weight of more than 5% in a month, and a decreased interest in preferred activities, among others. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
505,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Nadia should be referred to?,A trauma support group,Social skills group,A group for sex addiction,Couples counseling,"(A): A trauma support group
(B): Social skills group
(C): A group for sex addiction
(D): Couples counseling",A trauma support group,A,"Nadia may benefit from attending a group of victims of trauma for support to help her process her past and help her to see that other have been through similar situations. There is no indication that Nadia has a sex addiction. Seeking sexual partners in this case has to do with the trauma she has experienced. Nadia is having difficulty with her peers, but an anger management group may be more beneficial than a social skills group. Although Nadia is having difficulties in her current relationship, couples counseling will only be effective if both people are willing. Therefore, the correct answer is (C)",treatment planning
506,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.","Taylor realizes after several CBT exercises that she is not reacting to facts, but to her feelings. She doesn't understand where the feelings are coming from and asks what she can do to figure them out. Which of the following should be suggested based on her treatment plan?",Add a Trauma goal and conduct EMDR to get to the bottom of the feelings.,"Include journaling, narrative therapy, and empty chair exercises under communication skills.",Explain that it's normal to not always understand your feelings and not to worry.,Teach thought stopping and refocusing techniques for emotional management.,"(A): Add a Trauma goal and conduct EMDR to get to the bottom of the feelings.
(B): Include journaling, narrative therapy, and empty chair exercises under communication skills.
(C): Explain that it's normal to not always understand your feelings and not to worry.
(D): Teach thought stopping and refocusing techniques for emotional management.","Include journaling, narrative therapy, and empty chair exercises under communication skills.",B,"The activities of journaling, narrative therapy or timeline therapy and Gestalt theory-based exercises such as the Empty Chair technique are all effective and evidence-based methods of improving communication skills and increasing self-discovery at a client-led pace. Answer b) does not validate the client's desire to better understand herself. Neglecting to offer interventions that lead her to change but instead placating with sentiments of comfort is unhelpful and irresponsible. Thought stopping and refocusing strategies are useful for clients who suffer intrusive thoughts, traumatic memories, or struggle with ruminations and are not the best match for a client who desires to intentionally think more about her feelings with the goal of modifying her thought processes. Adding a trauma goal when the client has expressed that she has no trauma is also not necessary unless cognitive behavioral strategies and other interventions have been exhausted, or if in the future a traumatic event is recalled because of these other interventions. Therefore, the correct answer is (A)",treatment planning
507, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.","Leah makes a comment about how ""only other veterans understand her"" because of what she went through in the service. How can a counselor become more sensitive to veteran issues?",There is no limit to what strategies can be used,Join an auxiliary service or volunteer with their local American Legion,Ask their veteran clients to share and inform wherever possible,Read literature about military personnel transition to civilian stress,"(A): There is no limit to what strategies can be used
(B): Join an auxiliary service or volunteer with their local American Legion
(C): Ask their veteran clients to share and inform wherever possible
(D): Read literature about military personnel transition to civilian stress",There is no limit to what strategies can be used,A,"There is no wrong option for working to become more culturally knowledgeable of your clients by any means that are available. Cultural competency does not only refer to racial or ethnic identities, but also to cultures of varied work and life statuses that may experience challenges unique to others in mainstream society. Your willingness and ability to engage in any level of deepening your cultural sensitivity reflects this core counseling attribute of a culturally competent counselor. Therefore, the correct answer is (D)",counseling skills and interventions
508,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",John notes that he is having difficulty at work as well. He feels he can make more money as an executive for a construction company and is considering selling his shares in the marketing industry. You do not agree this is the right time for a major career change. The best approach is to?,Cheer him on enthusiastically! He needs somebody on his side right now,Open a spreadsheet and help him compare the pros and cons of his financial choices.,"Smile and nod, using motivational interviewing and Socratic questioning to learn more",Explain the risks associated with changing career fields and urge him to reconsider,"(A): Cheer him on enthusiastically! He needs somebody on his side right now
(B): Open a spreadsheet and help him compare the pros and cons of his financial choices.
(C): Smile and nod, using motivational interviewing and Socratic questioning to learn more
(D): Explain the risks associated with changing career fields and urge him to reconsider","Smile and nod, using motivational interviewing and Socratic questioning to learn more",C,"Your opinion is not helpful to John right now as he shares with you his career considerations from this vulnerable place in his life. The counselor's role is to support John's thinking process and provide clinical feedback and guidance to assist him in learning and practicing healthier, more adaptive strategies than what is being currently evidenced in his life. Learning more about his thoughts and feelings on the matter might steer the conversation in a therapeutic direction. Focusing on solely the content expressed in his concerns and not considering the whole picture dilutes the overall supportive counseling experience you are providing and takes away from what he could be learning for himself. Celebrating his every presented thought, especially thoughts you do not agree are in his best interest, is pandering to him as a friend and beyond the scope of your boundaries as his professional counselor. Helping him consider the pros and cons of his decision is not a bad option but getting involved in exploring the details of his financial situation is not the most appropriate use of this counseling moment. Therefore, the correct answer is (A)",counseling skills and interventions
509,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.  Sixth session You have seen the client every week since the initial intake. During today's session, the client tells you she has written a suicide note and left it in her room. Her mother is waiting in the lobby for the session to end. You tell the client you must bring her mother into the session and discuss the suicide note. You explain to the client that her mother's presence is necessary to explore and understand why the suicide note was written. The client expresses frustration and says, “You can’t bring my mom in here! She won’t understand why I wrote the note!” You empathize with her feelings, but also explain that it is important to discuss the reasons for writing the suicide note with her mother present. You reassure the client that you will guide the conversation to explore why she wrote the note and support her in addressing any underlying issues. You explain that understanding these reasons is an essential step toward moving forward and developing healthier coping strategies. The client reluctantly agrees, but insists on speaking with you alone first before bringing her mother into the session. You emphasize that it is important for her to be honest about her emotions and to talk about her experiences in order to identify the root cause of her distress. Throughout the conversation, you provide validation and affirmation in order to create a safe space for her to express her feelings. You remind her that she does not have to face the situation alone, and that you can work together to find a way forward.    Once the client has had an opportunity to share her thoughts and feelings, you ask if she is ready for you to invite her mother in. She agrees, and the mother joins you in session. You explain to the mother that her daughter wrote a suicide note and that the two of you have been discussing the suicide note and why it was written. You emphasize that your goal is to better understand the circumstances leading up to this situation, so that you can work together to find a way forward. You state that your primary focus is on finding solutions, rather than assigning blame or judgment. The mother looks at you in disbelief and says, ""What do you mean, she wrote a note saying she was going to kill herself? What are we doing here? I'm paying you to help my daughter, not make things worse!"" She grabs her daughter's hand and storms out, after expressing her anger loudly the whole way to her car.    You are unsure of how to proceed, so you discuss the case with your supervisor. Your supervisor listens and notes your concerns, offering advice and guidance on better handling the situation. He then suggests that you reach out to the client's primary care physician to discuss the possibility of hospitalization and other forms of support that might be available to the client. After further discussion, you call the client's physician and discuss the options.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",Which best describes the reason why a safety plan is created with a client?,To give the client a sense of security.,To be able to contact the client's parents,To have professionals/agencies in place in case of a crisis,To stay in touch with your supervisor,"(A): To give the client a sense of security.
(B): To be able to contact the client's parents
(C): To have professionals/agencies in place in case of a crisis
(D): To stay in touch with your supervisor",To have professionals/agencies in place in case of a crisis,C,"This plan is for the client and therapist to use as a resource in a crisis. Therefore, the correct answer is (B)",treatment planning
510,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice.  The client’s husband calls and requests the client’s records. You are hesitant to comply because there are documented conversations concerning marital discord","The client’s husband calls and requests the client’s records. You are hesitant to comply because there are documented conversations concerning marital discord. According to the HIPAA Privacy Rule, how should you respond?",You cannot provide the record to the husband because there is a potential for harm to the client.,You cannot provide the record to the husband without first asserting counselor-client privilege.,You cannot provide the record to the husband unless requested by a third-party payor.,You cannot provide the record to the husband unless the client is aware of the request and does not object.,"(A): You cannot provide the record to the husband because there is a potential for harm to the client.
(B): You cannot provide the record to the husband without first asserting counselor-client privilege.
(C): You cannot provide the record to the husband unless requested by a third-party payor.
(D): You cannot provide the record to the husband unless the client is aware of the request and does not object.",You cannot provide the record to the husband unless the client is aware of the request and does not object.,D,"The HIPAA Privacy Rule contains provisions about confidential information disclosures to family members. According to the HIPAA Privacy Rule, “Specifically, a covered entity is permitted to share information with a family member or other person involved in an individual’s care or payment for care as long as the individual does not object” Specific state laws may differ. For answer A, the ACA Code of Ethics (2014) states, “Counselors limit the access of clients to their records or portions of their records, only when there is compelling evidence that such access would cause harm to the client” Since there is no indication that conversations about marital discord would create harm for the client, answer A is incorrect. However, some stipulations allow portions of a client’s record to be removed if there are multiple clients. The ACA Code of Ethics (2014) further states, “in situations involving multiple clients, counselors provide individual clients with only those parts of records that relate directly to them and do not include confidential information related to any other client” Since there is no information indicating that you provided couples counseling, this stipulation does not apply. Counselors must assert counselor-client privilege if records are subpoenaed. Privilege is a legal requirement rather than a HIPAA Privacy Rule. The release of records to third-party payers is prohibited without the client’s consent. Therefore, the correct answer is (C)",professional practice and ethics
511,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ","Given the client's presentation during today's session, what would you prioritize as a short-term goal in her treatment plan?",Eliminate depression,Increase exercise,Extinguish anxiety,Decrease insomnia,"(A): Eliminate depression
(B): Increase exercise
(C): Extinguish anxiety
(D): Decrease insomnia",Decrease insomnia,D,"Increasing sleep is a short-term goal. She can be referred for medication such as Trazadone. You can create a sleep regime with her by using a tool such as a sleep diary to help with consistency. Therefore, the correct answer is (D)",treatment planning
512,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client attends a process-oriented CBT group that is nearing the middle stage of group development. The client presents today with a bright affect and arrives early to converse with two other women in the group. During group activities, she is reticent to share and is sensitive to a conflict between two members that has started to emerge. One member becomes openly critical of the group tasks and their usefulness. Other members start to weigh in and take sides. The conflict quickly escalates between two members, with one shouting at another, “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you.” Other members nod in agreement","After processing the conflict, what technique could you use to help group members recognize significant themes and patterns?",Genuineness,Summarization,Empathetic reflection,Unconditional positive regard,"(A): Genuineness
(B): Summarization
(C): Empathetic reflection
(D): Unconditional positive regard",Summarization,B,"Counselors use summarization to tie together certain concepts and themes. Summarization is particularly useful in the middle stages of group development, with special care being taken to emphasize positive growth or therapeutic progress. Genuineness, or congruence, occurs when the counselor’s responses are consistent with what the client is expressing. Counselors also use genuineness to show nonjudgmental acceptance, reflect empathetic attunement, and keep the focus on here-and-now interactions. Counselors express unconditional positive regard by showing nonjudgmental acceptance and care for clients. Counselors use empathetic reflection to respond to the client’s underlying feelings accurately. Empathetic reflections lead to empathetic responding, which consists of perceiving, understanding, and experiencing what the client is communicating. Therefore, the correct answer is (D)",counseling skills and interventions
513,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”","Lottie continues to refuse the safety question and changes the subject. She then snorts and shows you her mucus, followed by spitting onto the floor. What should your response be?",Swift and immediate boundary setting with clearly stated consequences.,Reprimand her and make her understand inappropriate actions.,Go get her mother from the car and tell her what happened.,Ignore it out of empathy for her situation.,"(A): Swift and immediate boundary setting with clearly stated consequences.
(B): Reprimand her and make her understand inappropriate actions.
(C): Go get her mother from the car and tell her what happened.
(D): Ignore it out of empathy for her situation.",Swift and immediate boundary setting with clearly stated consequences.,A,"With your knowledge of personality disorders at this practice, you should realize her defense mechanisms are attempts at pushing you away and waiting to see if you will remain with her despite her actions. She is intentionally trying to garner a response from you. Reprimanding will either cause shame or be ignored, and ignoring her behaviors is detrimental to your counseling while being neglectful to her growth. Getting her mother involved positions you as someone who cannot handle her on your own and shifts the dynamic into a disciplinary one as opposed to a healing one. Setting your boundaries with Lottie immediately, explaining consequences for each boundary infraction, will teach Lottie while also empowering her to make her own choices understanding their consequences. Therefore, the correct answer is (A)",counseling skills and interventions
514, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",Which of the following is not a behavioral definition of ADHD?,"Frequent disruptive, aggressive, or negative attention-seeking behaviors",Exhibiting a marked impairment or extreme variability in intellectual and cognitive functioning,Impulsivity as evidenced by frequent intrusions into other's personal business,Susceptibility to distraction by extraneous stimuli and internal thoughts,"(A): Frequent disruptive, aggressive, or negative attention-seeking behaviors
(B): Exhibiting a marked impairment or extreme variability in intellectual and cognitive functioning
(C): Impulsivity as evidenced by frequent intrusions into other's personal business
(D): Susceptibility to distraction by extraneous stimuli and internal thoughts",Exhibiting a marked impairment or extreme variability in intellectual and cognitive functioning,B,"This definition describes a facet of autism spectrum disorder; answers a) through c) all correctly fall underneath the symptoms of attention-deficit hyperactivity disorder. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
515,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","The client comes in, sits down, and immediately says that she has been thinking and decided that she is now ready to talk about the physical abuse that she has experienced. She recounts that from age 18 until age 20 she was with a boyfriend who would smack her if she said something he did not like. She believes this is why she is so preoccupied with pleasing others. The client’s second relationship was when she was 25 with a man who would get drunk nightly and punch her in the stomach or in the back when he was upset. You empathize with the client and reflect her emotions regarding these events. The client states, “I didn’t deserve it when the drunk guy hit me, but I do feel I wasn’t the best girlfriend with the first guy. I often didn’t do enough for him and often said the wrong thing.” Throughout the session, the client was tearful and started shaking slightly when speaking several times. The client paused for long periods before sharing more difficult parts of the story. You decide to assess for PTSD during this session, but she does not meet the criteria. When closing the session, the client states that she is not able to pay for today’s session until the end of the week. The client has no history of nonpayment with you thus far.  At the end of this session, the client gives you a gift card to a restaurant because it is the last time you will see this client before Christmas","At the end of this session, the client gives you a gift card to a restaurant because it is the last time you will see this client before Christmas. Which one of the following is the most appropriate clinical response considering ethics and your client’s needs?","Based on the presenting problems, you decline the gift.","Accepting gifts with a value of greater than $50 is inappropriate, so you decline the gift.","Accepting gifts is never appropriate, and you decline the gift.",You accept the gift because it is not high in value and because the client’s culture would view this rejection as offensive.,"(A): Based on the presenting problems, you decline the gift.
(B): Accepting gifts with a value of greater than $50 is inappropriate, so you decline the gift.
(C): Accepting gifts is never appropriate, and you decline the gift.
(D): You accept the gift because it is not high in value and because the client’s culture would view this rejection as offensive.","Based on the presenting problems, you decline the gift.",A,"It would be inappropriate to accept the gift because the client’s diagnosis of dependent personality disorder makes boundaries more complicated and could possibly allow for manipulation. The ACA Code of Ethics does not specify a dollar amount or a clear point of view about when to accept gifts; rather, it focuses on the motivation of accepting the gift or the client’s intent for giving the gift. Cultural considerations for accepting or declining gifts are an important consideration; however, the client’s diagnosis takes priority in the consideration of accepting gifts. Therefore, the correct answer is (D)",professional practice and ethics
516,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",Which technique would you employ to provide the client with an immediate shift in perspective?,Decatastrophizing,Stress Inoculation,Self-Monitoring,Internal Dialogue Exercise,"(A): Decatastrophizing
(B): Stress Inoculation
(C): Self-Monitoring
(D): Internal Dialogue Exercise",Decatastrophizing,A,"Decatastrophizing (""What If"" technique) is the most immediate and manageable technique that could be applied. First, the therapist has the client state his feared consequence of a situation and then identify strategies for coping. Therefore, the correct answer is (A)",counseling skills and interventions
517,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","   ence. Family History: The client is married and has a 10-year-old daughter from a previous marriage. The client explains that her father was “distant and quiet unless he was drinking.” She remembers hearing that her paternal grandfather declared bankruptcy “at least once” due to gambling losses. The client’s mother has been diagnosed with bipolar disorder, with acute episodes requiring hospitalization. The client indicates that a former therapist also diagnosed her with bipolar disorder, but she rejects the diagnosis stating her symptoms are “nothing like my mother’s",,Bipolar II disorder is a more severe form of bipolar I disorder.,Bipolar II disorder requires at least one episode of mania; bipolar I requires more than one episode of mania.,Bipolar II disorder requires at least one episode of major depression; bipolar I does not.,Bipolar II disorder is a milder form of bipolar I disorder.,"(A): Bipolar II disorder is a more severe form of bipolar I disorder.
(B): Bipolar II disorder requires at least one episode of mania; bipolar I requires more than one episode of mania.
(C): Bipolar II disorder requires at least one episode of major depression; bipolar I does not.
(D): Bipolar II disorder is a milder form of bipolar I disorder.",Bipolar II disorder requires at least one episode of major depression; bipolar I does not.,C,"Bipolar II disorder requires a major depressive episode; bipolar I does not. Specifically, “Bipolar II disorder, requiring the lifetime experience of at least one episode of major depression and at least one hypomanic episode, is no longer thought to be a milder condition than bipolar I disorder, largely because of the amount of time individuals with this condition spend in depression and because the instability of mood experienced by individuals with bipolar II disorder is typically accompanied by serious impairment in work and social functioning” (American Psychological Association, 2013). Further, bipolar I disorder no longer requires “the lifetime experience of a major depressive episode” (APA, 2013). Lastly, bipolar II no longer requires an episode of mania, but individuals must have a history of at least one hypomanic episode as a requirement for diagnoses. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
518,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client comes into your office and says hello in a quiet voice and then sits down, slumps his shoulders, and does not make eye contact. You inquire about what you see, and the client says that he has been feeling more depressed over the past week. The client says that he is experiencing low appetite, a down mood, fatigue, and irritability. You empathize with the client and discuss coping skills for depressive symptoms. The client expresses frustration with his church because he worked part-time in the church office until recently when they encouraged him to resign because he is divorced and he is now unable to work in the church because of this. You empathize with the client regarding his situation at church",Which of the following would be the most appropriate clinical modality to treat depression?,Dialectical behavior therapy,Behavioral therapy,Exposure therapy,Cognitive behavioral therapy (CBT),"(A): Dialectical behavior therapy
(B): Behavioral therapy
(C): Exposure therapy
(D): Cognitive behavioral therapy (CBT)",Cognitive behavioral therapy (CBT),D,"CBT is a consistently accepted approach to treating depression because it focuses on addressing the unhelpful cognitive and behavioral processes that affect functioning. Behavioral therapy alone would not treat the cognitive needs of depression because depression is often affected by cognitive distortions and behavioral effects. Although dialectical behavior therapy is helpful with depression, it was created to treat borderline personality disorder, and CBT would be more generally accepted as helpful. Exposure therapy is primarily used to treat anxiety. Therefore, the correct answer is (B)",treatment planning
519,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","Since the start of counseling and services with the local government mental health agency, the client has maintained sobriety from fentanyl and has been moved into stable housing via assistance from the agency. The client reports that the management of his anxiety has been better, but that he often feels lonely and unengaged. The client states that he is not sleeping well and thinks it is because he does not do much during the day. He continues to participate in Narcotics Anonymous daily in order to have interactions with other people. The client says that he tried to reach out to his children but they would not answer his phone call. You empathize with the client regarding his difficulty reaching out to his children. You and the client use this session in order to review progress and identify new goals",Which of the following would be the most effective cognitive reframing of the statement “My kids hate me and don’t want anything to do with me”?,"“I hurt my kids, and I need to learn to be okay without them.”","“My kids are done with me, and I should learn to move on.”","“My kids don’t like me right now, but eventually they will come around.”","“I hurt my kids, but I can take steps to rebuild my relationship with them.”","(A): “I hurt my kids, and I need to learn to be okay without them.”
(B): “My kids are done with me, and I should learn to move on.”
(C): “My kids don’t like me right now, but eventually they will come around.”
(D): “I hurt my kids, but I can take steps to rebuild my relationship with them.”","“I hurt my kids, but I can take steps to rebuild my relationship with them.”",D,"“I hurt my kids, but I can take steps to rebuild my relationship with them” is the most effective cognitive reframing statement. This reframing addresses the reality that the client hurt his children, and it provides the motivation to make changes to improve his relationship with them, but it does not promise an outcome because its focus is on taking steps. It is important to instill hope that the future can be better because a common cognitive distortion is that past experiences will be the same in the future. Expecting the children to “come around” does not acknowledge the work that is required on the part of the client for positive change to occur. Expressing the need to “learn to move on” or to “learn to be okay without them” does not provide the client with motivation to change. Therefore, the correct answer is (C)",counseling skills and interventions
520,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What additional resource will be most helpful to therapy and possibly contribute to a good prognosis for the client?,Referencing the client's history of school behaviors before this incident.,The child's previous academic performance.,"Family therapy as a therapeutic resource, given reported extended family support.",The mother's support as a primary therapy resource.,"(A): Referencing the client's history of school behaviors before this incident.
(B): The child's previous academic performance.
(C): Family therapy as a therapeutic resource, given reported extended family support.
(D): The mother's support as a primary therapy resource.","Family therapy as a therapeutic resource, given reported extended family support.",C,"Given the presented history, providing family therapy as additional therapeutic support could become a very resourceful consideration in this case. Family therapy can help maneuver family members to take a more active role in supporting the client to deal with the impact of the bullying than individual counseling might provide. Therefore, the correct answer is (B)",treatment planning
521,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.  Sixth session The client has not been following through with her mood journal. She says that she ""got bored and didn't feel like writing in it anymore."" During this session, a month and a half into therapy, she relays an incident that happened with the friend she went to visit out-of-state. They argued due to political differences and are currently not talking to each other. The client now considers her friend ""a drunk who doesn't know what she's talking about."" You suggest that the client's anger and judgment may be a defense that she uses to avoid feeling rejected as she did with her father. You state, ""It seems that in an attempt to avoid feeling hurt and rejected, you use anger and alcohol to push people away."" The client responds with reflective silence and begins to tear up.    You guide the client to examine her defensive behavior and understand why she relies on it when faced with difficult emotions. You emphasize that her feelings of hurt, rejection, and anger are valid, however, they can be managed in healthier ways. You suggest that part of processing these feelings is to recognize them and make attempts at reconnecting with her friend. Additionally, you recommend cultivating self-care practices. The client acknowledges the importance of looking after herself during this difficult time, understanding that if she is able to take care of herself first she will be in a better position to address her relationships.    You remind the client that it is important to take steps to move forward, even if those steps are small. You highlight her willingness to talk through her emotions and gain insight into her reactions as an opportunity to grow in self-awareness. You explain that having knowledge of one’s own feelings helps them to make better decisions and boundaries, which can lead to healthier relationships with others and ultimately, more peace within oneself. With this understanding, you create a plan of action together for how she will move forward between now and your next session. You close the session by telling the client that she has made progress today by having gained insight into her feelings, and that will lead to exploration of how to respond to them more productively. You conclude by encouraging her to keep exploring new methods of self-care and to bring up any additional topics she wants to discuss in the next session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",What suggestion would you refrain from making as an alternative to mood journaling?,Engage in a mindfulness exercise and write down what she is feeling in the moment,"Participate in an activity that is distracting, such as watching a favorite TV show",Create a visual representation of her feelings like a collage or drawing,Utilize an interactive app to track emotions and symptoms,"(A): Engage in a mindfulness exercise and write down what she is feeling in the moment
(B): Participate in an activity that is distracting, such as watching a favorite TV show
(C): Create a visual representation of her feelings like a collage or drawing
(D): Utilize an interactive app to track emotions and symptoms","Participate in an activity that is distracting, such as watching a favorite TV show",B,"This suggestion should be avoided as a mood journaling alternative because it does not promote self-reflection or insight into the client's feelings and behavior. Additionally, engaging in activities that are passive or overly distracting can be used to avoid processing difficult emotions, which can lead to further avoidance of personal growth. Therefore, the correct answer is (B)",counseling skills and interventions
522,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.","Given the dynamics and content of your interaction with the client during the session, what action have you taken that constitutes a breach of professional ethics?",Sharing former client information without consent.,Refusing to indicate that she attended therapy with her probation officer unless she actively participates.,Ignoring possible countertransference issues resulting from your attraction to the client.,Breaching the confidentiality of the client.,"(A): Sharing former client information without consent.
(B): Refusing to indicate that she attended therapy with her probation officer unless she actively participates.
(C): Ignoring possible countertransference issues resulting from your attraction to the client.
(D): Breaching the confidentiality of the client.",Sharing former client information without consent.,A,"By sharing with her the name of two clients, you have violated the confidentiality of your former clients. Therefore, the correct answer is (A)",professional practice and ethics
523,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",What is your primary intention in summarizing what the client has expressed to you about her experience at school?,Establish therapeutic rapport,"Integrate the client's thoughts, emotions, and behaviors",Help the client clarify therapy goals,Demonstrate a nonjudgmental stance,"(A): Establish therapeutic rapport
(B): Integrate the client's thoughts, emotions, and behaviors
(C): Help the client clarify therapy goals
(D): Demonstrate a nonjudgmental stance","Integrate the client's thoughts, emotions, and behaviors",B,"A client at this stage benefits from an integrative experience. Therefore, the correct answer is (D)",counseling skills and interventions
524,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.  Eighth session It has been seven weeks since the client presented for the initial interview. Today, the client returns to your office for his weekly session. He admits that he has not been following through with any of the activities you have assigned as part of his systematic desensitization plan, and he continues to feels overwhelmed by anxiety. His facial expressions reveal a sense of defeat and disappointment as he shares his struggles with making progress. He says, ""I just want to be a normal guy. What's wrong with me?"" The client expresses feeling overwhelmed with fear and shame at being unable to make any changes. He asks if you know of anyone else who has experienced social anxiety before and if there is any hope for him to get better. You normalize his experience and briefly share a story about being afraid to wear glasses in high school out of fear that your classmates would make fun of you. You then explain to him that even though it may feel like he is alone in his experience and feels discouraged, recovery is possible. You emphasize the importance of being patient with himself and expressing self-compassion as he works through the process.    During the session, the client also mentions that his parents are having a difficult time in their relationship which has been causing additional distress for him. You explain that this could cause extra feelings of worry and insecurity, even when he is away from them. He acknowledges the connection between his parents’ relationship dynamics and his own struggles with anxiety. In order to address the additional stressors created by the distress in the client's parents' relationship, you explore ways he can work on managing his own emotions and reactions. You explain that building self-awareness of his feelings and responses may help empower him to have greater control over his anxiety symptoms. You discuss mindful breathing and visualization techniques. Afterwards, you provide examples of cognitive reappraisal strategies that can be used to challenge any irrational beliefs related to fear of failure or embarrassment that might be driving his avoidance behaviors. You explain the importance of consistently doing the practice in order for it to be effective and positive changes can be expected with consistent effort. You also give the client a homework assignment to read about social anxiety.    Toward the end of the session, you summarize what you have discussed during today's session, and you address his feelings of disappointment in his perceived lack of progress by saying, ""I understand your frustration. It can seem like things are not changing but in reality, even small changes are a sign of progress. The most important thing for you to remember is that it takes time and effort to learn how to manage your anxiety and make meaningful change in your life. As you continue working on the strategies we have discussed, I want you to recognize any successes or moments of improvement as they occur; no matter how small they may be. This will help keep you motivated and encourage further growth.""","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",Which of the following is considered an open-ended question?,"""What does it mean to you to be a 'normal' guy?""","""Is feeling 'normal' important to you?""","""Are there times that you feel like a 'normal' guy?""","""Do you think you are 'normal?'""","(A): ""What does it mean to you to be a 'normal' guy?""
(B): ""Is feeling 'normal' important to you?""
(C): ""Are there times that you feel like a 'normal' guy?""
(D): ""Do you think you are 'normal?'""","""What does it mean to you to be a 'normal' guy?""",A,"This is a form of an open-ended question. It requires more than a one- or two-word answer. Therefore, the correct answer is (D)",counseling skills and interventions
525, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”",Which of the following would be most effective for helping the client be successful in counseling?,Help the client set some new goals around his alcohol use so he can be more successful,Ask the client what he had hoped to achieve in counseling and whether that has changed,Share your concerns about the client's continued alcohol use and its impact on him,Review the client's original goals and ask him whether he thinks he's achieving these,"(A): Help the client set some new goals around his alcohol use so he can be more successful
(B): Ask the client what he had hoped to achieve in counseling and whether that has changed
(C): Share your concerns about the client's continued alcohol use and its impact on him
(D): Review the client's original goals and ask him whether he thinks he's achieving these",Ask the client what he had hoped to achieve in counseling and whether that has changed,B,"Asking the client what he had originally hoped to achieve and whether that has changed allows the client autonomy to determine if his original goals were accurate or if he wishes to make changes to how he can use counseling. Clients frequently come to counseling with one idea in mind and realize that they have other needs they had not realized. Reviewing the client's original goals and asking him if he is achieving these, highlights the power imbalance between counselor and client and may make the client feel defensive or accountable to the counselor for their actions. Sharing your concerns about his alcohol use and helping him set goals around his use reflect more of the counselor's needs and desires for the client than the client's autonomous rights to make their own choices. Therefore, the correct answer is (C)",treatment planning
526,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.  Eighth session You continue to work with the client in outpatient therapy. During a previous session, the client identified a few sources of support and was able to tell her parents that she switched her major. Today, the client arrives for her appointment 20 minutes early. She appears eager to see you and excited to talk with you. When she sits down, she pulls several cookbooks out of her backpack. She tells you that she plans to go home during spring break and has collected recipes for a large meal she wants to make for her family. During this session, while exploring the client's relationship with food, you discover that she spends many hours in the library reading through cookbooks and watching baking shows on her computer. She says that she has an apple for breakfast, picks up a small salad ""to go"" from the campus cafeteria every day at exactly 12:00 p.m., and bakes a sweet potato for dinner in the microwave in her room at 6:00 p.m. She looks forward to her meals and plans her day around them. She says she is envious of other people who ""can eat anything whenever they want."" She tells you she is worried that if she eats extra food, she will become obese overnight and never stop eating.  You continue to explore the client's relationship with food by asking, ""What do you think would happen if you ate whatever you wanted?"" She replies, ""I'm afraid that if I eat extra food, I'll gain weight and never be able to stop eating. I'll keep getting bigger and bigger and turn into a severely obese person."" After taking a moment to think, the client shares, ""I'm scared that if I gain weight, no one will love me or care about me. Then I'll be completely alone, and it will be all my fault because I couldn't control my eating!"" You listen compassionately as the client shares her fear. You also emphasize that this is an extreme outcome and unlikely to occur. You encourage her to think realistically about the potential consequences of eating additional food and acknowledge that there may be some negative outcomes, but they are not guaranteed or irreversible.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","In consideration of the client's mood swings, what would be the most effective way to continue to maintain a supportive, positive therapeutic alliance with this client?","Allow the client to share her thoughts, feelings, and actions without critique",Provide bibliotherapy to the client regarding the course and progression of eating disorders,Guide the client to realizing how her anxiety regarding her parents is contributing to her unhealthy eating patterns,"Assist the client in identifying past and present sources of support, discussing the qualities of these relationships","(A): Allow the client to share her thoughts, feelings, and actions without critique
(B): Provide bibliotherapy to the client regarding the course and progression of eating disorders
(C): Guide the client to realizing how her anxiety regarding her parents is contributing to her unhealthy eating patterns
(D): Assist the client in identifying past and present sources of support, discussing the qualities of these relationships","Allow the client to share her thoughts, feelings, and actions without critique",A,"Unconditional positive regard, developed by Carl Rogers, is one of the tenets of client-centered therapy wherein the therapist maintains an accepting and caring attitude toward the client. The therapist provides acceptance and support to the client, regardless of what is said or done. Therefore, the correct answer is (C)",counseling skills and interventions
527,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness",Which of the following cognitive distortions best defines the client’s statement of “I already broke my sobriety; I may as well huff so that I can feel better”?,Magnification,Mental filters,Jumping to conclusions,Emotional reasoning,"(A): Magnification
(B): Mental filters
(C): Jumping to conclusions
(D): Emotional reasoning",Emotional reasoning,D,"This is an example of emotional reasoning. The client felt guilt and shame for breaking his sobriety, and he used these emotions to justify the feeling that it would not matter if he used inhalants again. Jumping to conclusions involves either trying to predict the future or assuming others’ thoughts and feelings. Magnification involves focusing on shortcomings and exaggerating their importance or effect and minimizing positive qualities and behaviors. Mental filters involve focusing solely on a shortcoming and ignoring everything else. Therefore, the correct answer is (A)",counseling skills and interventions
528,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.  Seventh session It has been almost two months since you began therapy with the client. You suggested a session in which both she and her mother were present to discuss the client's progress. She presents to today's session with her mother. The client followed up with your referral from a previous session for her to see a psychiatrist and has provided you with a release of information to communicate with her psychiatrist. The client has been prescribed an antidepressant and says she does not feel any notable change yet but the psychiatrist told her it would take a few weeks to know if the medication was working. The mother states that since her daughter started taking the antidepressant, she is sleeping more than usual and struggles to get out of bed. She has been late to school several times. She is also having trouble with motivation. You reflect the client's current state and suggest she establish a daily routine to gain a sense of control in her life. You discuss the importance of making small achievable goals and explain that taking on too much can be overwhelming, so it is more beneficial to focus on one task at a time. The mother begins listing off potential activities that her daughter should take part in. The client closes her eyes and begins to sigh. When you ask her about her reaction, she says, ""See, yet another example of my mom trying to control everything."" The mother responds by saying, ""I'm not trying to control you. Believe it or not, I just want what's best for you!""    Understanding the tension between them, you suggest a compromise. You explain that if the client completes one activity each day, her mother will not pressure her to do more. The client appears hesitant but agrees to try it out. You then turn to the mother, thanking her for being willing to compromise and understanding. You encourage them to be patient with one another and remind them that progress takes time. You suggest they continue to have regular check-ins so that each party is aware of how the other is doing in following through on the agreement. You end the session by summarizing what was discussed, reinforcing the importance of communication between the client and her mother.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",You suspect that the client's lack of motivation and energy may be due to too high a dosage of her medication. What should you do?,"Based on your extensive work with depressive clients, suggest a lower dosage.",Relate your concerns to the client,Consult with your supervisor,Consult with her psychiatrist,"(A): Based on your extensive work with depressive clients, suggest a lower dosage.
(B): Relate your concerns to the client
(C): Consult with your supervisor
(D): Consult with her psychiatrist",Consult with her psychiatrist,D,"If the medication is not acting in the expected way, the prescriber should be notified. Therefore, the correct answer is (B)",treatment planning
529,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","   ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years","Which approach would you implement to help understand the influence of the client’s social and cultural factors, including systemic racism, gender, religion, and birth order?",Rogerian,Freudian,Gestalt,Adlerian,"(A): Rogerian
(B): Freudian
(C): Gestalt
(D): Adlerian",Adlerian,D,"Adlerian therapists emphasize the importance of social connection, asserting that all individuals strive for “superiority,” which is achieved through a purposeful, goal-oriented “lifestyle” Adlerian therapists contextualize each client’s social and cultural factors, initially shaped by family constellation, including birth order. Adlerians focus on each individual’s lifestyle as it is influenced by multiple factors, including systemic racism, gender, religion, and sexual orientation. Adlerian and Freudian therapists are categorized as psychoanalytic, and both emphasize early childhood influences; however, Freudians differ in that they also emphasize unconscious processes whereas Adlerians do not. Gestalt therapists are categorized as experiential or relational. Gestalt therapists stress the integration of mind and body through increased awareness of the present moment. For gestalt therapists, wholeness involves the integration of one’s cognitive, emotional, and behavioral factors. As their name suggests, person-centered, or Rogerian, therapists allow the client to become fully functioning in the context of the therapeutic experience. The goal of Rogerian therapy is to facilitate congruence between the client’s self-image and idealized self. Therefore, the correct answer is (A)",counseling skills and interventions
530,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”","Based on the information provided, which of the following is true about this client?",This client's most accurate diagnosis is Body Dysmorphic Disorder,Cognitive behavioral theory is likely to be helpful in addressing this client's concerns,A cancer support group will likely be unhelpful for the client due to her sexuality,"This client's prognosis in this area is poor because cancer is a medical condition, not emotional","(A): This client's most accurate diagnosis is Body Dysmorphic Disorder
(B): Cognitive behavioral theory is likely to be helpful in addressing this client's concerns
(C): A cancer support group will likely be unhelpful for the client due to her sexuality
(D): This client's prognosis in this area is poor because cancer is a medical condition, not emotional",Cognitive behavioral theory is likely to be helpful in addressing this client's concerns,B,"Negative self-esteem and body image are best addressed with cognitive behavioral theory and having the client identify cognitive distortions and negative core beliefs about herself and her post-cancer body. This process allows her to develop more positive core beliefs and view herself in a more healthy and loving way. The diagnosis of body dysmorphic disorder (BDD) does not apply to this client as her post-cancer scars and body changes would not be viewed as minor imperfections to others. Additionally, she does not engage in repetitive behaviors such as mirror checking, skin picking, or mental acts in response to her concerns. BDD is a disorder related to obsessive compulsive disorders and this is not evident in the client's behaviors. Cancer impacts people across all cultural spectrums and the client's sexuality is not likely to impact how a cancer support group could benefit her. The client's prognosis in the area of body image and self-esteem is quite good because she has been successful already in counseling and while cancer is a medical condition, the diagnosis leads to many emotional issues such as anger, sadness, worry, and loss. Therefore, the correct answer is (C)",counseling skills and interventions
531,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","   ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage\. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining",What attitudes and behaviors would a client diagnosed with obsessive-compulsive personality disorder display (OCPD)?,"Persistent, unwanted thoughts and repetitive rituals",Excessive drive to attain financial success,Inflexibility regarding morals and values,Frequent fears of being alone,"(A): Persistent, unwanted thoughts and repetitive rituals
(B): Excessive drive to attain financial success
(C): Inflexibility regarding morals and values
(D): Frequent fears of being alone",Inflexibility regarding morals and values,C,"According to the DSM-5-TR, obsessive-compulsive personality disorder is a persistent preoccupation with organization and mental or interpersonal control. They may force themselves and others to follow rigid moral principles and very strict standards of performance” Persistent, unwanted thoughts and repetitive rituals characterize obsessive-compulsive disorder (OCD) rather than OCPD. OCPD is a Cluster C personality disorder. Anxious and fearful conditions are included in Cluster C personality disorders. Frequent fears of being alone are a symptom of dependent personality disorder. There is an excessive devotion to work and productivity for individuals with OCPD that is not otherwise accounted for or driven by financial success or necessity. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
532,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences","All of the following can negatively affect sleep quality, EXCEPT:",Exercise,Melatonin,Drinking water around bedtime,Alcohol,"(A): Exercise
(B): Melatonin
(C): Drinking water around bedtime
(D): Alcohol",Melatonin,B,"Melatonin is a natural dietary supplement with proven efficacy in improving sleep onset, although it is not recommended as the primary treatment of insomnia. It is available in low doses over the counter and in higher prescription-level doses, and it has no proven negative influences on sleep. Alcohol, although it may help people fall asleep, often affects sleep maintenance because it is disruptive to the sleep cycle. Exercise, if done regularly, can help sleep, but if it is done within 3–4 hours before sleep, it can have a negative impact on sleep quality. The chemicals released during exercise increase the heart rate and body temperature, which can delay the onset of sleep. Drinking a large amount of water near bedtime can disrupt sleep by the need to urinate waking the individual in order to use the bathroom. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
533,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","   sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time","When considering treatment goals, all of the following are indicated areas to explore, EXCEPT:",His relationship with his ex-wife,Depression symptoms that may lead to inhalant use,Grief or trauma regarding his son’s death,Barriers to maintaining employment,"(A): His relationship with his ex-wife
(B): Depression symptoms that may lead to inhalant use
(C): Grief or trauma regarding his son’s death
(D): Barriers to maintaining employment",Depression symptoms that may lead to inhalant use,B,"Depression is not indicated based on the presenting symptoms. Although depression may co-occur with inhalant use because the use of substances may alleviate depressive symptoms, the client did not report any depression symptoms. Grief and trauma related to the client’s son passing away are important areas to explore because these appear to be the triggering symptoms that led to his substance use. The client’s relationship with his ex-wife would be important to explore because the client is not able to see his children as much as he wants due to his substance use. The client also wants to maintain employment, so it would be helpful to focus on barriers to maintaining employment. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
534,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.  11th session The group as a whole has made progress, and members have found healthy outlets for expressing their thoughts and feelings. Rick has become more open with the women in the group and seems more receptive to what they have to say. Rick says that his grades have improved, his mother is proud, and he is encouraged by other group members who nod their heads and smile. The group has met its goals. The members have learned strategies to take with them as they prepare for termination. You remind the group that there are only a few more weeks left to meet. You begin to discuss the group members' feelings regarding the end of therapy. Rick starts to cry and says, ""Why does every woman in my life cause problems for me?""    The other group members offer Rick reassurance and empathy, but he continues expressing his frustration and sadness. You encourage the group to reflect on each person's progress and to be mindful of the emotions that this ending brings out. You explain to the group that endings can be difficult and that giving them permission to feel the emotions that arise during this transition is important.    Rick is still struggling with the idea of ending the therapy and expresses his fear of being left alone. He continues to express his feeling that every woman in his life has caused him pain and suffering, and this group's ending has triggered his worst fears. You recognize his fear and attempt to validate his experience by emphasizing his progress in the group and the positive changes he has seen in himself. You explain that the group can support him through the transition and the other members offer encouraging words of encouragement.    Rick is still anxious and overwhelmed. He talks about the difficulty of coping with the loss of the group and how he worries that he won't be able to manage his feelings without the support of the group. You explain to the group that it is natural to feel sadness and loss as well as gratefulness and pride in the progress they have all made. You encourage the group to identify the strategies they have learned in the group that they can use to manage their emotions. Finally, you assure Rick that he can use the skills he has learned in the group to cope with the emotions associated with the end of therapy.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","Although Rick has made significant progress in the group, you believe that he still has unresolved issues. What should you do to increase the likelihood of his success?",Reinforce progress that has been made in treatment,Offer to be available for individual therapy,Practice mindfulness skills during the next group session,Suggest that he join a new therapy group,"(A): Reinforce progress that has been made in treatment
(B): Offer to be available for individual therapy
(C): Practice mindfulness skills during the next group session
(D): Suggest that he join a new therapy group",Offer to be available for individual therapy,B,"At this time, the group has met its goals and is ready to enter the termination stage. The client has made progress in the group but still has unresolved issues. It would help if you made yourself available to him for individual counseling to address these issues. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
535,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.  Fifth session This is your fifth weekly session with the client, and she states that she likes the ""structure"" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, ""I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal.""    You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, ""I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships."" You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family.    During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she ""had other stuff going on.""",,What short-term goal would address the feelings of isolation?,Take classes to become a United States citizen,Improve social interactions,Increase study time to distract her from loneliness,Explore her sexuality,"(A): Take classes to become a United States citizen
(B): Improve social interactions
(C): Increase study time to distract her from loneliness
(D): Explore her sexuality",Improve social interactions,B,"This is relevant to the client's problem of feeling isolated and wishing she was more involved in college activities and the community. Therefore, the correct answer is (C)",treatment planning
536,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","   n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family.  Although Latinos are multiracial and multicultural, there are some cultural differences between Latinos and Anglo Americans","Although Latinos are multiracial and multicultural, there are some cultural differences between Latinos and Anglo Americans. Which statement accurately depicts these differences?","Latinos are more likely to engage in direct communication than indirect communication (e.g., idioms, metaphors, and stories).",Latinos place higher importance on their nuclear family than on their extended family.,Latinos place greater significance on supernatural forces than on nonspiritual forces.,"Latinos emphasize personal fulfillment over group (i.e., collective) harmony.","(A): Latinos are more likely to engage in direct communication than indirect communication (e.g., idioms, metaphors, and stories).
(B): Latinos place higher importance on their nuclear family than on their extended family.
(C): Latinos place greater significance on supernatural forces than on nonspiritual forces.
(D): Latinos emphasize personal fulfillment over group (i.e., collective) harmony.",Latinos place greater significance on supernatural forces than on nonspiritual forces.,C,"Latinos place greater significance on supernatural forces than on nonspiritual forces. Latinos believe that spiritual influences include intermediary saints and other supernatural powers. In addition, Latinos place high importance on extended family, are more likely to use indirect communication, and emphasize collective harmony over personal fulfillment. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
537,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","Based on the information gained in the intake interview and this session, which of the following would be the most appropriate diagnosis for this client?",Histrionic personality disorder (HPD),Dependent personality disorder (DPD),Borderline personality disorder (BPD),Antisocial personality disorder (ASD),"(A): Histrionic personality disorder (HPD)
(B): Dependent personality disorder (DPD)
(C): Borderline personality disorder (BPD)
(D): Antisocial personality disorder (ASD)",Borderline personality disorder (BPD),C,"Clients like this one are appropriately diagnosed with BPD and present with patterns of instability in interpersonal relationships and self-image such that the individual frantically attempts to avoid abandonment, alternates between idealizing and devaluing persons, demonstrates impulsivity in potentially self-harming activities, recurrent suicidal threats or behaviors, and inappropriate intense anger or difficulty controlling one's temper. Clients with ASD show some similar traits related to disregard for safety of self or others but also demonstrate a lack of remorse for hurting others as well as lying or conning others to get what they want. People with DPD rely on others to tell them how they should feel and have difficulty making everyday decisions without someone telling them what they should do. Those with HPD tend to use sexually provocative behavior when interacting with others and are deeply uncomfortable when they are not the center of attention. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
538,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which of the following should the counselor first seek to clarify during this session?,John's goals for counseling,Jane's goals for counseling,Helping Jane articulate how she feels about John's statement,Helping John build skills for demonstrating empathy,"(A): John's goals for counseling
(B): Jane's goals for counseling
(C): Helping Jane articulate how she feels about John's statement
(D): Helping John build skills for demonstrating empathy",John's goals for counseling,A,"The couple has presented for counseling sessions in distress and at the point of divorce. John appears to be disengaged from Jane and the marriage, so clarifying his goals for counseling is the most important task during this session. If John is not invested in counseling, movement toward resolution cannot be made. Jane's goals for counseling are also important, however, because she is the identified client, the one who both initiated counseling and the one who is seeking reconciliation with John, we can infer that her goal is to repair the relationship. Based on the information, Jane is engaged with her emotions and her affect is congruent with the sadness she feels at John's statement. John appears sad, which suggests that his affect is also congruent and that he is empathetic towards Jane. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
539,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”",Which goal best summarizes the intentions of a safety plan for Lottie?,Lottie will comply with crisis/safety plans while in counseling.,Therapist will assist Lottie in developing safety plan.,Lottie will sign crisis/safety plan with mother and review until discharge.,Lottie will review her safety plan monthly for duration of counseling.,"(A): Lottie will comply with crisis/safety plans while in counseling.
(B): Therapist will assist Lottie in developing safety plan.
(C): Lottie will sign crisis/safety plan with mother and review until discharge.
(D): Lottie will review her safety plan monthly for duration of counseling.",Lottie will comply with crisis/safety plans while in counseling.,A,"Developing, reviewing, and signing a safety plan are all objectives within an intended goal, of which in this case is Lottie's compliance with all items within the safety plan itself. Therefore, the correct answer is (A)",treatment planning
540, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,"At this time, it may be beneficial to refer?",Lori to have individual therapy with the same counselor,Carl and Lori to a financial advisor to manage their finances,Carl to a career specialist at the VA,Lori to attend Carl's group for anger management,"(A): Lori to have individual therapy with the same counselor
(B): Carl and Lori to a financial advisor to manage their finances
(C): Carl to a career specialist at the VA
(D): Lori to attend Carl's group for anger management",Carl to a career specialist at the VA,C,"Besides Carl's drinking, a primary source of stress is Carl's inability to retain employment. It is important for a counselor to be aware of available resources and refer to them when beneficial. Now that Carl is ready to make changes, a career specialist at the VA may be able to help Carl obtain and sustain employment. A financial advisor is not necessary currently. Although they are having financial difficulties, nothing indicates that they are not able to manage their finances once Carl has steady employment. The counselor is seeing Carl individually and brings Lori into some sessions to work on their communication. It is not advisable for the counselor to also see Lori individually as this may cause triangulation and confusion. It is also not advisable for Lori to attend Carl's group for anger management as it is a closed group for those who have been in combat. Therefore, the correct answer is (A)",treatment planning
541,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.",You are evaluating interventions that will help the client better cope with the loss of her son. Which of the following will be most beneficial for the client at this time?,Client will engage in concurrent prolonged exposure (PE) therapy to process her grief.,Family members will attend therapy to provide support and gain understanding of client's needs.,Client will ask family members to encourage her not to carry out her grieving behaviors.,Client will attend a concurrent grief therapy group.,"(A): Client will engage in concurrent prolonged exposure (PE) therapy to process her grief.
(B): Family members will attend therapy to provide support and gain understanding of client's needs.
(C): Client will ask family members to encourage her not to carry out her grieving behaviors.
(D): Client will attend a concurrent grief therapy group.",Client will attend a concurrent grief therapy group.,D,"Attending a grief therapy group while pursuing individual counseling will provide a safe place for the client to express her feelings and where she can be challenged by other group members about the effectiveness and appropriateness of her grieving behaviors. PE is an effective intervention but has high drop-out rates due to imaginal exposure. At this time, the client is not likely to be suited for PE as she is at higher risk for drop-out due to her depression symptoms. Having family members engage in therapy when they do not wish to do so or acting as accountability partners for a distressed client may cause further ruptures in family relationships. Therefore, the correct answer is (B)",treatment planning
542,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","During the previous session, the client committed to controlled drinking and agreed on a limit of two drinks per night. She admits to having limited success with this goal and concedes to over-indulging when feeling “stressed out.” You learn she ran into a woman from her church who she discovered was a recovering alcoholic. She agreed to meet the woman at an AA meeting, and the client was surprised she could relate to other alcoholics. The client’s affect brightened as she reported that she has had seven days of continuous sobriety. She continues to have a strained relationship with her now ex-husband. Her youngest child is home on spring break, which has helped improve her mood and kept her accountable for staying sober. She is able to use relaxation and mindfulness techniques for insomnia, which have been effective at times at improving her sleep pattern.  Your client states, “I can’t do anything right anymore; I’ve failed as a parent","Your client states, “I can’t do anything right anymore; I’ve failed as a parent.” Using Rational-Emotive Behavioral Therapy (REBT), you respond with the following:",“You told me you were a stay-at-home mother. Would a failed parent make that sacrifice?”,“All parents feel like that every so often. It’s just part of the human condition.”,“What evidence is there that indicates you haven’t failed but instead succeeded as a parent?”,"“You felt criticized by your ex-husband and your automatic thought was that you can’t do anything right, including parenting.”","(A): “You told me you were a stay-at-home mother. Would a failed parent make that sacrifice?”
(B): “All parents feel like that every so often. It’s just part of the human condition.”
(C): “What evidence is there that indicates you haven’t failed but instead succeeded as a parent?”
(D): “You felt criticized by your ex-husband and your automatic thought was that you can’t do anything right, including parenting.”",“What evidence is there that indicates you haven’t failed but instead succeeded as a parent?”,C,"Rational-Emotive Behavioral Therapy (REBT) takes the ABC model used in CBT and adds two more elements—D and E—with D representing disputing irrational thoughts and E representing the newly formed alternative thoughts. Counselors using the technique of forceful disputing ask the client to review evidence that supports or does not support the client’s irrational thought. Answer A is an example of cognitive behavioral therapy rather than REBT. The activating event would be the ex-husbands criticism. The dysfunctional automatic thought is the statement about her inability to do anything right, including parenting. The potential consequences are frustration, hopelessness, depression. If you state that every parent feels like a failure every so often (Answer B), you might leave the client thinking their feelings are invalid. Answer C uses a closed-ended question and does not enable the client to engage in the forceful disputing of an irrational belief. Therefore, the correct answer is (D)",counseling skills and interventions
543,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.  15th session You have been seeing the client regularly for the past four months. He states that he is feeling ""better"" these days, and he is doing better at work. He has been taking his antidepressant medication as prescribed and feels therapy has been helpful. You review the treatment plan and discuss the progress he has made and the termination process.    Near the end of the session, he tells you, ""Well, there is one more thing. I'm worried that my wife might be having an affair. I know it's probably crazy, but I can't help but think that she's seeing someone else. And you know what, I wouldn't blame her. I haven't been the best husband with my constant depression. I just think about her leaving me, and it makes me feel afraid."" You express understanding and validate his feelings, noting that it's not uncommon for people to have affair-related thoughts when feeling insecure in their relationship. You inquire whether he has been spending time with his wife and how he and his wife have been communicating. He reports that they have been talking more and that he has been trying to be more present when he is with her. You remind him of his progress in therapy and how much better he has been feeling overall, which has likely contributed to him being able to engage more in his marriage. You suggest that as he continues to work on himself and generally feels better, his worries about his wife cheating on him will likely lessen. In the meantime, you caution against drinking to cope with his anxiety, as it can lead to further problems down the road.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.","You respond to the client's disclosures in the session by stating, “What I hear you saying is that you're feeling as though you haven't been there for your wife, yet I'm struck by how you're able to do all that is required at your job, and you still have the resolve to work on yourself and your relationship. How do you do that?” What technique are you using?",Structural Analysis,Paradoxical Intervention,Reframing,Coping Question,"(A): Structural Analysis
(B): Paradoxical Intervention
(C): Reframing
(D): Coping Question",Coping Question,D,"The coping question technique underscores his personal resources that he is not acknowledging. This is tailored to help him recognize coping skills he already uses with his relationship issues. Therefore, the correct answer is (D)",counseling skills and interventions
544,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",Which of the following assessment instruments would provide you with the most comprehensive evaluation of the client's distress?,Beck Anxiety Inventory (BAI),DSM-5-TR Level 1 Cross-Cutting Symptom Measure,Beck Depression Inventory (BDI-II),Minnesota Multiphasic Personality Inventory (MMPI-3),"(A): Beck Anxiety Inventory (BAI)
(B): DSM-5-TR Level 1 Cross-Cutting Symptom Measure
(C): Beck Depression Inventory (BDI-II)
(D): Minnesota Multiphasic Personality Inventory (MMPI-3)",DSM-5-TR Level 1 Cross-Cutting Symptom Measure,B,"The DSM-5-TR Level 1 Cross-Cutting Symptom Measure would provide the most comprehensive evaluation of the client's distress as it explores symptoms of depression and anxiety in addition to several other mental health domains. It also determines the severity of those symptoms. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
545,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,Which of the following is not relevant to a comprehensive assessment of Michael?,Michael's medical history,Any recent significant events in Michael's life,Michael's current support system,If the suspension goes on Michael's permanent record,"(A): Michael's medical history
(B): Any recent significant events in Michael's life
(C): Michael's current support system
(D): If the suspension goes on Michael's permanent record",If the suspension goes on Michael's permanent record,D,"Whether the suspension goes on Michael's permanent record is not relevant information for a comprehensive assessment. Relevant information would include assessing Michael's current support system. Also, since this recent event seems uncharacteristic for Michael, it is important to understand any recent events that could have triggered this behavior. Finally, a person's medical history can provide a holistic framework and thorough assessment. Therefore, the correct answer is (D)",counseling skills and interventions
546,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","    flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya",Which one of the following is a possible symptom or criterion of a manic episode?,Hallucinations,Symptoms are present but do not impair social or occupational functioning,Symptoms last at least 4 days,An inflated sense of self or grandiosity,"(A): Hallucinations
(B): Symptoms are present but do not impair social or occupational functioning
(C): Symptoms last at least 4 days
(D): An inflated sense of self or grandiosity",An inflated sense of self or grandiosity,D,"An inflated sense of self and/or grandiose thinking are symptoms that often occur with manic episodes. Manic episodes have a criterion of 1 week of symptoms, whereas at least 4 days of symptoms is a criterion for a hypomanic episode. A hypomanic episode is not as severe as a manic episode and does not affect functioning in social or occupational settings. Hallucinations are not a symptom of a manic episode. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
547,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",Davone agrees to work on communication skills. Which of the following would best support Davone's situation?,Help Davone write an apology letter to his ex-wife.,Teach Davone assertiveness for verbalizing desires and clarifying boundaries.,Conduct mock interviews for Davone to practice gaining employment.,Use Empty Chair technique for Davone to talk to his father.,"(A): Help Davone write an apology letter to his ex-wife.
(B): Teach Davone assertiveness for verbalizing desires and clarifying boundaries.
(C): Conduct mock interviews for Davone to practice gaining employment.
(D): Use Empty Chair technique for Davone to talk to his father.",Teach Davone assertiveness for verbalizing desires and clarifying boundaries.,B,"Supporting Davone's direct interaction with specific people or agencies is secondary to teaching Davone how to assert his wants and needs and be capable of defining and differentiating between them. Answers a), c) and d) are also therapist-led suggestions and do not necessarily reflect the objectives desired by Davone in the first place. By prioritizing answer b), Davone can develop the skills necessary to further clarify what he wants to use his communication skills for and that could lead to collaborating on new, specific objectives. Therefore, the correct answer is (B)",counseling skills and interventions
548,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.",What information should you gather about Melanie's current level of functioning?,How she manages her daily routine including eating and sleeping,Whether she is up to date on her child support payments,Her interest level in activities that bring her joy,The quality of a relationship between her and her son,"(A): How she manages her daily routine including eating and sleeping
(B): Whether she is up to date on her child support payments
(C): Her interest level in activities that bring her joy
(D): The quality of a relationship between her and her son",How she manages her daily routine including eating and sleeping,A,"How Melanie functions daily is vital to understanding her level of current functioning both cognitively and physically. Relationship dynamics, depression, as evidenced by lack of interest in activities, and her ability to cope with external stressors such as financial obligations can all be better understood considering this first set of baseline data in answer c). Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
549, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.","The client received a score of t=55 on the total Antisocial scale, with a significant elevation on the Antisocial-Acts subscale (t=76), but no elevations on the Antisocial Egocentricity (t=39) or Antisocial-Stimulation Seeking (t=40) subscales t=55 on the total Antisocial scale, with a significant elevation on the Antisocial-Acts subscale (t=76), but no elevations on the Antisocial Egocentricity (t=39) or Antisocial-Stimulation Seeking (t=40) subscales. Which of the following is the most accurate diagnostic choice after reviewing the scores on the assessment of the client's current needs?",Antisocial Personality Disorder,"Bulimia Nervosa, In Full Remission",Conduct Disorder,Narcissistic Personality Disorder,"(A): Antisocial Personality Disorder
(B): Bulimia Nervosa, In Full Remission
(C): Conduct Disorder
(D): Narcissistic Personality Disorder","Bulimia Nervosa, In Full Remission",B,"Based on the client's self-report, she previously met criteria for a diagnosis of Bulimia Nervosa from the ages of 13 to 20. These include the acts of binging and purging, at least once a week for 3 months. Based on her descriptive comments about her weight and self-image, she meets criterion C as her self-evaluation was unduly influenced by her body weight and shape. Because she has not engaged in the binge-purge cycle for 5 years, she merits the specifier, In Full Remission. The assessment shows a significant elevation in antisocial acts, which is expected due to her past criminal history, but no elevations in egocentricity or stimulation-seeking. A diagnosis of antisocial personality disorder would require elevations in all three areas. Additionally, her score on the total Antisocial scale is within 10 points of the Mean, which is not clinically significant. The client may have demonstrated some traits in the past of a narcissistic personality disorder such as a grandiose sense of self-importance, desiring excessive admiration, and is interpersonally exploitative as indicated by her criminal history and the people she interacted with using false personas. However, she does not meet the required five criteria for diagnosis as she shows remorse and insight of her past actions, which is not characteristic of someone with this personality disorder. Conduct disorder is a child and adolescent disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
550,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,"The counselor states, ""Let's take a step back and take deep breaths. The good thing is that you are both here. Now let's try to talk to each other, using I statements and focus on your feelings."" This is an example of?",Paraphrasing,Capping,Reflection of feeling,Regrouping,"(A): Paraphrasing
(B): Capping
(C): Reflection of feeling
(D): Regrouping",Capping,B,"Capping is an intervention that counselors use when they observe the escalation of emotions. By giving the couple a task, it switches their thinking from an emotional level to a cognitive one. Regrouping means to be regrouped or reassembled. It is not a clinical intervention. Paraphrasing is a skill that lets the client know that they are heard by the counselor repeating the client's words. Reflection of feeling is when the counselor focuses on the feeling regarding what was just expressed to also show understanding. Therefore, the correct answer is (D)",counseling skills and interventions
551,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","   tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her",What information would be the most important to guide the development of a treatment plan for this client within the scope of the counselor?,The client stating that she wants to make friends,Reported frequency of trauma responses,The client stating that she wants to find housing,Reported amount of sleep per night,"(A): The client stating that she wants to make friends
(B): Reported frequency of trauma responses
(C): The client stating that she wants to find housing
(D): Reported amount of sleep per night",The client stating that she wants to make friends,A,"The most important thing when treatment planning is to support the client’s goals and objectives. Although insomnia and trauma responses are important observations as presenting symptoms, the client expressed the desire to make friends, which would be an appropriate focus in therapy because it likely would include treating most of the client’s symptoms in order to reach this goal. The client’s housing needs are also important to therapy and an indicated desire by the client, but this would be outside the scope of the counselor and would require either a referral for support or support from elsewhere within the government agency. Therefore, the correct answer is (C)",treatment planning
552,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","The client comes to the counseling center during walk-in hours. The client is continuing to experience a manic episode. She reports that she went out to dance with friends the previous evening and ended up buying a gram of cocaine for $100 and reported doing several lines throughout the night. The client says that she has never used any drugs before and that it scared her that she would spend that much money on drugs and that she used drugs at all. You empathize with the client’s frustration with her behavior and provide psychoeducation on impulse control to support her. The client appears tired as evidenced by her affect and slow movements, and she also appears to have poor hygiene because her clothes have visible stains and she has a slight body odor","Based on the information presented, all of the following are behavioral triggers for impulsive behavior EXCEPT:",The client’s routine is not maintained.,The client is out of the home late at night.,The client uses drugs.,The client is awake late at night.,"(A): The client’s routine is not maintained.
(B): The client is out of the home late at night.
(C): The client uses drugs.
(D): The client is awake late at night.",The client uses drugs.,C,"Managing behavioral triggers is a way to become more aware of when impulsive behavior may occur during a manic episode and provides activities that should be avoided or coped with in order to prevent impulsivity. Drug use is not a behavioral trigger for this client because the drug use was a result of impulsive behavior and did not lead to more impulsive behavior. For this client, being up late, going out with friends, and poor adherence to her usual routine increase the likelihood of impulsivity. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
553,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","Given the situation that occurred during this session, what would you prioritize working on with this client?",The client's resentment of women and his mother,The client's expressed need to fantasize about his ex-girlfriend to get an erection,The client's need to separate from his verbally abusive wife,The client's issues with his father that may be contributing to his erectile dysfunction,"(A): The client's resentment of women and his mother
(B): The client's expressed need to fantasize about his ex-girlfriend to get an erection
(C): The client's need to separate from his verbally abusive wife
(D): The client's issues with his father that may be contributing to his erectile dysfunction",The client's resentment of women and his mother,A,"His issues with his mother and his resentment of women need to be addressed as his conflict continues with his wife. He recognizes that his wife triggers him with her comments, and working with his beliefs about women and mother issues is paramount. Therefore, the correct answer is (B)",treatment planning
554,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.  Eighth session You have been seeing the client for a few months now, and she has consistently come to therapy and has made some progress, but some areas still need work. Regarding the death of her friend, she remains in the denial stage of his passing. She had been prescribed medication to help with her insomnia and depression, which seemed to be helping somewhat. In addition, she is limiting her alcohol intake, but she has not stopped drinking altogether. She had also been working on identifying her triggers for anxious distress, and you discussed several of them during previous sessions.    Today, you focus on the stress the client reports in relationship to her job. You ask, ""What has been going on at work that has been making you feel stressed out?"" She starts to talk about her boss and seems to be caught up in the details, getting lost in her story. You notice her becoming agitated. You ask her to explain what she is feeling and she says, ""overwhelmed, frustrated, and like I can't keep up."" She tells you that just talking about it makes her feel physically uncomfortable. You offer the client some grounding techniques to help her stay in the present moment. You suggest she take a few deep breaths and focus on her breathing. You then ask her to focus on her physical sensations, including any tension or tightness in her body and gently encourage her to release that tension. You suggest she identify something in the room that can help her stay grounded and focus on it if her mind starts to wander.    When she appears to be calm again, you ask her to describe the situation at work that is causing her the most distress in simple terms, without getting caught up in details. The client goes on to explain that her supervisor is often critical of her and she feels as though he does not appreciate the hard work she puts in. You listen to her and empathize, then encourage her to think about specific ways she can address the situation at work. You suggest that she start by making a list of her skills and competencies, so that she can remind herself of her worth when feeling attacked.    Throughout the session, you mirror the client's body language by following her lead. When she leans forward, you lean forward. When she furrows her brows or crosses her arms, you do the same. You also make eye contact with the client, giving her your undivided attention.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",What intervention would best enable you to accomplish the treatment objective of increasing the client's support network?,Encourage the client to reconnect with her friends,Suggest that the client reconnect with her siblings,Recommend grief group for the client,Explore the client's relationship with her father,"(A): Encourage the client to reconnect with her friends
(B): Suggest that the client reconnect with her siblings
(C): Recommend grief group for the client
(D): Explore the client's relationship with her father",Recommend grief group for the client,C,"A group would provide good social support for the client to help her through her grief. Her best friend died, and she does not have a healthy family dynamic. Therefore, the correct answer is (C)",treatment planning
555, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.","Using the information provided, which of the following represents the client's current struggle?",Lack of support,Lack of boundaries,Desire for control,Desire for approval,"(A): Lack of support
(B): Lack of boundaries
(C): Desire for control
(D): Desire for approval",Desire for control,C,"The client's narrative focuses on her desire to control herself by controlling others. She required her parents to buy and eat the way she is eating. She became angry at her brother for not acquiescing to her demands and at her father when he ignored them and ate a doughnut. She tells you she is aware of her mother's attempts to control her but shows no recognition of her own attempts to control others. The client demonstrates rigid boundaries for how others should act around her so while they are not appropriate, she is not lacking boundaries. Her family's actions, as narrated, do not show a lack of support for the client but instead show some resistance to her desires to control them. The client likely does desire her mother's approval but is currently engaged in a power struggle with her mother to determine who ultimately will control the client. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
556,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.  Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience.    You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",Which of the following is not a developmental domain of Multicultural Counseling and Social Justice Competencies (MSJCC)?,Culturally sensitive unconditional positive regard,Counseling relationship,Counseling and advocacy interventions,Client worldview,"(A): Culturally sensitive unconditional positive regard
(B): Counseling relationship
(C): Counseling and advocacy interventions
(D): Client worldview",Culturally sensitive unconditional positive regard,A,"Although it is appropriate to use unconditional positive regard with culturally diverse populations, this is not one of the developmental domains that help lead to multicultural and social justice competence. Therefore, the correct answer is (A)",core counseling attributes
557,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","You are meeting with the client individually and providing parenting training with the client’s PGM. The client’s teacher has implemented a behavioral chart for the classroom, and you ensure the client is receiving appropriate reinforcement for targeted behaviors. The teacher believes the client’s behavior indicates ADHD, and you have agreed to conduct classroom observations. During the observation, you note that the client gets out of her seat multiple times to sharpen her pencil. While doing so, she glares at other students and is observed balling up her fists and threatening others. The teacher yells at the client to sit down and stop disrupting the classroom, which has little effect on the client’s behavior.  You are working collaboratively with the client’s teacher and PGM to establish treatment plan goals",,SMART goal setting,Goal Attainment Scaling (GAS),Functional Behavioral Assessment (FBA),Behavior Intervention Plan (BIP),"(A): SMART goal setting
(B): Goal Attainment Scaling (GAS)
(C): Functional Behavioral Assessment (FBA)
(D): Behavior Intervention Plan (BIP)",Goal Attainment Scaling (GAS),B,"Goal Attainment Scaling (GAS) is a criterion-referenced, collaborative goal setting method that allows participants to measure three targeted behaviors. The targeted behaviors can be transferred to the client’s treatment plan, with goals and objectives designed to measure incremental changes. For each targeted behavior, minimum, moderate, and significant improvement measures are used to determine the client’s progress. SMART goal setting uses the SMART acronym to guide goal setting. SMART goals are specific, measurable, achievable, relevant, and time sensitive. A Behavior Intervention Plan (BIP). is generally implemented as part of a student’s Individualized Education Plan (IEP). or 504 plan. The function of the BIP. is to identify problematic behaviors, determine their cause, and implement strategies that reward appropriate behavior. A Functional Behavioral Assessment (FBA). entails identifying problematic behavior, measuring the behavior, and determining the function of the behavior. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
558,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","    History of Condition: The client’s milestones were all developmentally appropriate; he was walking at ten months, toilet trained by 24 months, and speaking in complete sentences at almost 30 months. The mother describes the client as “moody” beginning in kindergarten. His temper outbursts began to escalate in intensity and duration within the last few years. During this time, there were no known associated stressors. The mother reports that the client has always had a hard time following directions and difficulty complying with authority figures. Family History: The client has two maternal half-brothers, ages 18 and 20, and has positive relationships with both of them. His parents divorced when the client was three years old, and the mother has physical custody of the child\. Before the divorce, the client witnessed verbal and physical altercations between his parents. The client’s father visits periodically, and he has been in and out of substance abuse treatment centers for most of the client’s life. When angry with his mother, the client tells her he wishes he could live with his father. The client’s maternal grandmother is diagnosed with bipolar disorder, and the client’s mother states she struggles “off and on” with depression. Aside from the father’s substance use disorder, a paternal history of mental illness is unknown",What information would best guide the initial development of the client’s treatment plan?,Consultation with an interdisciplinary team,The client’s motivation to change,Classroom observation,Collateral information from the client’s teacher,"(A): Consultation with an interdisciplinary team
(B): The client’s motivation to change
(C): Classroom observation
(D): Collateral information from the client’s teacher",Collateral information from the client’s teacher,D,"Remember, you are looking for the best option for creating an initial plan of care. Since you are school-based, collateral information obtained from the client’s teacher would best guide this process. Collateral information from the teacher allows you to obtain measurable information about the client’s presenting problem. In doing so, you can determine the frequency, duration, and severity of the client’s angry outbursts. Classroom observations are useful, but only provide information for a moment in time and are subject to the Hawthorne effect. The Hawthorne effect occurs when a subject changes their behavior simply due to knowing they are being observed. An interdisciplinary approach is used when seeking to improve or enhance treatment outcomes but is not the best option for information gathering. Lastly, the client’s motivation to change is an important consideration for adults but less so for children. For children, the therapeutic alliance and the family’s treatment compliance greatly influence the client’s motivation to change. Therefore, the correct answer is (A)",treatment planning
559, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.","What is the difference between ""Acute Stress Disorder"" and ""Acute Stress Reaction"" in the DSM-5?",reaction symptoms usually appear within hours to days of the traumatic event,"reaction symptoms include intrusion, negative mood, dissociation, avoidance, and arousal",the duration of symptoms in acute stress disorder extends beyond 1 month,disorder symptoms usually appear within hours to days of the traumatic event,"(A): reaction symptoms usually appear within hours to days of the traumatic event
(B): reaction symptoms include intrusion, negative mood, dissociation, avoidance, and arousal
(C): the duration of symptoms in acute stress disorder extends beyond 1 month
(D): disorder symptoms usually appear within hours to days of the traumatic event",reaction symptoms usually appear within hours to days of the traumatic event,A,"Symptoms of Acute Stress Reaction are within the normal range of reactions given the extreme severity of the stressor, and usually appear within hours to days of the impact of the trauma. This applies to Maria as she experienced her trauma two days prior to this initial assessment. The duration of the disturbance of symptoms for criteria to be met for Acute Stress Disorder is persistence of at least three days to one month after trauma exposure and include nine or more specific symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal. Symptoms present beyond one month begin criteria development for post-traumatic stress disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
560,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice.  You smile and tell the client, “You’ve done a lot of hard work to get to this place. I’m so pleased with how far you’ve come","You smile and tell the client, “You’ve done a lot of hard work to get to this place. I’m so pleased with how far you’ve come.” This is an example of which one of the following?",Congruence,An encourager,Summarization,Empathy,"(A): Congruence
(B): An encourager
(C): Summarization
(D): Empathy",Congruence,A,"This is an example of congruence. Counselors demonstrate congruence through genuine and authentic feedback. Congruence is a person-centered technique communicated by counselors when their verbal and nonverbal messages are aligned. Along with congruence, empathy is a person-centered facilitative condition. Counselors display empathy when reflecting a client’s feelings, thoughts, and perceptions from the client’s point of view. An encourager is a verbal or nonverbal signal for the client to continue talking (eg, saying “Please, go on”). Summarization ties together multiple concepts, feelings, or ideas. Therefore, the correct answer is (B)",counseling skills and interventions
561, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",You learn from Jonny's university mentor that he has dropped out of his classes and moved out of his dorm. Both the university Dean and Jonny's mother have called requesting to discuss what has happened. You are feeling incredibly overwhelmed and fearful. How do you handle this?,Immediately call them apologizing how your actions caused these choices.,Immediately call them and explain why it was not your fault.,Take a short vacation from work prior to returning everyone's calls.,"Address your self-care as needed, then proceed to engage in honest discussions as soon as reasonably possible.","(A): Immediately call them apologizing how your actions caused these choices.
(B): Immediately call them and explain why it was not your fault.
(C): Take a short vacation from work prior to returning everyone's calls.
(D): Address your self-care as needed, then proceed to engage in honest discussions as soon as reasonably possible.","Address your self-care as needed, then proceed to engage in honest discussions as soon as reasonably possible.",D,"Whether or not Jonny's actions were a direct response to his anger towards your comments, you must first take care of yourself mentally and emotionally prior to engaging in discussions about what occurred. Processing the events, your assessment of Jonny's emotional state and behavior, your own personal feelings towards his reported choices; all of these must be filtered through a lens that has been well-fed and after a good night's sleep. You will be more confident and clinically capable of utilizing your professional counseling skills in your conversations with others after you have taken the time to prepare. Escaping or avoiding these conversations is neglectful considering Jonny's risk factors, but jumping into explanations without feeling prepared can also be harmful to both you as a counselor and your confidential agreements with Jonny. Therefore, the correct answer is (D)",counseling skills and interventions
562, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",You must assign Bob a category for the group therapy schedule. Which is the most appropriate?,seniors 65 and up because he would benefit from a same-age peer group,working professionals because he strongly identifies with his occupation,adults 18-65 so he can view a wide range of perspectives,faith-based 12-step track due to his identified spirituality,"(A): seniors 65 and up because he would benefit from a same-age peer group
(B): working professionals because he strongly identifies with his occupation
(C): adults 18-65 so he can view a wide range of perspectives
(D): faith-based 12-step track due to his identified spirituality",faith-based 12-step track due to his identified spirituality,D,"In this case, a faith-based 12-step track would be the most appropriate to address his addiction due to Bob's spiritual belief that ""only God can judge him"". This group would focus on faith-based interventions helping Bob view his addiction through the perspective of originating from his Higher Power. The Big Book in Alcoholics Anonymous teaches that if you admit to being powerless over your addiction, then you need a higher power that is greater than you or your addiction to help you get clean. This attitude would be supportive of Bob's mental state as he seems to be rejecting clinical evidence of his need for recovery. Answer a) would likely trigger Bob since he was just relieved of his occupation and these groups focus around how to balance substance use recovery and an active professional career. A group where Bob would be the oldest adult as in answer b) might also not be helpful based on his presentation and attitude of disinterest in rehabilitation, which could be negatively influential on the others in the group. Answer c) would put Bob in a category where he would be the youngest in a group of seniors, which might deter him considering he presents as in denial over retiring in disgrace and reported feeling ""too young to stop working"". Therefore, the correct answer is (D)",treatment planning
563,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,"Regarding her relationship and the allegations that her boyfriend is hitting her, the counselor should immediately?",Encourage Elaina to leave him,Provide Elaina trauma focused CBT to help her understand her relationship patterns,Encourage Elaina to invite her boyfriend to a session,Complete a crisis plan that Elaina can use if she feels that she is in danger,"(A): Encourage Elaina to leave him
(B): Provide Elaina trauma focused CBT to help her understand her relationship patterns
(C): Encourage Elaina to invite her boyfriend to a session
(D): Complete a crisis plan that Elaina can use if she feels that she is in danger",Complete a crisis plan that Elaina can use if she feels that she is in danger,D,"A crisis plan is important to have if a client is in frequent crises or a possibly dangerous situation. It should include practical steps with accessible resources for the client. Considering the allegation that Elaina's boyfriend is hitting her, a crisis plan should be made if Elaina feels that things are beginning to escalate. It is not up to the therapist to tell Elaina to leave her boyfriend, this may damage the therapeutic relationship or Elaina may not return to therapy. Trauma focused CBT would be a good intervention for Elaina, after the crisis plan is constructed. Inviting Elaina's boyfriend to a session may or may not be a good idea, depending on how open he would be to this suggestion. Knowing that Elaina told the counselor may anger the boyfriend. Therefore, the correct answer is (C)",counseling skills and interventions
564,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,"When reviewing confidentiality, the counselor should not include?",Limits of confidentiality,Confidentiality of electronic communication,What information will be provided to Harold's supervisor,What information Harold should share with his supervisor,"(A): Limits of confidentiality
(B): Confidentiality of electronic communication
(C): What information will be provided to Harold's supervisor
(D): What information Harold should share with his supervisor",What information Harold should share with his supervisor,D,"Confidentiality does not apply to what the client chooses to share with others about themselves. In accordance to the code of ethics, a counselor should review the limits of confidentiality which includes duty to warn. Confidentiality of electronic communication including the use to text messages, email and social media should be reviewed as well. Since the counseling was suggested as the result of coworker's grievances, what will or will not be reported to Harold's supervisor should also be reviewed. Therefore, the correct answer is (D)",professional practice and ethics
565,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ","Given the client's emotional state, which therapeutic technique would be beneficial?",Creating a structural family map,Using empathic listening,Utilizing circular questioning,Applying positive and negative reinforcement,"(A): Creating a structural family map
(B): Using empathic listening
(C): Utilizing circular questioning
(D): Applying positive and negative reinforcement",Using empathic listening,B,"The client is anxious, has issues with his wife, and drinks to cope with his stress. Being able to listen and empathize with the client's difficulties will be most beneficial. Therefore, the correct answer is (B)",counseling skills and interventions
566,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",What short-term objective are you trying to achieve with your homework assignment for the client's mother?,Teach her how to effectively discipline her son when he exhibits temper outbursts,Provide her with greater understanding of why her son feels angry and frustrated,Educate her on effective parenting strategies and techniques for managing her son's behavioral issues,Encourage her to become more involved in her son's activities and strengthen their bond with each other,"(A): Teach her how to effectively discipline her son when he exhibits temper outbursts
(B): Provide her with greater understanding of why her son feels angry and frustrated
(C): Educate her on effective parenting strategies and techniques for managing her son's behavioral issues
(D): Encourage her to become more involved in her son's activities and strengthen their bond with each other",Educate her on effective parenting strategies and techniques for managing her son's behavioral issues,C,"The short-term objective of assigning homework to the client's mother is to educate her on effective parenting strategies and techniques for managing her son's behavioral issues. By providing her with a parent training handbook and specific tasks to complete, you aim to empower her with knowledge and practical tools that she can use to manage his disruptive behavior. Therefore, the correct answer is (B)",treatment planning
567,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","The client comes in, sits down, and immediately says that she has been thinking and decided that she is now ready to talk about the physical abuse that she has experienced. She recounts that from age 18 until age 20 she was with a boyfriend who would smack her if she said something he did not like. She believes this is why she is so preoccupied with pleasing others. The client’s second relationship was when she was 25 with a man who would get drunk nightly and punch her in the stomach or in the back when he was upset. You empathize with the client and reflect her emotions regarding these events. The client states, “I didn’t deserve it when the drunk guy hit me, but I do feel I wasn’t the best girlfriend with the first guy. I often didn’t do enough for him and often said the wrong thing.” Throughout the session, the client was tearful and started shaking slightly when speaking several times. The client paused for long periods before sharing more difficult parts of the story. You decide to assess for PTSD during this session, but she does not meet the criteria. When closing the session, the client states that she is not able to pay for today’s session until the end of the week. The client has no history of nonpayment with you thus far","All of the following are considerations that influence the reporting of abuse, EXCEPT:",The client asking you not to report the abuse,Having insufficient information about the abuse,The age of the client,The cognitive ability of the client,"(A): The client asking you not to report the abuse
(B): Having insufficient information about the abuse
(C): The age of the client
(D): The cognitive ability of the client",The client asking you not to report the abuse,A,"The client signed an informed consent at the start of services, and in doing so she has already agreed that you can report abuse or neglect. Additionally, even if she does not want you to report the abuse, as a mandatory reporter, you are legally required to do so. The age of the client and their cognitive ability are factors that influence the reporting of abuse because adult abuse and neglect includes elderly and intellectually disabled individuals. Having sufficient information also influences the reporting of abuse, because certain elements are necessary to include, such as the name of the abuser. Therefore, the correct answer is (D)",professional practice and ethics
568,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,"The counselor responds to Carlos by stating, ""It's okay to be angry or hopeless. I can see your strengths. You came today which is a start."" The counselor is expressing?",Denial,Positive regard,Congruence,Empathy,"(A): Denial
(B): Positive regard
(C): Congruence
(D): Empathy",Positive regard,B,"Positive regard is the display of warmth and acceptance by the counselor. This also includes the counselor's belief that the client is capable of positive changes. Denial is a Freudian defense mechanism in which a person refuses to see the truth because it brings up feelings of discomfort or pain. Empathy is the ability for the counselor to ""walk in the shoes"" of the other person. Congruence is when the counselor gives honest feedback regarding the client and his progress. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
569, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,At this point Theodore would not need a referral to a?,Cognitive assessment to make sure he can live on his own,A physician for a physical exam,Care manager for housing,Group for bereaved spouses,"(A): Cognitive assessment to make sure he can live on his own
(B): A physician for a physical exam
(C): Care manager for housing
(D): Group for bereaved spouses",Cognitive assessment to make sure he can live on his own,A,"There is no indication that Theodore's cognitive functioning is in question. It would also be unethical to refer him to an assessment that is not necessary. A care manager may be able to help Theodore during this stressful time and find appropriate housing for him. A bereavement group may also be a support for Theodore, so that he can be around others who have suffered the same type of loss. Theodore's physical health is just as important as his mental health. Since he has been neglecting himself and dropped a significant amount of weight, a physical exam would be beneficial. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
570,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past.  The client’s food log has the following statement: “I’m not worth anything if I get fat, and I’m going to die","The client’s food log has the following statement: “I’m not worth anything if I get fat, and I’m going to die.” All of the following are more rational ways of reframing this thought, EXCEPT:","“Although being overweight isn’t healthy, my worth isn’t defined by weight.”","“My body isn’t letting me down, and my husband loves me.”","“The reality is that I could get fat, which may result in my husband’s unhappiness and my own death, but I can be healthy and keep this from happening.”","“My worth isn’t defined by my weight, and there are ways that I can be healthy to reduce my chances of dying younger than I want to.”","(A): “Although being overweight isn’t healthy, my worth isn’t defined by weight.”
(B): “My body isn’t letting me down, and my husband loves me.”
(C): “The reality is that I could get fat, which may result in my husband’s unhappiness and my own death, but I can be healthy and keep this from happening.”
(D): “My worth isn’t defined by my weight, and there are ways that I can be healthy to reduce my chances of dying younger than I want to.”","“The reality is that I could get fat, which may result in my husband’s unhappiness and my own death, but I can be healthy and keep this from happening.”",C,"While identifying the reality of becoming overweight and its possible consequences may carry elements of truth, there is a balance that needs to be found when reframing this client’s cognition. The thought that she could become overweight and suffer the consequences (her husband’s unhappiness and her own death), but that she can do something to keep that from happening may accept a reality, but it also encourages the unhealthy behavior that the client already engages in. In this situation, identifying that her body is not letting her down and that her worth is not defined by weight is a healthier balance in thinking. Therefore, the correct answer is (A)",counseling skills and interventions
571,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.","What characteristics would be most important for you, as Gregory's therapist, to exhibit for the therapeutic process to be successful?",You must be able to work with adolescents and set firm limits when needed.,You must be able to motivate Gregory to change and teach warmth and acceptance.,You must be able to take a nonjudgmental stance and reinforce confidentiality.,"You must be accommodating, genuine, supportive, and action-oriented.","(A): You must be able to work with adolescents and set firm limits when needed.
(B): You must be able to motivate Gregory to change and teach warmth and acceptance.
(C): You must be able to take a nonjudgmental stance and reinforce confidentiality.
(D): You must be accommodating, genuine, supportive, and action-oriented.",You must be able to work with adolescents and set firm limits when needed.,A,"The client has been diagnosed with ODD. These are the ideal characteristics needed to treat a client with ODD. Therefore, the correct answer is (A)",counseling skills and interventions
572,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions.  The client brings up how she often avoids certain restaurants and stores because they remind her of arguments she has had with her past partners that led to her experiencing physical abuse",The client brings up how she often avoids certain restaurants and stores because they remind her of arguments she has had with her past partners that led to her experiencing physical abuse. Which one of the following treatments would be most helpful in managing this avoidance?,DBT,Integrative therapy,Exposure therapy,CBT,"(A): DBT
(B): Integrative therapy
(C): Exposure therapy
(D): CBT",Exposure therapy,C,"Exposure therapy, when completed over an appropriate period of time with gradually more difficult exposures, can be effective in treating the avoidance-related symptoms of PTSD. Although it makes sense that an individual would want to avoid stimuli that trigger strong emotions, restaurants and stores are not actual threats to the client, and her avoidance of these settings is inhibiting her ability to live her life. Through gradual exposure, the client can see that she is safe in those environments and does not need to avoid them. DBT and CBT are each therapy modalities that have cognitive and behavioral aspects that might benefit treatment of PTSD, but they do not address the avoidance behavior adequately on their own. Integrative therapy is the blending of different therapy techniques for a holistic approach to treatment; however, this would not be as effective in treating avoidance behaviors. Therefore, the correct answer is (A)",treatment planning
573, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.","Considering Maria no longer has parents to sign consent for counseling and Maria is a minor, what should you do regarding legal and ethical boundaries in providing services?",You cannot legally or ethically provide counseling for a child without parental consent.,Have the school officials sign in lieu of parents.,Make every attempt to communicate with and obtain consent from her grandmother.,Have Maria sign her own consent and proceed with counseling.,"(A): You cannot legally or ethically provide counseling for a child without parental consent.
(B): Have the school officials sign in lieu of parents.
(C): Make every attempt to communicate with and obtain consent from her grandmother.
(D): Have Maria sign her own consent and proceed with counseling.",Make every attempt to communicate with and obtain consent from her grandmother.,C,"With the knowledge that Maria and her siblings have a next of kin who will likely become their official guardian, it is of legal and ethical best practice to attempt coordination with their grandmother. You may need to obtain a translator, or have Maria provide translation in signing consent documentation provided she is capable; but it is the safest option for both you and Maria. You still may be able to provide Maria counseling without her grandmother's knowledge. If Maria insisted on privately counseling, or if there were no familial options available, it may be possible for Maria to sign her own consent forms provided she is able to demonstrate understanding of her confidentiality rights. You must first check with your state's laws concerning minors seeking therapy without parental consent, as some states allow for a counselor to provide a limited number of sessions or for specific circumstances for children as young as 12 years old. Another option would be for Maria's school counselor to provide Maria counseling within the school, but school officials would not be able to take the place of Maria's guardians on your agency's consent paperwork. Additional options would be to offer lay counseling or other local resources for Maria and her siblings should you not be able to work out an appropriate counseling situation. Therefore, the correct answer is (B)",professional practice and ethics
574,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","When considering the client's desire to address his alcohol use in counseling, which of the following interventions would be used first?",Identify irrational core beliefs,Implement an abstinence contract,Implement motivational interviewing,Use the Prochaska-DiClemente's Stages of Change assessment,"(A): Identify irrational core beliefs
(B): Implement an abstinence contract
(C): Implement motivational interviewing
(D): Use the Prochaska-DiClemente's Stages of Change assessment",Identify irrational core beliefs,A,"Identifying irrational or negative core beliefs is a proven CBT intervention that is part of the process when addressing substance abuse issues. Clinicians use different methods to identify these, however, identifying and modifying unhelpful core beliefs is the most important part of the process. Both the Stages of Change model and motivational interviewing are used when a client is resistant to making changes or when the counselor is unsure whether the client is interested in making changes. As the client has presented with a stated desire to address his alcohol use, the counselor can move directly into helping him work in this area. Abstinence contracts have shown positive and negative outcomes depending on the client and their values and willingness to embrace abstinence. Substance abuse treatment counselors vary in supporting an abstinence model or a harmful reduction model of treatment. Implementing an abstinence contract may not coincide with the client's values and desires. Therefore, the correct answer is (C)",counseling skills and interventions
575,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","Even though the client is sharing about her life within the context of a depressed mood, she is able to elaborate on her feelings about her breakup with her boyfriend, and her role in it. What cognitive error, or distortion, did you detect as she spoke?",Jumping to Conclusions,Disqualifying the positive,Black-and-white thinking,Catastrophizing,"(A): Jumping to Conclusions
(B): Disqualifying the positive
(C): Black-and-white thinking
(D): Catastrophizing",Black-and-white thinking,C,"In this situation, the cognitive error that you would bring to the client's attention is black-and-white thinking; she views her situation as either all or nothing (ex. calling herself a ""total failure"" and describing her actions as ""treating him like dirt"" the entire time they were together). You could point out the tendency to think of her situation in extremes and how this is likely making it difficult for her to find a healthy resolution. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
576,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family","You assess for disturbances in social cognition, which is indicated by several symptoms or observations EXCEPT which of the following?",Difficulty remembering names of acquaintances,Diminished motivation in pursuing hobbies,Difficulty remembering social cues,Increased introversion,"(A): Difficulty remembering names of acquaintances
(B): Diminished motivation in pursuing hobbies
(C): Difficulty remembering social cues
(D): Increased introversion",Difficulty remembering names of acquaintances,A,"Difficulty remembering names of acquaintances is not a symptom or observation included in the social cognition domain. In the DSM-5-TR, Criteria A, the diagnosis of mild neurocognitive disorder (MND) is marked by a modest decline in cognitive functioning. Individuals with mild neurocognitive disorder exhibit moderate difficulty with memory, planning, organization, attention, learning, or processing social cues. Symptoms or observations of individuals who avoid use of specific names of acquaintances is included in the language domain. Further, the DSM-5-TR defines the cognitive domains associated with neurocognitive disorders which also includes symptoms or impairments impacting everyday activities. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
577,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day",Which of the following would be an example of reflection skills when the client is talking about the need to start working soon because he feels like he is doing nothing every day?,"“In addition to being frustrated and anxious about finances, it sounds like you might also feel bored and unengaged.”",“It sounds like we need to focus very intently on figuring out what you are going to do for work because this is causing you a lot of distress.”,“It sounds like most days have been hard because you feel you are not doing much.”,“I can see how hard it must be feeling the pressure of finding a new job and dealing with conflict at home.”,"(A): “In addition to being frustrated and anxious about finances, it sounds like you might also feel bored and unengaged.”
(B): “It sounds like we need to focus very intently on figuring out what you are going to do for work because this is causing you a lot of distress.”
(C): “It sounds like most days have been hard because you feel you are not doing much.”
(D): “I can see how hard it must be feeling the pressure of finding a new job and dealing with conflict at home.”","“In addition to being frustrated and anxious about finances, it sounds like you might also feel bored and unengaged.”",A,"Reflection is about identifying the underlying feelings that the client is experiencing based on what he says. Identifying that the client’s statement about “doing nothing” every day might mean that he feels bored and unengaged identifies an unspoken feeling behind the statement and would be considered reflection. Stating that the client’s days are hard because he is not doing much is a paraphrase because it restates the client’s words in a different manner. Stating the difficulty of the pressure that the client is facing is an empathetic statement. Although it is important to focus on the client finding meaningful employment, this is not reflection. Paraphrasing, reflecting, empathizing, and defining goals all show the client that you are listening and are attuned with him. Therefore, the correct answer is (A)",counseling skills and interventions
578,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","    flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya","Following the intake session, you determine that you have the experience and education to provide counseling, but because this is not your specialty, what would be an appropriate next step?",Refer to a psychiatrist for medication management and continued observation by another professional.,Seek continuing education regarding treatment of bipolar disorder.,Refer to a therapist that specializes in bipolar disorder.,"Continue to provide counseling, but seek peer supervision/consultation to ensure your interventions are clinically appropriate, and refer to a psychiatrist for medication management.","(A): Refer to a psychiatrist for medication management and continued observation by another professional.
(B): Seek continuing education regarding treatment of bipolar disorder.
(C): Refer to a therapist that specializes in bipolar disorder.
(D): Continue to provide counseling, but seek peer supervision/consultation to ensure your interventions are clinically appropriate, and refer to a psychiatrist for medication management.","Continue to provide counseling, but seek peer supervision/consultation to ensure your interventions are clinically appropriate, and refer to a psychiatrist for medication management.",D,"You have the experience and education for treatment of bipolar disorder; therefore, clinical supervision or consultation would be beneficial in ensuring that you are providing appropriate treatment. Therapists should seek supervision in areas of new specializations per the ACA Code of Ethics in order to ensure that the service provision is appropriate (2014, p 8). That said, because evidence-based practice in the treatment of bipolar disorder supports the combination of counseling and medication management, a referral to psychiatry to oversee the medication management is also required because this is outside the scope of the counselor. A referral to another therapist would not be necessary because your education and experience are appropriate for effective treatment. It is always beneficial to seek ongoing education as a therapist, but if the client came to counseling and you did not already have the education in the area required to appropriately support her, you would refer her to another therapist. Therefore, the correct answer is (C)",treatment planning
579, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.",Which of the following would be the most appropriate response to the client's question?,I'm so sorry that you feel this way.,You feel torn between caring for your parents and caring for yourself at the same time.,You are not terrible. Culture is important but so is what you need and want.,Have you tried talking to your parents and explaining what you are trying to do?,"(A): I'm so sorry that you feel this way.
(B): You feel torn between caring for your parents and caring for yourself at the same time.
(C): You are not terrible. Culture is important but so is what you need and want.
(D): Have you tried talking to your parents and explaining what you are trying to do?",You feel torn between caring for your parents and caring for yourself at the same time.,B,"The most appropriate response is paraphrasing the client's problem, giving her the opportunity to hear her dilemma restated. This provides an opening for the client to talk about how her collectivist culture and individualism are struggling within her and gives her the opportunity to begin processing this. Telling the client ""I am so sorry"" puts the focus on the counselor rather than the client and is likely to make the client regret sharing her distress, especially if she believes it is negatively impacting the counselor. Telling the client she is not terrible can provide some normalization, however, minimizing the importance of culture to the client suggests the counselor is not aware of its importance to the client. Asking if the client has tried talking to her parents suggests the counselor lacks cultural awareness and may be bringing her own cultural biases into the session by suggesting the client tell her parents what she wants to do. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
580,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ","Using a behavioral approach, which of the following techniques would be appropriate to use to decrease the client's phobic avoidance?",Looking for exceptions,Systematic desensitization,Looking for previous solutions,Reframing the problem,"(A): Looking for exceptions
(B): Systematic desensitization
(C): Looking for previous solutions
(D): Reframing the problem",Systematic desensitization,B,"Systematic desensitization is a behavioral technique which is commonly used to address phobias and anxiety-related issues. To create a systematic desensitization plan, it is important to first identify the individual's specific fears and anxieties related to social situations. Once these have been identified, the therapist and client can work together to create a list of hierarchy of fears that they can systematically work through. For example, if a person is afraid of speaking in front of an audience, their list might start with smaller goals such as introducing oneself to a stranger, then gradually increase in difficulty such as leading a group discussion. Therefore, the correct answer is (C)",counseling skills and interventions
581,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",What do you identify as a potential treatment barrier for the client?,Language barrier,Lack of social support,Inability to commit to treatment,Lack of insight,"(A): Language barrier
(B): Lack of social support
(C): Inability to commit to treatment
(D): Lack of insight",Lack of insight,D,"The client displays an unwillingness to take responsibility for his actions with substance use, makes excuses for why he is late or misses work, and denies any current thoughts of homicidal ideations. These all suggest that the client has a lack of insight into his behaviors and that addressing this barrier will be essential in his treatment. Therefore, the correct answer is (A)",counseling skills and interventions
582,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,A referral that can be made prior to the next session would be?,A medical referral for Molly's stomach aches,A support group for teens who have lost a parent,Extra help for Molly's decline in grades,A psychiatrist for medication,"(A): A medical referral for Molly's stomach aches
(B): A support group for teens who have lost a parent
(C): Extra help for Molly's decline in grades
(D): A psychiatrist for medication",A medical referral for Molly's stomach aches,A,"It is important to first rule out medical issues. Molly's stomachaches have had a significant impact in her school functioning, and it should be determined if the cause is medical or psychological. Although a support group may be beneficial later, it does not seem that Molly is ready for that yet. It is important to first address the areas of functioning that have significantly declined such as her schoolwork and her relationship with her mother. This can be a possible long-term goal. Part of the reason that Molly's grades have declined was due to missing a lot of school. Prior to her father's death Molly was in advanced placement classes and achieved high scores. Molly was not discharged from the hospital with medication. If it is determined that her hearing her father's voice is a hallucination, or if suicidal ideation worsens, medication may be warranted later. At this point it would benefit Molly to try therapy first. Therefore, the correct answer is (A)",treatment planning
583,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.",Which of the following will be most helpful for the client in reducing her negative emotions related to being late?,Reassure the client that being late at times is a normal occurrence,Create a plan that gradually acclimates the client to arriving late to some events,Ask the client to choose two events in the next week and arrive at least 10 minutes late,Help the client identify ways that she can be proactive in being on time to events,"(A): Reassure the client that being late at times is a normal occurrence
(B): Create a plan that gradually acclimates the client to arriving late to some events
(C): Ask the client to choose two events in the next week and arrive at least 10 minutes late
(D): Help the client identify ways that she can be proactive in being on time to events",Create a plan that gradually acclimates the client to arriving late to some events,B,"Prolonged exposure helps an individual to gradually become more comfortable with situations that cause high emotions or anxiety. The client's rigidity that causes her distress when she is late can be modified by helping her create a plan that gradually exposes her to not meeting her own time constraints and allows her to become more comfortable without her perfectionistic tendencies related to time. Asking the client to choose two events and arrive late without preparation may increase the client's embarrassment and self-anger because she has not yet experienced positive situations when she has been late. Helping the client increase her need for perfectionism in not being late through proactive planning will not help her manage unforeseen circumstances or help her manage her negative emotions when she cannot control the situation. Therefore, the correct answer is (B)",counseling skills and interventions
584, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,Which of the following steps should be taken in the intake stage?,Convince Carl to include his wife in counseling sessions,"Tell Carl that he if he does not attend individual or group therapy, he is violating his probation",Assess the severity of Carl's alcohol use,Ensure Carl goes to group therapy,"(A): Convince Carl to include his wife in counseling sessions
(B): Tell Carl that he if he does not attend individual or group therapy, he is violating his probation
(C): Assess the severity of Carl's alcohol use
(D): Ensure Carl goes to group therapy",Assess the severity of Carl's alcohol use,C,"Alcohol use seems to be a contributing factor in Carl's current issues. A comprehensive assessment would include assessing the severity of Carl's alcohol use to gain an accurate clinical picture and to help determine goals. Although it may be beneficial to have Carl's wife in therapy sessions, that may come later, after the intake and assessment. Group therapy would benefit Carl, but the question is, what needs to be completed as part of the intake session. Finally, the counselor is trying to build rapport and trust with Carl. If the counselor comes across as confrontational to Carl about violating his probation, this may hinder the alliance building process. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
585, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,A psychosocial cause of drug addiction is?,Drugs stimulate the brain producing immediate pleasure,Exposure to substances in utero,Genetics,Failures in parental guidance,"(A): Drugs stimulate the brain producing immediate pleasure
(B): Exposure to substances in utero
(C): Genetics
(D): Failures in parental guidance",Failures in parental guidance,D,"Children with parents who abuse drugs or alcohol may not have the proper guidance to avoid drugs/alcohol themselves. Other psychosocial causes include using drugs/alcohol to relieve tension and an expectation or social norm which portrays alcohol to ""loosen up"" or increase their popularity in social settings. Genetics, exposure to substances in utero, and the positive feeling drugs may give are the physical causes of addiction. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
586,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.",tion. Family History: The husband and wife have been married for 13 years. They report that they met when friends introduced them and that they dated for about 2 years before getting married. The couple have two children: two daughters (ages 7 and 10). The couple reports that they have been in “parent mode” for the past few years and have not been emotionally connected to each other because their attention has been predominantly focused on their children,Which of the following assessments would be the most helpful in treatment planning for this couple?,Gottman Relationship Checkup,Family APGAR assessment,Relationship Assessment Tool,Love Language Quiz,"(A): Gottman Relationship Checkup
(B): Family APGAR assessment
(C): Relationship Assessment Tool
(D): Love Language Quiz",Gottman Relationship Checkup,A,"The Gottman Relationship Checkup assesses several areas in a relationship including conflict resolution, finances, housework, parenting, and more. This would be helpful in identifying areas that led to the affair because the relationship was likely experiencing difficulties prior to this culminating point. The Relationship Assessment Tool assesses intimate partner violence, which is not indicated for assessment at this time. The Family APGAR assessment reviews family relational aspects and would not be appropriate for the issues that this couple is experiencing. The Love Language Quiz identifies how each partner most feels and expresses love, but it is not an evidence-based theory to use during the assessment process. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
587,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.",What further information would be most helpful in determining the client's diagnosis?,Whether the client has been exposed to a traumatic death or serious injury,Whether the client fears her anxiety symptoms will lead to rejection from others,Whether the client experiences anorexia or binge eating,Whether the client has experienced difficulties being in line or in a crowd,"(A): Whether the client has been exposed to a traumatic death or serious injury
(B): Whether the client fears her anxiety symptoms will lead to rejection from others
(C): Whether the client experiences anorexia or binge eating
(D): Whether the client has experienced difficulties being in line or in a crowd",Whether the client experiences anorexia or binge eating,C,"Clients who are preoccupied with their appearance may be diagnosed with body dysmorphic disorder as long as symptoms do not meet criteria for an eating disorder. The client's symptoms do not suggest a traumatic stress disorder as she does not experience flashbacks, nightmares, or avoidance of stimuli associated with a traumatic experience. Her expressed symptoms do not represent criteria for agoraphobia, such as fear of large or small places, and/or crowds. While the client worries that others will negatively evaluate her body related to her perceived flaws, she is not concerned that they will evaluate her anxiety, which is seen in social anxiety disorder. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
588,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",What is most important when gathering information regarding Gregory's presenting problem?,Gregory's eating habits and sleep schedule,"Gregory's frequency, intensity, and duration of symptoms",Gregory's frequency of symptoms and correlating sleep schedule,Gregory's ability to complete homework despite frequent symptoms,"(A): Gregory's eating habits and sleep schedule
(B): Gregory's frequency, intensity, and duration of symptoms
(C): Gregory's frequency of symptoms and correlating sleep schedule
(D): Gregory's ability to complete homework despite frequent symptoms","Gregory's frequency, intensity, and duration of symptoms",B,"The client's frequency, intensity, and duration of symptoms are the essential interview questions when gathering information on the client's presenting problem. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
589,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",What short-term goal would you include in your treatment plan?,Explore ambivalence and determine where he is in the stages of change,Uncover the underlying factors contributing to the client's behavior and resolve this conflict,Modify oppositional behaviors at school to more positive interactions,Decrease the occurrence and intensity of confrontational behaviors towards adults,"(A): Explore ambivalence and determine where he is in the stages of change
(B): Uncover the underlying factors contributing to the client's behavior and resolve this conflict
(C): Modify oppositional behaviors at school to more positive interactions
(D): Decrease the occurrence and intensity of confrontational behaviors towards adults",Explore ambivalence and determine where he is in the stages of change,A,"At this point, the client and his mother are in a destructive cycle. In order to move forward, you need to explore the client's ambivalence; he does not seem interested in the therapy process. Therefore, the correct answer is (C)",treatment planning
590,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client arrives twenty minutes late for his appointment today. He explains that Mondays are the days he does laundry, and he cannot come again on a Monday. You review the required components of informed consent with the client. He expresses an understanding of the counseling process and provides written consent. The client states he has re-considered counseling because he believes you can help him find another girlfriend who will have sex with him. You tell him about a small group you run with other neurodiverse men, most of whom are on the autism spectrum. He expresses an interest in joining after hearing that sexual intimacy would be part of the curriculum. He provides a more solid commitment when you tell him the group is not held on Mondays","Because of his history with the campus police, you focus on helping the client regulate angry emotional outbursts using which one of the following techniques?",Systematic desensitization,Mapping,Cognitive reappraisal,Rolling with resistance,"(A): Systematic desensitization
(B): Mapping
(C): Cognitive reappraisal
(D): Rolling with resistance",Cognitive reappraisal,C,"Cognitive appraisal is a technique used to help with emotional regulation. The client’s difficulties with emotional regulation led to the run-in with campus police. Cognitive reappraisal is a staged process beginning with the client examining his initial perception of the associated stressor, discerning if he has the skills and resources to cope with the stressor, and understanding if the solution lies in changing the situation or in his reaction to the situation. Systematic desensitization is used with anxiety and involves replacing a fear response with a relaxation response in counterconditioning. Reciprocal inhibition uses the new relaxation response to replace the fear response. MI uses “roll with resistance” as a nonconfrontational means for lessening opposition to change. The counselor is attempting to regulate outburst, rather than committing to a change. Mapping is a structural family technique used to creating a visual representation of family patterns of interaction, including family rules and family structures. Therefore, the correct answer is (B)",counseling skills and interventions
591,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",Which assessment instrument would provide the most comprehensive information about the client's level of suicidality?,Mental Status Examination (MSE),Hamilton Depression Rating Scale (HDRS),Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD),Beck Anxiety Inventory (BAI),"(A): Mental Status Examination (MSE)
(B): Hamilton Depression Rating Scale (HDRS)
(C): Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD)
(D): Beck Anxiety Inventory (BAI)",Mental Status Examination (MSE),A,"The MSE will provide the most comprehensive information about the client's level of suicidality. The MSE provides a snapshot of the client's current mental health functioning and behaviors within the clinical setting. This examination explores the client's overall impulse control and the likelihood of committing suicide or homicide. Because the MSE relies on your observations of the client while in session, you can gain valuable non-verbal cues within these crisis states. This allows for a far more comprehensive examination than the other answer options. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
592,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that her husband’s patience continues to wear thin, so she has explored the possibility of alternate employment. She states that she applied for a position as a curriculum sales representative but did not get an interview. The client reports that the company used a personality inventory to prescreen job applicants. She says that someone in human resources told her she was not selected for an interview because the company was looking for someone who was more extraverted and a “thinker” rather than a “feeler.” The client explains that she was under the impression that they were looking for a male. She expresses an interest in using personality inventories to help identify employment that would be a good fit for her",Which of the following personality inventories is based on Carl Jung’s theory of psychological types?,Strong Interest Inventory,Career Orientations Inventory,Myers-Briggs Type Indicator,Ashland Interest Inventory,"(A): Strong Interest Inventory
(B): Career Orientations Inventory
(C): Myers-Briggs Type Indicator
(D): Ashland Interest Inventory",Myers-Briggs Type Indicator,C,"The Myers-Briggs Type Indicator is based on Carl Jung’s theory of psychological type. The Strong Interest Inventory helps individuals identify careers based on interests. The Career Orientations Inventory is based on Edgar Schein’s career anchors or career identities. The Ashland Interest Inventory is available to individuals with employment barriers, including certain educational, mental, cognitive, or physical conditions. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
593,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",her. Family History: The client says that she has a good relationship with her parents. She says that they are encouraging and supportive of her. The client says that she has a younger brother who is 6 years old and an older brother who is 16 years old. The client states that she has a good group of friends and spends time with them regularly.  You continue to have trouble assisting the client with becoming more comfortable by talking about topics that may interest her,You continue to have trouble assisting the client with becoming more comfortable by talking about topics that may interest her. What else can you do in order to build a level of comfort with the client?,Explain the nature of therapy and how it can be helpful to her.,Use the immediacy skill to address the client’s feelings about the session and the therapist.,Use the silence skill to encourage the client to talk about what is happening.,Play a board game with the client.,"(A): Explain the nature of therapy and how it can be helpful to her.
(B): Use the immediacy skill to address the client’s feelings about the session and the therapist.
(C): Use the silence skill to encourage the client to talk about what is happening.
(D): Play a board game with the client.",Play a board game with the client.,D,"Because talking has not been beneficial, playing a game may help develop comfort because play is a nonthreatening activity that does not require disclosure. Play also helps some children lower their guard, and they may begin talking or be more willing to talk while you play. You have tried talking with her, and she is resistant to talking about what is happening; therefore, explaining the nature of therapy would not provide further benefit because you did this as part of informed consent. Immediacy has been attempted because you identified the client was not comfortable and tried to support her in this feeling. Silence may make the client feel pressured and even more uncomfortable, although it may be valuable later on in therapy because it does encourage reflection and communication. Therefore, the correct answer is (B)",counseling skills and interventions
594,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,Informed Consent should?,"Explain the risks, benefits, and limitations of the counseling process",Be regularly revisited and reassessed,All of the above,Allow the client to decide about which provider they should use for treatment,"(A): Explain the risks, benefits, and limitations of the counseling process
(B): Be regularly revisited and reassessed
(C): All of the above
(D): Allow the client to decide about which provider they should use for treatment",All of the above,C,"The counselor should always act in the best interest of the client. If the client is a minor, it is necessary to discuss confidentiality and the limitations with the legal guardian. Collaboration is necessary to have a therapeutic alliance with all parties. Informed consent should include information such as client background, credentials, methods of payment, etc. so that the client can have the information needed to choose the provider who would best meet their needs. Clients must be informed of procedures that may be utilized in counseling. Risks, benefits, and limitations of the counseling process should be discussed, as well as any risk or benefits in using different modalities of treatment such as telemental health. Informed Consent is fluid and should be revisited throughout the life of the counseling relationship. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
595,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","Following the 10th session, the client has not responded to your attempts to contact him and the only communication from the client has been the cancellation of the 11th session",Which of the following would be the most ethical response to the client’s lack of communication regarding cancellations?,You attempt to reach out several times to provide contact information and referral information.,You continue to attempt to make contact with the client until a response is provided.,"You terminate services because the client is participating voluntarily and if he does not want to attend, then he does not have to.","You reach out after the first no-show, and then you wait for the client to make contact to initiate services again.","(A): You attempt to reach out several times to provide contact information and referral information.
(B): You continue to attempt to make contact with the client until a response is provided.
(C): You terminate services because the client is participating voluntarily and if he does not want to attend, then he does not have to.
(D): You reach out after the first no-show, and then you wait for the client to make contact to initiate services again.",You attempt to reach out several times to provide contact information and referral information.,A,"If you determine that the client is not going to initiate contact regarding services, then reaching out several times to ensure that he knows how to reconnect with you or another therapist is an appropriate next step. This demonstrates that you have attempted to follow up with the client and that you are not abandoning him. Termination based only on whether the client is voluntary or involuntary does not matter because you want to ensure that the client has the information that he needs and that you make every effort to continue services. Continuing to attempt contact without a cutoff point does not make the best use of your time, and it does not put the responsibility on the client to decide if therapy is important enough for him to participate in. Reaching out once and waiting for a response might be missed by the client and does not demonstrate genuine attempts to support the client. Therefore, the correct answer is (B)",professional practice and ethics
596,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",What would be the most effective strategy for reducing her social anxiety symptoms?,in-vivo exposure,group therapy,behavioral therapy,behavioral activation,"(A): in-vivo exposure
(B): group therapy
(C): behavioral therapy
(D): behavioral activation",behavioral therapy,C,"Evidence-based practices within Dialectical Behavior Therapy, Cognitive Behavioral Therapy, and Acceptance and Commitment Therapy are all better choices than answers b through d because they will help support Mary's thinking process, using her own values to make different choices, and help her prepare for eventual exposure on her own timeline. In-vivo exposure mandating Mary to slowly attempt social engagements until she becomes comfortable may be harmful since Mary has concerns about Covid-19. Behavioral activation is a tool used for clients with depression who have poor motivation to take charge of their behaviors but may become more inclined once they engage in their desired behaviors regardless of how they feel. Mary has expressed desire to do the things she used to; she is just inhibited from doing so. Group therapy might be a great asset for Mary in time, but there should be a foundation of cognitive restructuring and learned coping skills for Mary to thrive in a group setting. Therefore, the correct answer is (A)",counseling skills and interventions
597,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","   ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation.  Your client is unmotivated to seek employment because he doesn’t want to be “shot down","Your client is unmotivated to seek employment because he doesn’t want to be “shot down.” According to person-centered theory, what is the root of your client’s maladaptive behavior?",The client has an underlying irrational belief that he must be capable in all areas of life or else he is worthless.,The client has developed a failure identity as the result of not taking responsibility for change.,The client has adopted the unhealthy life position of “I’m not okay. You’re not okay.”,The client has developed incongruence between the value of being employed and the behavior of not seeking employment.,"(A): The client has an underlying irrational belief that he must be capable in all areas of life or else he is worthless.
(B): The client has developed a failure identity as the result of not taking responsibility for change.
(C): The client has adopted the unhealthy life position of “I’m not okay. You’re not okay.”
(D): The client has developed incongruence between the value of being employed and the behavior of not seeking employment.",The client has developed incongruence between the value of being employed and the behavior of not seeking employment.,D,"Person-centered therapy is a non-directive approach designed to help clients recognize incongruence between their personal values (ie, the value of being employed) and behavior (not seeking employment). Core facilitative conditions used to help the client obtain this goal are empathy, genuineness, and unconditional positive regard. Glasser’s reality therapy helps clients transform failure identities into success identities by encouraging personal responsibility. Rational-emotive behavioral therapy (REBT) would attribute the client’s maladaptive behavior to the irrational belief that he must be capable in all areas of life or else he is worthless, leading to remaining stuck. Healthy and unhealthy life positions are characteristics of transactional analysis. Therefore, the correct answer is (C)",counseling skills and interventions
598,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.  Eighth session The client and his mother arrive for today's session. You begin by meeting with the client alone and plan to speak with his mother afterwards. You ask the client how he has been doing since last week. He is quiet and shrugs his shoulders. You take a moment to notice his non-verbal cues and then gently ask him, ""It looks like something is on your mind. Do you want to tell me about it?"" He hesitates for a moment and then says, ""I don't know. My mom told me that I have to stop playing video games so much. She said it's getting in the way of my homework. But I don't have any friends and video games are the only thing that makes me feel better. It's not fair. My mom gets to do whatever she wants."" You listen attentively and validate his feelings. You explain to him that it is important to have a balance between recreational activities and taking care of responsibilities, like doing your homework. You say, ""Your mom has a job, right? Sometimes she has to take care of things like going to work or paying bills, and it's the same when we have responsibilities at school. It takes time and effort, but if we do it, then it can free up some time for fun activities like playing video games."" He shrugs and says, ""Yeah, I guess.""    You continue the session by discussing his behavior in school and ask him if he can think of any positive experiences he has had since the last session. He thinks for a moment, then starts to shout excitedly, ""Yes! There was something!"" You intervene by giving him a choice of writing down his feelings or starting over with a quieter tone. He stops, takes two breaths, then proceeds to tell you about his experience in the school playground, where he managed to stay calm when he was provoked by a classmate. He said that his teacher was watching and praised him for staying calm. She gave him a sticker and told him that he could choose the game they would play at recess. You congratulate him on his success and praise him for his efforts.    After you conclude the session with him, you invite his mother to your office and direct the client to wait in your waiting room. You talk to his mother to determine how her home parent training is going and review the client's treatment plan with her. His mother states that when she tried to set boundaries on gaming time, he had a ""melt down"". You suggest that she could consider increasing the amount of time he can play his video games in increments if he meets certain goals, such as completing all of his homework or cleaning up his room. She agrees to try this during the upcoming week. She also mentions that her son continues to struggle socially. When she told him that he could invite a friend over for pizza, he said, ""What friend? Making friends is dumb. Who needs them anyway?""    Following the session, you receive a phone call from the client's father who states that he has recently reconnected with his family. He says, ""My wife told me that you've been working with my son. I know he's got some issues. I'm trying to get back in his life and make things right. What should I do?""","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",The client's father calls and tells you that he has recently reconnected with his family. He knows you are working with his son and asks what he can do to help. How would you respond?,"""I'm so glad that you called. I believe that your son can benefit from a positive male role model if your wife agrees.""","""Thank you for your willingness to help. Can you join us in the next session?""","""Is there a time when I can meet with you and your wife to get her consent and bring you up to date on parent management training?""","""I cannot confirm or deny any information regarding my clients. I suggest that you contact your son's mother and discuss the issue with her directly.""","(A): ""I'm so glad that you called. I believe that your son can benefit from a positive male role model if your wife agrees.""
(B): ""Thank you for your willingness to help. Can you join us in the next session?""
(C): ""Is there a time when I can meet with you and your wife to get her consent and bring you up to date on parent management training?""
(D): ""I cannot confirm or deny any information regarding my clients. I suggest that you contact your son's mother and discuss the issue with her directly.""","""I cannot confirm or deny any information regarding my clients. I suggest that you contact your son's mother and discuss the issue with her directly.""",D,"The client's mother has full legal custody of son. She has not given you permission to speak with the father concerning her son's treatment. This response protects the client's confidentiality while also acknowledging the father's desire to reconnect. Therefore, the correct answer is (D)",professional practice and ethics
599,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What question would you ask the mother to gather more information about the client's needs?,"""Does he prefer playing alone or with others?""","""What strategies have been most effective in addressing his behaviors thus far?""","""What has been the most challenging aspect of parenting your son so far?""","""How would you describe your parenting style?""","(A): ""Does he prefer playing alone or with others?""
(B): ""What strategies have been most effective in addressing his behaviors thus far?""
(C): ""What has been the most challenging aspect of parenting your son so far?""
(D): ""How would you describe your parenting style?""","""What strategies have been most effective in addressing his behaviors thus far?""",B,"By asking this question, the therapist is able to gain more insight into the client's needs and behavior patterns, as well as what strategies have been successful in helping him regulate his emotions and interact with others. Additionally, this question can help inform the therapist about any potential risk factors associated with therapy for the client. This will enable them to tailor their plan of care based on the needs and history of the client. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
600,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.",Which of the following interventions should be implemented during this session?,Provide psychoeducation on systems and the impact of change,Process the client's desire to continue in his marriage relationship,Remind the client that change is difficult and his spouse needs additional kindness,Help the client set strong boundaries to protect the success he has made,"(A): Provide psychoeducation on systems and the impact of change
(B): Process the client's desire to continue in his marriage relationship
(C): Remind the client that change is difficult and his spouse needs additional kindness
(D): Help the client set strong boundaries to protect the success he has made",Provide psychoeducation on systems and the impact of change,A,"Individuals exist in systems and systems theory states that when one member of the system changes, this causes distress for the other members of the system as they respond to the change. The client's changes are helpful for him but create dissonance for his husband when the client is not responding as he usually does. Providing education on change and its impact on the family system allows the client to understand current circumstances and may help him respond with empathy to his partner as they navigate the changes. It would be inappropriate for the counselor to suggest the client might not want to stay in the relationship or suggest that the client should either strengthen or lower his boundaries to appease his spouse. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
601, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.",Which of the following interventions would help Leah better understand her own enigmas?,Journaling,Trauma-informed cycle,Guided meditation,Empty chair technique,"(A): Journaling
(B): Trauma-informed cycle
(C): Guided meditation
(D): Empty chair technique",Journaling,A,"Through journaling assignments, Leah can identify, process, and build insight into her many reported enigmas as well as share them with you or others to receive feedback or review. The empty chair technique is supportive of helping Leah speak her truths to someone without them being there. Guided meditation can assist with reducing anxiety. Trauma-informed care is guided by the principles of safety, choice, collaboration, trustworthiness, and empowerment and is used to help educators break the cycle of client trauma and work to prevent client re-traumatization. Therefore, the correct answer is (B)",counseling skills and interventions
602,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","You have attempted to arrange a family session with the mother, but she is unable to take off work to attend. The client arrives for his second session eager to share that he is “on green” this morning, which means the client’s behavior for the day has been good. You praise him for staying in his seat and keeping his hands and feet to himself. The client responds well to your praise. When engaging in a feelings identification activity, the client identifies feeling unhappy and worried when his father doesn’t show up for scheduled visitation. The client explains that his parents frequently argue about “how to take care of me” and “sometimes push each other.” He quickly abandons the feelings activity and asks if he can go back to class. You deny the client’s request to leave and instead give him the option of selecting another activity. The client refuses to do so and begins to kick your file cabinet repeatedly. He proceeds to knock papers off your desk. When redirected, the client’s behavior escalates. He quickly becomes inconsolable as he cries and yells, “I hate counseling, this school, and everyone in it!”  Your client could benefit from a referral for in-home counseling, but the client’s insurance does not cover the services. Your supervisor asks you to find an in-network provider for the client","Your client could benefit from a referral for in-home counseling, but the client’s insurance does not cover the services. Your supervisor asks you to find an in-network provider for the client. In doing so, you adhere to which one of the following ethical principles?",Fidelity,Justice,Autonomy,Veracity,"(A): Fidelity
(B): Justice
(C): Autonomy
(D): Veracity",Justice,B,"Justice is an ethical principle, and social justice is a professional value associated with the ethical commitment to promote equal access to resources, rights, and opportunities for everyone. The ACA Code of Ethics (2014) defines justice as “treating individuals equitably and fostering fairness and equality” Equitable treatment includes having equal opportunities for accessible healthcare. Finding a provider that takes the client’s insurance is one way to practice the principle of justice. Doing so helps to improve outcomes, instill trust, and provide equal opportunities for the client and his family. The principle of veracity calls on counselors to conduct themselves truthfully and professionally. Autonomy is expressed when counselors support the client’s right to control the direction of their lives. Autonomy is the foundational principle of informed consent. Fidelity involves respecting commitments and honoring promises. Therefore, the correct answer is (B)",professional practice and ethics
603,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","You are on maternity leave, and your supervisor is covering your cases while you are out of the office. The supervisor meets with the client and daughter for the first time today and discusses the client’s progress and her treatment plan goals. The client and her daughter report measurable improvements with symptoms of depression and apathy. During today’s session, the supervisor also learns that you and the daughter went to high school together and share multiple acquaintances. There is no documentation in the client’s chart indicating that the risks and benefits of multiple relationships were reviewed with the client. At the end of the session, the supervisor asks the client for her copay. The daughter and the client state that you have “always just waived the copay,” indicating that the final bill would eventually be “written off by the agency.”  The client has met her goals for reducing symptoms of depression and apathy; however, her memory has not improved","The client has met her goals for reducing symptoms of depression and apathy; however, her memory has not improved. How should you proceed?",Continue to work with the client and create treatment plan goals addressing memory impairment.,Discuss termination due to the client meeting her goals related to depression and apathy.,Continue to work with the client and renew treatment plan goals for depression and apathy.,Discuss referring the client to another professional who can address her memory impairment.,"(A): Continue to work with the client and create treatment plan goals addressing memory impairment.
(B): Discuss termination due to the client meeting her goals related to depression and apathy.
(C): Continue to work with the client and renew treatment plan goals for depression and apathy.
(D): Discuss referring the client to another professional who can address her memory impairment.",Discuss referring the client to another professional who can address her memory impairment.,D,"The best choice for this client is to refer her to another professional who can address her memory impairment. Because the client’s PET scan identified changes associated with Alzheimer’s disease, you would need to find a specialist, such as a neuropsychologist, who could better address the client’s cognitive impairment. Discussing termination is a possibility, but it precludes the client benefiting from additional resources. Continuing to work with the client on improving her memory impairment is also a possibility. However, research shows cognitive impairment is progressive, and there is little more the counselor can do to help with this. Renewing client treatment goals for depression and apathy is unnecessary because the client has already achieved them. This would only apply if the client met her short-term goals and the counselor and client decide together to focus on long-term goals. Therefore, the correct answer is (B)",treatment planning
604,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,When interviewing someone who is actively psychotic you should first asses?,Symptoms,Treatment,Diagnosis,Safety,"(A): Symptoms
(B): Treatment
(C): Diagnosis
(D): Safety",Safety,D,"Ensuring safety is a top priority. Considerations include seating arrangement, whether to have family members in the room and ensuring the comfort of the client. Although the diagnosis is helpful in determining effective treatment, it is the least important factor when interviewing someone who is actively psychotic. The assessment of severity of symptoms is necessary to establish level of functioning and help formulate treatment goals. Discussing treatment options is also important as part of the informed consent process and can be done after safety is assessed. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
605,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning","Based on the information that you already have, which of the following would be a clinically indicated behavioral intervention to manage increasing depressive symptoms?",Encourage the client to spend time with friends because this makes her happy.,Encourage the client to follow up with the psychiatrist in order to discuss medication for depression.,"Encourage the client to plan out pleasurable activities that she has enjoyed in the past, and mention that she should do them even if she feels like she will not enjoy them.",Develop an exercise routine because exercise focuses on general well-being and can improve mood by releasing endorphins.,"(A): Encourage the client to spend time with friends because this makes her happy.
(B): Encourage the client to follow up with the psychiatrist in order to discuss medication for depression.
(C): Encourage the client to plan out pleasurable activities that she has enjoyed in the past, and mention that she should do them even if she feels like she will not enjoy them.
(D): Develop an exercise routine because exercise focuses on general well-being and can improve mood by releasing endorphins.","Encourage the client to plan out pleasurable activities that she has enjoyed in the past, and mention that she should do them even if she feels like she will not enjoy them.",C,"Based on the information provided, it would be most beneficial to encourage the client to plan activities that she knows she has enjoyed in the past. The cognitive distortion associated with assuming that she will not enjoy herself is called fortune-telling because she is assuming an outcome without knowledge to support the assumption, and she may in fact enjoy things more than she thinks, even if it is not to the extent that she used to. Exercise can improve mood and well-being, but the client has not expressed any interest in this activity. The client already spends time with friends and should continue to do so. The client reports not feeling ready to take medication, so this is an ongoing discussion. Therefore, the correct answer is (B)",treatment planning
606,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","   . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation","Based on the client’s clinical presentation, what topic should be discussed to help develop initial treatment plan goals?",Social isolation and other interpersonal deficits,The effects of internalized biphobia,Cognitions associated with depressed mood,Behaviors maintaining maladaptive eating,"(A): Social isolation and other interpersonal deficits
(B): The effects of internalized biphobia
(C): Cognitions associated with depressed mood
(D): Behaviors maintaining maladaptive eating",Behaviors maintaining maladaptive eating,D,"You would first identify behaviors maintaining maladaptive eating. Goals related to the client’s maladaptive eating patterns are prioritized because binge-eating disorder is the client’s primary diagnosis, and the client has expressed the desire to stop binge eating. There are several areas of exploration for this client, including depressive symptoms, her relationship with her family since coming out, her spirituality, and binge eating. The client prioritized the focus of treatment by stating, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating” While treatment engagement is generally accomplished using a strengths-based approach, best practices for eating disorders suggest identifying and changing maladaptive eating first, followed by addressing any underlying issues. Therefore, the correct answer is (B)",treatment planning
607,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.  Eighth session The client has been seeing you once a week for the last two months. Today, he appears calm, and his thoughts are coherent. The client tells you that he has not completely abstained from alcohol, but his use has significantly decreased. He reports that he went to a virtual AA meeting but did not find it helpful, so he signed off. The client opens up and states, ""I think one of the reasons I am anxious is because I am having an affair. Ever since my wife hurt her back, we have not been intimate."" The client's speech becomes more rapid, and he begins to lose eye contact as he discloses the details of his affair to you. Your client tells you, ""I'm not happy with my wife, either sexually or emotionally. The new woman I'm seeing understands me, and I don't want to drink when I'm around her. She helps me forget everything that causes me stress."" In response to your client focusing on the positives of his affair, you engage the client in a discussion to explore the issue from other perspectives. You ask questions like, ""What do you think would happen if your wife found out about your affair?"" Your client pauses for a moment and looks down, and then says, ""I'm not sure. I care about my wife, but I don't know if she will ever be able to understand me in the way that this other woman does. I feel like I'm trapped."" You listen empathically as your client expresses his feelings of anxiety, despair and confusion. You provide clarification when necessary and strive to help your client gain insight into his thoughts and behaviors.    In the session, you explore the client's anxiety and how it has been related to his affair. You address underlying issues that may be contributing to the anxiety such as unresolved feelings of guilt or fear of being discovered. You emphasize that anxiety is often a sign of trying to avoid uncomfortable emotions and situations, but acknowledging them can help him understand anxiety in a different way. You also talk about the role alcohol has played in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to incorporating strategies to address these issues in his treatment plan, such as scheduling regular self-care activities and exploring the relationship between his thoughts and behaviors. Toward the end of this session, the client appears calmer and confident in his ability to make positive changes. As you are wrapping up the session, the client confides to you that ever since he started having an affair, he has found himself sexually attracted to his daughter. He says, ""It's just kind of exciting to peek in the bathroom and watch her in the bathtub. But I would never touch her! It's just a passing thought. I know that I need to stop. The thrill of my affair is satisfying enough.""","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ","You tell your client, ""I have some pretty strong feelings about affairs. My father cheated on my mother, and I feel that having an affair is a cowardly way out of a marriage."" What has transpired between you and the client?",You followed the ethical rule of justice.,You have overly self-disclosed due to countertransference.,You followed the ethical rule of fidelity.,You told the client how you feel to broaden his perspective.,"(A): You followed the ethical rule of justice.
(B): You have overly self-disclosed due to countertransference.
(C): You followed the ethical rule of fidelity.
(D): You told the client how you feel to broaden his perspective.",You have overly self-disclosed due to countertransference.,B,"This is correct. The client brought up feelings in you and caused a reaction. He reminded you of your father (countertransference), and you reacted by self-disclosing too much of your own history. Therefore, the correct answer is (A)",professional practice and ethics
608,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals",Which cognitive-behavioral technique (CBT) can be used to investigate alternative explanations for the client’s delusions?,Scaling questions,Symptom analysis,Peripheral questioning,Unified detachment,"(A): Scaling questions
(B): Symptom analysis
(C): Peripheral questioning
(D): Unified detachment",Peripheral questioning,C,"Peripheral questioning is used to investigate alternative explanations for the client’s delusions (eg, “How do you know the shadow man is poisoning your food?. What methods would he use to do this?”). This technique focuses on the client’s specific symptoms to understand their origins and plausibility. Slowly, incremental reality testing is used to present hypotheses for alternative explanations. This technique helps reduce blame and enhances the therapeutic alliance. Scaling questions are associated with solution-focused brief therapy and are used to help clients track progress towards identified goals. For example, “Where are you on a 1-10 scale concerning the resolution of your problem?” Unified detachment is a technique used in integrative behavioral couple therapy (IBCT) involving communication in a detached and non-accusatory manner. Symptom analysis is a Jungian therapy technique used to help individuals achieve a state of individuation and self-realization. Therefore, the correct answer is (C)",counseling skills and interventions
609, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.","Reflecting on your conversation with mom, you recall that Raul's primary pastime is playing video games. What can this piece of information help you understand about Raul?",He uses dissociation for coping.,He can be motivated through use of gaming language.,Video games worsen his ADHD symptoms.,He doesn't really have ADHD.,"(A): He uses dissociation for coping.
(B): He can be motivated through use of gaming language.
(C): Video games worsen his ADHD symptoms.
(D): He doesn't really have ADHD.",He uses dissociation for coping.,A,"If the only activity Raul engages in on his own time involves a distraction from his reality, it is reasonable to assume this is what he turns to for escape, release, comfort, enjoyment, and/or safety. This is vitally helpful in treatment planning and providing interventions to help Raul learn to accept his reality, adapt to his circumstances, and cope with his distress, to prepare him for a successful future in an unpredictable world. One can control several factors in video gaming, giving a false sense of security and predictability as one navigates the rules of the game. When met with unprecedented challenges or failure, the consequences are minimal and thus capable of being managed with little effort. Gamers may experience and feel losses or frustrations in games passionately, resulting in large expressions of emotions and often impulsive behavior such as throwing their controller across a room; these are expressions of much deeper emotional conditions that have found a rather controllable outlet. While overstimulation may negatively affect an individual with ADHD, some games have been proven to support certain cognitive functions that can help with certain ADHD conditions when well-managed with boundaries and a balance of other activities. The ability to hyper-focus on gaming does not rule out ADHD; some people think if a child can focus on something like their video games, they could not possibly have ADHD. However, the deficits in the disorder relate to how well a child can pay attention to low interest activities or content. Children with ADHD can develop an obsession with high-interest activities due to their cognitive processing inflexibility. There is no evidence to support answer c) would be effective, although use of this idea in interventions would not be harmful. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
610,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",What would be considered a long-term goal for this client?,Resolve the core conflict that is the cause of the client's anxiety,Implement coping strategies to reduce anxiety and manage panic symptoms,Increase presence at school and job,Articulate a clear understanding of the manifestations and causes of panic attacks,"(A): Resolve the core conflict that is the cause of the client's anxiety
(B): Implement coping strategies to reduce anxiety and manage panic symptoms
(C): Increase presence at school and job
(D): Articulate a clear understanding of the manifestations and causes of panic attacks",Resolve the core conflict that is the cause of the client's anxiety,A,"Resolving the core conflict that is causing the client's anxiety will be a long-term goal of therapy. By exploring his memories and addressing the issues at their root, your client can gain insight into why he feels anxious, develop strategies to manage it, and ultimately work toward overcoming it. Therefore, the correct answer is (C)",treatment planning
611,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ","In response to the client's statement about The Flash, you suggest that he join the track team. What method are you employing with your suggestion?",Paradoxical intention,Building on the client's strengths,Humor as part of the therapy,Challenging the client to be more realistic,"(A): Paradoxical intention
(B): Building on the client's strengths
(C): Humor as part of the therapy
(D): Challenging the client to be more realistic",Building on the client's strengths,B,"Sometimes defense mechanisms can be helpful to move us forward in our effort to change. Thinking he is Flash is not all that bad a fantasy, and now maybe he can do something about it by actually joining the track team himself. Does this sound a little far-fetched?. Maybe, but maybe not. You will want to caveat the attempt with some realism and reality, but at the same time do so with encouragement to try something new. Therefore, the correct answer is (A)",counseling skills and interventions
612,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.","Considering the first session notes, which of Mary's issues would you attempt to discuss with her next?",shopping addiction,stress from dog's health,redirect back towards social phobia,complex grief,"(A): shopping addiction
(B): stress from dog's health
(C): redirect back towards social phobia
(D): complex grief",stress from dog's health,B,"Mary has just told you her here-and-now functioning is being negatively affected due to stress that her only live-in companion is not doing well. Address this with Mary right away as it demonstrates compassion and concern, helps you better understand her feelings and fears, and focuses in on another stressor that could be driving maladaptive behavior. Mary presents as in denial over her shopping patterns which may be driven more by perfectionism, compulsion out of boredom, and lack of life satisfaction more so than addiction. This would require further processing, but Mary does not have insight into this considering her response to your question during session. Changing the topic entirely to a different treatment plan goal or projecting her fears about her dog onto other known issues such as grief are both not the most compassionate and empathic choices. Therefore, the correct answer is (B)",counseling skills and interventions
613,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client has made steady progress toward reducing maladaptive eating. After several weeks of collecting self-monitoring data, you and the client successfully identify patterns that maintain the problem of binge eating. The client’s depressive symptoms have improved, and she is seeking interpersonal connections. She has set appropriate boundaries with her family and distanced herself from their church. The client briefly attended a more liberal church, experienced biphobia, and did not return. She explains, “In my parent’s church, I’m not straight enough. In the LGBTQ community, I’m not gay enough.” You have introduced her to dialectical behavioral therapy, and she attributes mindfulness to improved depressive symptoms.  Which Dialectical Behavior Therapy (DBT) module teaches radical acceptance using alternative coping skills (e\. g","Which Dialectical Behavior Therapy (DBT) module teaches radical acceptance using alternative coping skills (e.g., self-soothing)?",Distress tolerance,Interpersonal effectiveness,Emotional regulation,Core mindfulness,"(A): Distress tolerance
(B): Interpersonal effectiveness
(C): Emotional regulation
(D): Core mindfulness",Distress tolerance,A,"Distress tolerance is one out of four DBT skills modules. Distress tolerance teaches clients to accept the present situation and employ coping or survival skills such as self-soothing, distraction, and weighing the pros and cons. Radical acceptance involves adopting a nonjudgmental stance and accepting or tolerating the outcome. The DBT module of core mindfulness is used to help the client remain fully aware and in the present moment. Interpersonal effectiveness uses assertiveness strategies and conflict resolution skills to help clients with interpersonal issues. Lastly, emotional regulation helps clients learn how to accurately label current feelings, decrease reactionary responses, and decrease the intensity of emotional experiences. Therefore, the correct answer is (D)",counseling skills and interventions
614,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","Since the fourth session, child protective services investigated the client’s abuse allegations and determined that they were unfounded. You discuss this with the client and he says he was lying because he was mad at his parents that day. You praise the client for being forthright today regarding the allegations and discuss how false allegations can be incredibly harmful to others and can strain his relationship with his parents further. You and the client process several situations similar to this in which he avoided responsibility. You empathize with the client and support his reflection on his behavior.  The client’s parents have not paid for the past three sessions","The client’s parents have not paid for the past three sessions. All of the following are important considerations, EXCEPT:",Inform the client in a timely fashion of your intention to use a collections agency.,Waive the session payments because the client is unable to afford them and you want to preserve the counseling relationship.,Offer the client the opportunity to pay for the past three sessions.,"The policy should be covered in your informed consent document, and you should follow the agreed-upon terms.","(A): Inform the client in a timely fashion of your intention to use a collections agency.
(B): Waive the session payments because the client is unable to afford them and you want to preserve the counseling relationship.
(C): Offer the client the opportunity to pay for the past three sessions.
(D): The policy should be covered in your informed consent document, and you should follow the agreed-upon terms.",Waive the session payments because the client is unable to afford them and you want to preserve the counseling relationship.,B,"The client has agreed to certain payment expectations as outlined in the informed consent documents and is not paying as agreed. You are able to refrain from waiving the payments if you would prefer because they have been consented to. Informing the client of intentions to use a collections agency, allowing the opportunity to pay for recent sessions, and including this information in the informed consent are all important ethical considerations in this situation, according to the ACA Code of Ethics. Therefore, the correct answer is (D)",professional practice and ethics
615, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.","In considering concurrent treatment for this client, which of the following would be most helpful?",Referral to process-oriented group counseling,Referral to family doctor for monitoring weight,Referral to psychoeducational group counseling,Referral to psychiatry for medication evaluation,"(A): Referral to process-oriented group counseling
(B): Referral to family doctor for monitoring weight
(C): Referral to psychoeducational group counseling
(D): Referral to psychiatry for medication evaluation",Referral to process-oriented group counseling,A,"Process-oriented groups focus on the here-and-now relationships between the members of the group. They are longer term groups where members end up recreating their interactions with others through the process of transference with other members of the group. Process-oriented groups allow for members to provide positive and negative feedback to each other to promote personality change and growth. This will be helpful for the client to have others speak directly to her interpersonal interactions with people and how it is received by others. Referring her to a psychoeducational group would be less helpful as psychoeducational groups teach about a specific diagnosis, coping skill, or other strategy for self-improvement. Psychoeducational groups do not allow members to confront other members as they can in process-oriented groups. This client does not need referral to psychiatry as she has no diagnoses that requires medication. Additionally, a referral to her family doctor for weight monitoring moves the focus of counseling to her bulimia, which is in full remission. Since she is not engaged in disordered eating, there is no reason for monitoring weight from a counseling perspective. Therefore, the correct answer is (C)",counseling skills and interventions
616,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",What kinds of activities can you do with Mary related to her grief?,assign journal writing assignments,listen to music with her,EMDR,guided art projects,"(A): assign journal writing assignments
(B): listen to music with her
(C): EMDR
(D): guided art projects",listen to music with her,B,"Mary has mentioned in her intake that country music calms her. Incorporating this positive coping method into her treatment is a great way to help her associate counseling with something that already brings her peace. Through this practice you can offer to listen to memories of her loved ones, share stories, or even teach mindfulness. Writing or art would be too challenging for Mary as she has already shared that she developed arthritis and has limited use of her hands for intricate tasks. EMDR is eye-movement desensitization and reprocessing, a trauma therapy for those prepared to engage in intense focused treatment to reduce symptoms of trauma reactions. This might be something useful for her eventually either through a referral or if you become certified to provide this service. Therefore, the correct answer is (D)",counseling skills and interventions
617, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,"All of the below therapeutic techniques may be beneficial to treat Carl's PTSD symptoms, except?",Pet therapy,Exercise program,Anti-epileptic medication,Anger Management,"(A): Pet therapy
(B): Exercise program
(C): Anti-epileptic medication
(D): Anger Management",Anti-epileptic medication,C,"Anti-epileptic medication has not been proven effective to treat PTSD. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) have been found to be effective for PTSD. Anger management skills can teach Carl coping skills to manage his reactions. Pet therapy has also been found to be an effective form of intervention for combat veterans diagnosed with PTSD. Exercise also helps to release endorphins which can help combat Carl's irritability and aggression. Therefore, the correct answer is (D)",treatment planning
618, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.",Which of the following is the most appropriate to discuss with the client at the beginning of counseling?,Career counseling can include personal issues that impact career and career decisions,Career counseling focuses only on exploring career and occupational choices,Career counselors are not mental health counselors,Career counseling is a specialty area that only some counselors are trained to provide,"(A): Career counseling can include personal issues that impact career and career decisions
(B): Career counseling focuses only on exploring career and occupational choices
(C): Career counselors are not mental health counselors
(D): Career counseling is a specialty area that only some counselors are trained to provide",Career counseling can include personal issues that impact career and career decisions,A,"Career counseling focuses on career decisions and choices as well as any personal or mental health issue that impacts a client's career satisfaction or career decision-making. Career counseling, therefore, does not focus only on exploring career and occupational choices. Responses c and d are incorrect because all mental health counselors are trained in career counseling, and licensure exams require competence in career theories and career-oriented models for counseling. Therefore, the correct answer is (B)",counseling skills and interventions
619,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","The client discusses how his case manager has gotten him into a shelter and is currently working on securing housing for him. The client processes feelings surrounding the shelter and has begun a detox program for his fentanyl addiction. The client verbalizes that he is experiencing anxiety surrounding being at meetings with the case manager, talking with other residents, reintegrating into a “more normal life,” and worrying about whether he can ever have a relationship with his kids or ex-wife if he gets sober. Through processing, you realize that this anxiety was present prior to drug use and that he has experienced anxiety throughout his life",All of the following are considered short-term objectives for therapy EXCEPT:,Identifying triggers for anxiety in order to understand the root of the anxious thoughts,Learning and implementing coping skills with a resulting decrease in anxiety and improved functioning,Learning and implementing strategies to delay the onset of anxiety following a trigger,Using the Generalized Anxiety Disorder-7 item (GAD-7) scale to determine the client’s baseline anxiety and progressing toward reduction of anxiety symptoms,"(A): Identifying triggers for anxiety in order to understand the root of the anxious thoughts
(B): Learning and implementing coping skills with a resulting decrease in anxiety and improved functioning
(C): Learning and implementing strategies to delay the onset of anxiety following a trigger
(D): Using the Generalized Anxiety Disorder-7 item (GAD-7) scale to determine the client’s baseline anxiety and progressing toward reduction of anxiety symptoms",Learning and implementing coping skills with a resulting decrease in anxiety and improved functioning,B,"Learning and implementing coping skills with a resulting increase in functioning would be considered a long-term goal for therapy because many steps need to occur prior to this result. Identifying triggers, monitoring the client’s progress with the GAD-7, and teaching strategies to delay the onset of anxiety following a trigger are appropriate short-term goals that can generally be accomplished in the immediate weeks of initiating therapy. Therefore, the correct answer is (A)",treatment planning
620, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,A physical cause of drug addiction is?,A person's biological makeup,Alcohol flush reaction,Expectations of social success,Failure of parental guidance,"(A): A person's biological makeup
(B): Alcohol flush reaction
(C): Expectations of social success
(D): Failure of parental guidance",A person's biological makeup,A,"The physical causes of drug addiction include the pleasurable feeling drugs may cause, craving and genetic vulnerability, as well as exposure to substances. Expectations of social success and failures of parental guidance are psychosocial causes of drug addiction. Alcohol flush reaction is a physical reaction to alcohol seen primarily in people of Asian descent in which the body cannot break down the enzymes in alcohol. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
621, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,"In response to Darrel's sharing, the counselor should?",Deny feelings about counselor's own cultural identity,Encourage Darrel to assimilate to American culture,Focus on understanding Darrel's cultural view of the world,Tell Daniel that his feelings will soon pass,"(A): Deny feelings about counselor's own cultural identity
(B): Encourage Darrel to assimilate to American culture
(C): Focus on understanding Darrel's cultural view of the world
(D): Tell Daniel that his feelings will soon pass",Focus on understanding Darrel's cultural view of the world,C,"An effective counselor will develop an important skill of being able to see things from the client's perspective, including multicultural views. The counselor should not encourage Darrel to assimilate to American culture or dismiss his feelings of racial dissonance. The counselor should also be self-aware of her feelings about the topic and regarding her own cultural identity. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
622,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","The client discusses how his case manager has gotten him into a shelter and is currently working on securing housing for him. The client processes feelings surrounding the shelter and has begun a detox program for his fentanyl addiction. The client verbalizes that he is experiencing anxiety surrounding being at meetings with the case manager, talking with other residents, reintegrating into a “more normal life,” and worrying about whether he can ever have a relationship with his kids or ex-wife if he gets sober. Through processing, you realize that this anxiety was present prior to drug use and that he has experienced anxiety throughout his life.  During the session, the client states, “I don’t see how things will improve because things have been bad for so long","During the session, the client states, “I don’t see how things will improve because things have been bad for so long.” Which of the following best defines this type of cognitive distortion?",Minimizing,Catastrophizing,Black-and-white thinking,Generalization,"(A): Minimizing
(B): Catastrophizing
(C): Black-and-white thinking
(D): Generalization",Generalization,D,"Generalization involves taking a situation, such as the client’s recent history, and assuming that the future will be the same. Catastrophizing involves thinking the worst-case scenario will happen. Although the client thinks things will not improve, he isn’t focused on the worst-case scenario. Rather, he is experiencing hopelessness that things will ever be different. Black-and-white thinking means thinking things have to be either perfect or a complete failure. Although the client worries about things being the same, he is not focused on two extreme outcomes, but on the continuation of his situation. Minimizing is reducing the actual impact of a situation by not thinking about a situation as being as intense or severe as it actually is. Therefore, the correct answer is (D)",counseling skills and interventions
623,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client arrives twenty minutes late for his appointment today. He explains that Mondays are the days he does laundry, and he cannot come again on a Monday. You review the required components of informed consent with the client. He expresses an understanding of the counseling process and provides written consent. The client states he has re-considered counseling because he believes you can help him find another girlfriend who will have sex with him. You tell him about a small group you run with other neurodiverse men, most of whom are on the autism spectrum. He expresses an interest in joining after hearing that sexual intimacy would be part of the curriculum. He provides a more solid commitment when you tell him the group is not held on Mondays.  You arrive to your client’s group to find members on their cell phones sharing pictures of you and your family from your private social media account",You arrive to your client’s group to find members on their cell phones sharing pictures of you and your family from your private social media account. How should you respond?,Use it as a basis to explain the importance of group-specific parameters regarding confidentiality.,"Use it to explain the benefits, limitations, and boundaries included in your social media policy.",Redirect the members to group tasks and personally seek technological knowledge and skills required for the ethical and legal use of social media.,Use it as a teachable moment to educate members on respecting the privacy of others.,"(A): Use it as a basis to explain the importance of group-specific parameters regarding confidentiality.
(B): Use it to explain the benefits, limitations, and boundaries included in your social media policy.
(C): Redirect the members to group tasks and personally seek technological knowledge and skills required for the ethical and legal use of social media.
(D): Use it as a teachable moment to educate members on respecting the privacy of others.","Use it to explain the benefits, limitations, and boundaries included in your social media policy.",B,"You should first use this as an opportunity to initiate a discussion or review your social media policy. According to the ACA Code of Ethics (2014), “Counselors clearly explain to their clients, as part of the informed consent procedure, the benefits, limitations, and boundaries of the use of social media” Using the event to teach members to respect the privacy of others does not explicitly address social media use. Using the event as a basis for discussing group confidentiality, privacy, and violations is helpful, but this does not expressly address the use of social media. The ACA Code of Ethics (2014) states, “Counselors who engage in the use of distance counseling, technology, and/ or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (eg, special certifications, additional course work)” If counselors have a social media presence, they have an ethical and legal obligation to seek required technical knowledge and skills (eg, use privacy settings). However, the primary course of action must include informing group members of their use of social media as part of the ongoing process of informed consent. Additionally, the NBCC Code of Ethics (2016) states that “After carefully considering all of the ethical implications, including confidentiality, privacy, and multiple relationships, [counselors] shall develop written practice procedures in regard to social media and digital technology, and these shall be incorporated with the information provided to clients before or during the initial session”. Therefore, the correct answer is (D)",professional practice and ethics
624,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","You meet with the client alone, and he appears to be more comfortable with you because he comes in and starts talking about a video game that he plays. You share that you have played that video game before. During the session, the client mentions that his parents got his first report card of the year and found out that he was failing most of his classes. He started to say that he was worried that his dad was going to hit him because of his grades. You ask if his father hits him often, and he replies that he does several times a week. You try to inquire about the manner of hitting his father uses because a certain level of corporal punishment is legal in the state that you work in. The client says that he is not going to talk any more about this. You remind the client that you likely will need to report this to child protective services and he says, “I don’t care” in response. You spend the rest of this session processing his relationship with his parents, and he discloses that he does love them, but that they are not his real parents. You meet with the client’s parents near the end of the session, and, while talking with them, they report that he was neglected while in foster care because the foster parent was “just in it for the money","Based on the client’s report that his father hits him several times each week, which would be the next step based on best practice?",Assess to determine if the abuse allegations are credible before reporting them to the relevant authorities.,Continue to check in with the client during the next few sessions to determine if you can gather more substantial information before reporting any abuse to the relevant authorities.,Gather the necessary information and report it to the relevant authorities regardless of whether or not the allegations seem credible.,Request that the parents join the session to further process the allegations and determine their credibility.,"(A): Assess to determine if the abuse allegations are credible before reporting them to the relevant authorities.
(B): Continue to check in with the client during the next few sessions to determine if you can gather more substantial information before reporting any abuse to the relevant authorities.
(C): Gather the necessary information and report it to the relevant authorities regardless of whether or not the allegations seem credible.
(D): Request that the parents join the session to further process the allegations and determine their credibility.",Gather the necessary information and report it to the relevant authorities regardless of whether or not the allegations seem credible.,C,"Your obligation as a mandated reporter is to report allegations of abuse, neglect, or exploitation of minors, regardless of whether you think they are credible or not. It is the local government agency’s responsibility to assess and determine if allegations are founded. Do not wait too long after the abuse to report it for several reasons. Your state may have laws on the time frame to report (eg, some states require that you report allegations within 24 hours of the report), and the client may in fact be at risk of further harm from his father if the allegations are true. Bringing the parents into the session can be helpful in certain circumstances, but it is important to consider if this may cause more harm to your client because the father may retaliate toward him. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
625,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","   ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.”  The client’s insurance company is requesting a level-of-care assessment","The client’s insurance company is requesting a level-of-care assessment. In behavioral health settings, which of the following would best help with this determination?",Treatment summary,Diagnosis,Medical necessity,Payor source,"(A): Treatment summary
(B): Diagnosis
(C): Medical necessity
(D): Payor source",Medical necessity,C,"Insurance providers require clinicians to establish medical necessity when determining a client’s appropriate level of care. Services must be medically necessary to receive provider reimbursement, including approval for the frequency, length, and duration of clinical services. Medical necessity determines preapproval and ongoing approval for authorized services. Medical necessity, service utilization, and functional impairment are considered when assigning a client’s level of care. The level of care is used when determining the least restrictive setting for a client’s treatment, with lower levels of care assigned to those receiving outpatient services and a higher level of care required for more restrictive settings (eg, hospitalization to residential treatment). Diagnosis is a level-of-care consideration, but the diagnosis alone does not reflect functional impairment and the client’s level of distress. In general, treatment summaries are insufficient for determining the level of care. A payor source refers to an individual or entity responsible for charges generated from treatment services. Payor sources request level of care assessments; they do not provide clinical assessment. Therefore, the correct answer is (A)",professional practice and ethics
626,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with client 3 for his individual therapy session. The client continues to be resistant, stating that he does not need to meet with you. You spend the session trying to build rapport with the client and are successful in taking down some of his walls. The client says he knew client 2 from back when he was in high school and began telling you that she slept with a bunch of guys and did a lot of drugs. You redirect the client back to focusing on himself. The client starts to open up about his relationship with his parents growing up and how he thinks they did not really try to show him affection and this made him sad talking about it. The client concludes by saying “I feel overwhelmed sharing all of this because I’ve never talked about it before.” You thank the client for sharing and you empathize with him",Which of the following statements demonstrates the use of empathy regarding the client’s disclosure about his relationship with his parents?,"“I’m sorry to hear that you had little affection from your parents, but I’m proud of you for talking about it now even though it’s hard.”","“Correct me if I’m wrong, but it sounds like you didn’t feel a connection with your parents growing up and this is hard to talk about.”",“I can imagine that it’s hard to talk about something so personal and that it would be sad to not be close with your parents.”,“It sounds like talking about this is difficult for you.”,"(A): “I’m sorry to hear that you had little affection from your parents, but I’m proud of you for talking about it now even though it’s hard.”
(B): “Correct me if I’m wrong, but it sounds like you didn’t feel a connection with your parents growing up and this is hard to talk about.”
(C): “I can imagine that it’s hard to talk about something so personal and that it would be sad to not be close with your parents.”
(D): “It sounds like talking about this is difficult for you.”",“I can imagine that it’s hard to talk about something so personal and that it would be sad to not be close with your parents.”,C,"The use of the wordimagineand attempting to connect with the client’s situation would best demonstrate empathy. Empathy is focused on connecting and relating to the emotions expressed by the client and demonstrating your understanding to the client. Expressing sorrow with the client demonstrates an expression of sympathy because it is a reaction to someone else’s distress. The response stating that it sounds like talking about the topic is difficult is an example of paraphrasing because it identifies the client’s feeling and restates it. The statement stating that it sounds like the client did not feel much of a connection with his parents and acknowledging that it must be hard to talk about this topic is an example of summarization because it identifies the major elements of what was shared by the client. Therefore, the correct answer is (D)",counseling skills and interventions
627,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.","When forming your treatment plan for the couple, how do your observations from the mental status exam inform your approach?",Focus on improving the couple's emotional connection and trust,Focus on the wife's lack of assertiveness skills and explore ways for her to gain more independence,Focus on the son's treatment for Autism.,"Focus on their communication issues, and incorporate cognitive-behavioral techniques to address them.","(A): Focus on improving the couple's emotional connection and trust
(B): Focus on the wife's lack of assertiveness skills and explore ways for her to gain more independence
(C): Focus on the son's treatment for Autism.
(D): Focus on their communication issues, and incorporate cognitive-behavioral techniques to address them.",Focus on improving the couple's emotional connection and trust,A,"During the MSE, your observations indicate that the couple is experiencing a lack of trust between them - they are sitting far apart from each other and refusing to look at each other. Exploring the trust issues between the husband and wife would be the most effective approach when creating a treatment plan for this couple. Therefore, the correct answer is (A)",treatment planning
628,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",What is the best response to the client's statement about giving up?,"""It sounds like you're feeling overwhelmed and discouraged, but it's important to remember that you can make it through this difficult time. Let's examine your options.""","""It sounds like you're feeling overwhelmed and discouraged. Have you tried talking to your husband about why he left?""","""It sounds like you're feeling down and deciding what course of action to take to move forward. Have you considered talking to an attorney?""","""It's understandable that you're feeling overwhelmed and discouraged. How can I help you feel better right now?""","(A): ""It sounds like you're feeling overwhelmed and discouraged, but it's important to remember that you can make it through this difficult time. Let's examine your options.""
(B): ""It sounds like you're feeling overwhelmed and discouraged. Have you tried talking to your husband about why he left?""
(C): ""It sounds like you're feeling down and deciding what course of action to take to move forward. Have you considered talking to an attorney?""
(D): ""It's understandable that you're feeling overwhelmed and discouraged. How can I help you feel better right now?""","""It sounds like you're feeling overwhelmed and discouraged, but it's important to remember that you can make it through this difficult time. Let's examine your options.""",A,"This response acknowledges the client's feelings while providing reassurance and hope. It helps to reframe the client's experience and delivers a supportive and encouraging message. It also helps give a sense of direction and encourages the client to take small steps to help on the journey toward self-improvement. Through this response, it is possible to build trust and rapport with the client and open up meaningful conversations. Therefore, the correct answer is (B)",counseling skills and interventions
629,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","   e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family","For adolescents, hypothesized psychological vulnerabilities for GAD include which of the following?",Sleep irregularity,Cognitive biases,Autonomic hyperreactivity,Positive valence systems,"(A): Sleep irregularity
(B): Cognitive biases
(C): Autonomic hyperreactivity
(D): Positive valence systems",Cognitive biases,B,"Hypothesized psychological vulnerabilities for GAD include cognitive biases. Counselors assess clients for vulnerabilities to help identify specific factors that may predispose someone to certain psychological disorders. Psychological vulnerabilities for GAD include cognitive biases, insecure attachment, unstable affect management, and unconscious conflicts. Biological vulnerabilities include sleep irregularities and autonomic hyperactivity, which is a physiological component of GAD and includes physiological symptoms such as dry mouth, heart palpitations, and sweating. Negative rather than positive valence systems are associated with GAD. Negative valence includes affective states such as anxiety and depression, whereas positive valence includes happiness and joy. Social vulnerabilities, such as trauma, certain parenting styles, and peer rejection, are also associated with GAD development. Therefore, the correct answer is (D)",professional practice and ethics
630,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex."," Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother.  You suspect that the client also has generalized anxiety disorder",You suspect that the client also has generalized anxiety disorder. All of the following would confirm this diagnosis EXCEPT:,Fear of panic attacks,Having trouble falling asleep,Excessive anxiety experienced on more days than not for 6 months,Being easily fatigued,"(A): Fear of panic attacks
(B): Having trouble falling asleep
(C): Excessive anxiety experienced on more days than not for 6 months
(D): Being easily fatigued",Fear of panic attacks,A,"The fear of panic attacks meets the criteria for panic disorder, but it is not part of the required criteria for generalized anxiety disorder. Excessive anxiety that is present for more than 6 months, being easily fatigued, and trouble falling asleep are all criteria for generalized anxiety disorder. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
631,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.","Mary's daughter Evelyn calls to speak with you, and you answer the call because it is an unknown number and could be a potential new client. She identifies herself and asks you how her mother is doing in therapy, adding that her mother has been avoiding her calls. How should you respond?","""Let me ask her to sign a release of information and then we can talk.""","""Can you tell me more about your observations of her behaviors?""","""I'm sorry, Ms. Evelyn, I cannot confirm or deny information about a client.""","""Oh hi! Your mother is doing her best, I believe. She'll get there.""","(A): ""Let me ask her to sign a release of information and then we can talk.""
(B): ""Can you tell me more about your observations of her behaviors?""
(C): ""I'm sorry, Ms. Evelyn, I cannot confirm or deny information about a client.""
(D): ""Oh hi! Your mother is doing her best, I believe. She'll get there.""","""I'm sorry, Ms. Evelyn, I cannot confirm or deny information about a client.""",C,"Counselors are bound by HIPAA confidentiality laws to maintain client confidentiality unless they already have specific, written consent to speak with another person about their care or are responding out of attempt to help a client who is in grave danger. Even confirming you have a client in your care is breaking confidentiality, which is why answer b) is incorrect. Once obtaining a signed release of information, you may contact the family member back and discuss whatever was permitted on the consent form. In this case, the scenario does not indicate that Mary signed consent for anyone. Therefore, the correct answer is (C)",professional practice and ethics
632, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.","Noting Maria's resistance and sensitivity, how should you proceed?",Challenge her to focus on her own feelings.,Listen attentively and empathize.,Have her complete the Trauma-Informed Self-Assessment Tool.,Point out your observation.,"(A): Challenge her to focus on her own feelings.
(B): Listen attentively and empathize.
(C): Have her complete the Trauma-Informed Self-Assessment Tool.
(D): Point out your observation.",Listen attentively and empathize.,B,"Answers a) or c) may stop the flow of her openly sharing since she has already made clear she does not want to admit to her own feelings. Pointing out your observation or insisting she focus on herself may cause her to resist further. The Trauma-Informed Self-Assessment Tool is designed to help organizations identify how to improve their programming by making it more trauma-informed. The best way to help Maria continue to share freely is to just apply active listening skills as you would if she were sharing about herself. Therefore, the correct answer is (B)",core counseling attributes
633,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",When would it be most effective for you to use the skill of summarization with this client?,When you want to demonstrate to the client that you understand what she has said and what she is feeling,When the client is emotive and needs to be grounded on a cognitive level,When you want to outline the main themes that are emerging in the session,When you want to clarify what the client is feeling,"(A): When you want to demonstrate to the client that you understand what she has said and what she is feeling
(B): When the client is emotive and needs to be grounded on a cognitive level
(C): When you want to outline the main themes that are emerging in the session
(D): When you want to clarify what the client is feeling",When you want to outline the main themes that are emerging in the session,C,"When using the summarization skill, the therapist shares the main emerging points in the session. This allows the client to correct the therapist if she feels or sees things differently. Summarizing can also help structure sessions when the client has difficulty focusing on topics and objectives. Therefore, the correct answer is (D)",counseling skills and interventions
634,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ",What would you address first in your initial treatment plan?,The client's intense feelings regarding her inability to function within societal norms regarding gender presentation,Your experience in working with clients who have gender dysphoria,The client's thoughts of harming herself,The father's intransigence regarding his ways of expressing his displeasure regarding his child's expressed gender identity,"(A): The client's intense feelings regarding her inability to function within societal norms regarding gender presentation
(B): Your experience in working with clients who have gender dysphoria
(C): The client's thoughts of harming herself
(D): The father's intransigence regarding his ways of expressing his displeasure regarding his child's expressed gender identity",The client's thoughts of harming herself,C,"Safety is the primary issue in this case with the client's verbal threats of suicide and self-report of depression. Therefore, the correct answer is (A)",treatment planning
635,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ","After disclosing suicidal ideation, the client asks if you have to inform her parents. At which point in the therapy process do you go over this information?",During individual sessions with the parents,Immediately after the client discloses suicidal ideation,During the intake session,At the time of the pre-admission process of setting up sessions.,"(A): During individual sessions with the parents
(B): Immediately after the client discloses suicidal ideation
(C): During the intake session
(D): At the time of the pre-admission process of setting up sessions.",During the intake session,C,"Information about the limits of confidentiality should be provided to the client and parents during the intake session. No mental health services should be provided until after the client has completed this process. Therefore, the correct answer is (B)",professional practice and ethics
636,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.","Using Gestalt therapy, which technique would be most appropriate for the client to explore interpersonal conflict?",Reversal technique,Empty chair,Internal dialogue exercise,Staying with the feeling,"(A): Reversal technique
(B): Empty chair
(C): Internal dialogue exercise
(D): Staying with the feeling",Internal dialogue exercise,C,"The internal dialogue exercise involves asking the client to imagine they are having a conversation with themselves, or another person, in which they can express their feelings and perspectives freely and openly without fear of judgment or criticism. By exploring these feelings and perspectives internally, the client can gain insight into their thoughts and behaviors that may be causing distress. In the client's case, this technique could help him identify and work through his feelings towards his family in a productive way. Through the internal dialogue exercise, the client can gain insight into why he feels the need to act out or become aggressive when expressing his anger and resentment towards his family. Therefore, the correct answer is (C)",counseling skills and interventions
637,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and sits down. Their body language does not appear as uncomfortable as it has in previous sessions because they are sitting a little closer together. You ask both individuals what they need to work on. The wife says that she knows that she needs to rebuild trust, and the husband says that he wants to know more about what happened in the affair before they move forward. The couple report that they tried to engage in sex, but that the husband stopped during intercourse. The husband states that he could not get the idea out of his mind that his wife does not find him attractive because she was with a woman. You ask the husband what it means for their marriage if his wife does not find him attractive, and he states that it means he will not be able to please her. You then ask him what it means for the relationship if he cannot please her, and he responds that it means he cannot be a good husband. You follow up asking what it means if he cannot be a good husband, and he says that they will have a miserable marriage. You support effective communication strategies and empathize with the couple. After the session, the wife comes back to get her coffee that she left and says that she knows that she hurt her husband and is in the wrong, so she will do whatever her husband needs to rebuild trust.  At one point during the session, the husband stops talking completely","At one point during the session, the husband stops talking completely. Which one of the following actions is the most effective way to deal with this example of stonewalling?",Encourage the couple to support each other in coping with strong emotions and then help them process how they are feeling.,Instruct the client to walk away without saying something that would escalate the situation.,Instruct the client to express that he is overwhelmed and to request a break.,Encourage the couple to discuss how they are feeling and address their presenting emotions and thoughts.,"(A): Encourage the couple to support each other in coping with strong emotions and then help them process how they are feeling.
(B): Instruct the client to walk away without saying something that would escalate the situation.
(C): Instruct the client to express that he is overwhelmed and to request a break.
(D): Encourage the couple to discuss how they are feeling and address their presenting emotions and thoughts.",Instruct the client to express that he is overwhelmed and to request a break.,C,"According to Dr John Gottman’s four negative behaviors, or the “Four Horsemen of the Apocalypse,” there are four characteristics of communication within a couple that increase the risk for divorce: stonewalling, contempt, criticism, and defensiveness. The most effective way to manage stonewalling, according to Gottman, is for the client to express that he is overwhelmed and to request a break. Walking away without saying anything would reinforce the stonewalling and would likely escalate the situation. A discussion with the couple or encouragement in coping with strong emotions together may lead to further escalation due to the gravity and rawness of the husband’s emotions and would not support him in managing these strong emotions. Therefore, the correct answer is (A)",counseling skills and interventions
638,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.  Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior.    Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships.  Seventh session The client was a ""no show"" for his session last week. You did not hear from him and ended up reaching out to him to reschedule. He arrives at this session on time and is eager to talk about a situation that occurred with his daughter. He had reached out to her to talk about repairing the relationship, and after some convincing, she had agreed. She came to pick him up to go for lunch, and while they were in a car together, he used a term that is now considered politically incorrect to refer to one of her friends. His daughter got upset with him and would not speak with him any further. He attempted to defend himself by saying that the term he used was not derogatory.    He presents this as ""yet another example"" of his children not liking him, and ""never giving him a chance"". He does not know how to move forward. He tells you that he ""can't do anything right"" and is a failure where his children are concerned. He mentions that this episode was especially frustrating, because he has so happy at arranging this meeting. You disclose your own frustration with one of your family members and explain that sometimes that person only seems interested in connecting with you when they need help. You also incorporate a strengths-based approach to build the client's resilience.",,"What is the best way to address the client's ""no show"" to his previously scheduled session?",Remind the client about your cancellation policy,"Submit an invoice to the client for the ""no show""",Engage the client concerning the deeper motivation behind his absence.,"Overlook the ""no show"" and move on to the next session","(A): Remind the client about your cancellation policy
(B): Submit an invoice to the client for the ""no show""
(C): Engage the client concerning the deeper motivation behind his absence.
(D): Overlook the ""no show"" and move on to the next session",Remind the client about your cancellation policy,A,"It is best to remind the client of your cancellation policy. It benefits the client more to have the appropriate consequence as motivation for modifying his actions. Also, you deserve to have clients who respect and value your time and who can maintain their commitments. Therefore, the correct answer is (C)",professional practice and ethics
639,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.  Ninth session Logan arrives at the session a few minutes late and apologizes. He says that he was outside playing kickball with his class. He reports that he has been feeling better about being in school lately. His classmates are friendlier to him, or at the very least, ""they don't bother me so much,"" He is now eating lunch back in the lunchroom. He is learning to play soccer and plans to ask his parents if he can join the summer league. Next, you call Logan's mother and share his progress in counseling with her. Finally, you examine Logan's care plan and assess for any changes needed.    Logan's progress in counseling has been notable as he has demonstrated increased social engagement and involvement in extracurricular activities. It appears that the therapeutic interventions implemented have successfully addressed his initial concerns regarding social anxiety and peer relationships. In addition, Logan's newfound interest in soccer and desire to join a summer league further demonstrates his willingness to engage with peers and develop new skills.    In conversation with Logan's mother, you emphasize the importance of fostering a supportive home environment to encourage Logan's growth and self-confidence. The mother expresses gratitude for the improvements in her son's well-being and commits to facilitating Logan's involvement in the summer soccer league. Additionally, she agrees to maintain open communication with the counselor to address any potential concerns that may arise in the future.    Upon reviewing Logan's care plan, the counselor determines that the current therapeutic goals and interventions remain appropriate and relevant to Logan's ongoing progress. However, it may be beneficial to introduce supplementary strategies to further enhance his self-esteem and resilience and promote effective communication and problem-solving skills. By doing so, Logan will be better equipped to navigate any challenges that may emerge as he develops and maintains positive relationships with his peers.    After the session, you receive a phone call that your wife has passed away. In the midst of the sudden loss of your beloved wife, you find yourself struggling to maintain your usual level of composure, which is understandable, feeling overwhelmed and emotionally drained during this difficult time. Being a therapist, you recognize the weight of your emotional burden and decide to reach out to your supervisor to discuss your struggles. After a heartfelt conversation, you feel a sense of relief and connection with your supervisor, who has provided you with support and understanding.    As the conversation draws to a close, you make an unexpected request of your supervisor: that she attend your wife's memorial and wake so that she can meet your family and share in the memories of your loved ones. This request may seem a lot to ask, but you feel comforted by the thought of having someone close to you share in this challenging time. You also ask if she can take over your caseload as you deal with your wife's passing.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What is the most appropriate response for your supervisor to give when you invite them to attend your wife's memorial service and wake?,The supervisor may opt to attend the memorial and wake.,"The supervisor should take over your caseload without attending the memorial service or wake, as the supervisor's professional duty is to ensure clients' needs are met.",The supervisor should express understanding towards the supervisee and recommend seeking an alternate therapist than herself to oversee clients while away.,The supervisor may opt to attend the memorial and have a brief interaction with you to show support.,"(A): The supervisor may opt to attend the memorial and wake.
(B): The supervisor should take over your caseload without attending the memorial service or wake, as the supervisor's professional duty is to ensure clients' needs are met.
(C): The supervisor should express understanding towards the supervisee and recommend seeking an alternate therapist than herself to oversee clients while away.
(D): The supervisor may opt to attend the memorial and have a brief interaction with you to show support.",The supervisor may opt to attend the memorial and have a brief interaction with you to show support.,D,"Having the supervisor attend the memorial can be appropriate and supportive as long as both parties are mindful of dual roles and boundaries. Therefore, the correct answer is (A)",professional practice and ethics
640,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling",Which of Yalom’s curative factors does the client experience when saying he feels less isolated and alone?,Cohesiveness,Universality,Catharsis,Instillation of hope,"(A): Cohesiveness
(B): Universality
(C): Catharsis
(D): Instillation of hope",Universality,B,"Universality helps members feel less isolated and alone by learning that others share some of the same issues and problems. Psychosocial interventions are included in best practices for individuals with schizophrenia. Treatment generally consists of psychoeducation and social skills training, with group therapy serving as the primary treatment modality. Cohesiveness is theweaspect of group therapy. It is different from universality in that cohesiveness reflects unified members, whereas universality is experienced when one realizes they are not alone. The installation of hope helps members have a positive outlook on the future. Catharsis is the release of feelings expressed in a safe group environment. Therefore, the correct answer is (B)",counseling skills and interventions
641,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group for the sixth session, and they are focused and appear to be more respectful toward you because it appears that you can get their attention more easily to start the session. You separate the group into dyads at the start of the session and prompt the group members to talk about feelings related to the pros and cons of engaging in school. You overhear client 4 telling client 3 that it does not matter if client 3 does well in school because he is in juvenile detention for sexual assault and therefore he cannot redeem himself. You intervene and remind client 4 of the group rules about respecting others.  You notice that one group member appears to be sexually attracted to another group member",You notice that one group member appears to be sexually attracted to another group member. Which of the following options would be the most likely to support the group goals?,Remind the group members that they cannot have a relationship with each other.,Discuss with the involved individuals that an outside relationship could adversely affect the group process.,Continue to monitor how the relationship affects the group because individuals will do what they want regardless of the group rules.,Discuss the relationship dynamics with the group because others may feel that the relationship is affecting group processes.,"(A): Remind the group members that they cannot have a relationship with each other.
(B): Discuss with the involved individuals that an outside relationship could adversely affect the group process.
(C): Continue to monitor how the relationship affects the group because individuals will do what they want regardless of the group rules.
(D): Discuss the relationship dynamics with the group because others may feel that the relationship is affecting group processes.",Discuss with the involved individuals that an outside relationship could adversely affect the group process.,B,"It would be most helpful to talk with the involved individuals about their relationship and how it might adversely affect the group’s process. Discussing the group rules, relationship dynamics, and monitoring the effects on the group will be helpful, but individuals will often proceed with the relationship anyway. Therefore, the correct answer is (D)",counseling skills and interventions
642,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","   k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress","In the DSM-5-TR, which of the following is considered the essential feature of adjustment disorders?",Emotional or physical symptoms in response to an identifiable stressor,Emotional or behavioral symptoms in response to an identifiable stressor,Emotional or physiological symptoms in response to an identifiable stressor,Emotional or cognitive symptoms in response to an identifiable stressor,"(A): Emotional or physical symptoms in response to an identifiable stressor
(B): Emotional or behavioral symptoms in response to an identifiable stressor
(C): Emotional or physiological symptoms in response to an identifiable stressor
(D): Emotional or cognitive symptoms in response to an identifiable stressor",Emotional or behavioral symptoms in response to an identifiable stressor,B,"According to the DSM-5-TR, the presence of emotional or behavioral symptoms in response to an identifiable stressor is the first criteria and the essential feature of adjustment disorders. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
643,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher.  Ninth session The client, his parents, and the math teacher present to your office. The teacher reports that the client seems to be achieving academic success with the addition of having a separate location for tests and extra time to complete assignments. The parents state they see improvement at home after deciding to put him on Ritalin. They are smiling as they report that their son seems to have entered a ""new phase."" His progress is evident in his increased engagement in the classroom and his improved academic performance. He is able to follow instructions and complete assignments in a timely manner, and is better able to interact with his peers. His attitude towards class participation has improved and he is able to self-regulate his emotions better. He has also expressed an increased level of self-esteem and self-efficacy in math class. Overall, the client has demonstrated improved functioning in the academic arena and the addition of Ritalin has helped him to become more alert and focused. The client appears content and keeps asking if it is time to go back to class yet.    To further ensure successful progress and to provide additional support for the client, you suggest that the teacher and parents have consistent and frequent communication about the client’s academic progress. You recommend that the teacher provide regular feedback and encouragement to the client, and you suggest that the parents continue to provide a structured and supportive environment at home. Additionally, you discuss potential academic supports that the parents may consider to help the client maintain his academic progress. Finally, you suggest that the client continue to utilize his self-regulation strategies and other coping skills to manage any anxiety or other challenging emotions related to math class."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ","You tell the client that when you were his age, you had trouble with math and could not keep up. What did you do here as the therapist?",Redirected the session,Created a new narrative for the client,Used appropriate self-disclosure,Crossed a boundary,"(A): Redirected the session
(B): Created a new narrative for the client
(C): Used appropriate self-disclosure
(D): Crossed a boundary",Used appropriate self-disclosure,C,"You demonstrated self-disclosure. Self-disclosure can be appropriate as long as it does not take away from the client. Therefore, the correct answer is (A)",counseling skills and interventions
644,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community","Which graphical depiction would you use to represent the client’s family dynamics, including cross-generational coalitions, subsystems, and other significant interactions?",Family map,Sculpting,Ecomap,Genogram,"(A): Family map
(B): Sculpting
(C): Ecomap
(D): Genogram",Family map,A,"SalvadorMinuchin, credited with developing structural family therapy, used family maps to graphically depict family dynamics, including cross-generational coalitions, subsystems, and differentiated intersectional boundaries. Family maps also show community supports and stressors, making it a good option for assessing protective factors and risk factors within the client’s community. A genogram is also a visual depiction of family dynamics and is commonly associated with multigenerational (extended) family systems therapy, also known as Bowenian therapy. Family maps differ from genograms in that family maps show family dynamics and identify social supports and connections. Genograms depict family interactions and generational relationships to reduce inappropriate boundaries (eg, triangulation) by increasing diffusion. An eco-map is similar to a family map, but the emphasis is on intrafamily dynamics within their current social context. For this client, identifying social relationships and connections within the community can help determine protective factors (eg, church, school) and identify risk factors (eg, social isolation, peers) for the parents and the client. Eco-maps differ from genograms and family maps by viewing family boundaries as either open or closed to their social environment. Virginia Satir used sculpting as a human validation process model technique. Sculpting is a nonverbal exercise in which counselors instruct family members to physically position themselves to represent certain aspects and patterns of family relationships and interactions. Therefore, the correct answer is (B)",counseling skills and interventions
645,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.  10th session During your last session with the client, she discussed the anxiety that she was feeling about going home for winter break in a few weeks. She told you that her mom and stepdad always prepare a large meal for the holidays, and the extended family members get together to eat. She expressed a desire to participate in the family festivities but concern about her mom and stepdad's lack of understanding about her illness. She told you, ""I don't want to make anyone feel bad, but I just can't eat like everyone else. It's not only the food - it's the conversations and comments about my body that really bother me."" You listened as she expressed her fear of disappointing her family and reassured her that is was okay to set boundaries and have conversations about food. Together, you brainstormed coping strategies to manage her anxiety. You also suggested that she bring a dish of food that she would be comfortable eating to the winter break gathering. At the end of the session, she asked if she could bring her parents to the next session in an effort to gain their support and to help them understand what she is going through. You agreed to her request and scheduled an appointment to meet with the client and her parents.    At the start of today's session, you introduce yourself to her parents and explain your role in helping their daughter. The client's mother tearfully shares that she had no idea her daughter was struggling so much and that she wishes she had picked up on the signs sooner. The stepfather appears quiet and reserved. You help guide a conversation between the client and her parents about her eating disorder and symptoms that she is experiencing. The client shares her fears, triggers, and struggles around food. Her stepfather speaks up and says, ""I've heard enough. This is just ridiculous. You should just be able to eat, like everyone else. Your generation has gone 'soft' and started making up problems. There are people out there who don't have any food. When I was growing up, we had nothing. Your behavior is disrespectful."" As he is talking, the client's mother is quiet and visibly uncomfortable. The client interjects, ""Are you kidding? I'm the one who's being disrespectful?"" She looks toward you and says, ""When I'm home, he cooks these extravagant meals and refuses to let me leave the table until I've eaten what he's served me because it's 'wasteful to throw away food.' It's abuse! I feel like a captive when I'm at home."" She looks back at her stepfather and says, ""All I'm asking is that you understand what I'm going through and try to be a little more supportive."" The stepfather's face turns red with anger, and he gets up to leave the room. You intervene and ask him to stay, offering a suggestion that you all take a few moments to reflect on what each person has shared before continuing the conversation. While the stepfather takes a break, you encourage the mother to open up and express her feelings. She reveals that she is scared of not being able to help her daughter and feels helpless in understanding how to come together as a family. You discuss ways that she can be supportive and provide an empathetic environment for her daughter.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ",What approach should you take to provide the client's parents with information about Anorexia Nervosa?,Psychoeducational approach,Psychodynamic approach,Cognitive-behavioral approach,Systems approach,"(A): Psychoeducational approach
(B): Psychodynamic approach
(C): Cognitive-behavioral approach
(D): Systems approach",Psychoeducational approach,A,"A psychoeducational approach would be most appropriate to share information with the client's parents about the nature of her illness. Therefore, the correct answer is (C)",professional practice and ethics
646,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",her. Family History: The client says that she has a good relationship with her parents. She says that they are encouraging and supportive of her. The client says that she has a younger brother who is 6 years old and an older brother who is 16 years old. The client states that she has a good group of friends and spends time with them regularly,All of the following are appropriate short-term treatment goals EXCEPT:,Assisting the client with identifying barriers to school attendance,Referring for psychological testing to determine the cause of the refusal to attend school,Building trust so the client can feel comfortable enough to begin to identify and express feelings regarding her school attendance,Beginning to discuss increasing social connectedness due to withdrawn behavior,"(A): Assisting the client with identifying barriers to school attendance
(B): Referring for psychological testing to determine the cause of the refusal to attend school
(C): Building trust so the client can feel comfortable enough to begin to identify and express feelings regarding her school attendance
(D): Beginning to discuss increasing social connectedness due to withdrawn behavior",Referring for psychological testing to determine the cause of the refusal to attend school,B,"Referral for psychological testing likely would not return much helpful information because the client is not comfortable enough to talk about what is happening. The goals should be achievable and should be relevant to the presenting situation. Building trust and identifying barriers to school attendance are important because this is the only obvious presenting problem even with minimal client participation. The focus on improving social connectedness is important due to withdrawn behavior. Therefore, the correct answer is (B)",treatment planning
647,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family",Which one of the following is true of individuals with mild neurocognitive disorder?,"Cognitive deficits interfere with activities of daily living (i.e., bathing, dressing)",Cognitive deficits occur exclusively in the context of delirium,Cognitive deficits do not interfere with the capacity for independence,Cognitive deficits interfere with successfully completing tasks such as paying bills and other complex instrumental activities,"(A): Cognitive deficits interfere with activities of daily living (i.e., bathing, dressing)
(B): Cognitive deficits occur exclusively in the context of delirium
(C): Cognitive deficits do not interfere with the capacity for independence
(D): Cognitive deficits interfere with successfully completing tasks such as paying bills and other complex instrumental activities",Cognitive deficits do not interfere with the capacity for independence,C,"According to the DSM-5-TR’s description of mild neurocognitive disorder, the diagnosis of mild neurocognitive disorder is marked by a modest decline in cognitive functioning. Individuals with mild neurocognitive disorder exhibit moderate difficulty with memory, planning, organization, attention, learning, or processing social cues, but these do not interfere with  performing everyday activities independently and are often managed with the use of compensatory strategies, such as keeping a written schedule, the use of mnemonics, assistance with organization, and related accommodations. It is not true that these deficits must occur exclusively in the context of a delirium, nor are deficits so severe that they disrupt activities of daily living or instrumental activities of daily living. Therefore, the correct answer is (C)",professional practice and ethics
648,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues.  Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand.    When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have ""one drink."" He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""","Given your inability to reach the client's emergency contact, what is the most appropriate action to take at this time?",Call the hospital for readmittance,Immediately contact the police,Contact a mobile crisis unit,Stay with the client in the office until he is sober,"(A): Call the hospital for readmittance
(B): Immediately contact the police
(C): Contact a mobile crisis unit
(D): Stay with the client in the office until he is sober",Contact a mobile crisis unit,C,"Mobile crisis can safely get the client back to his home. Therefore, the correct answer is (B)",professional practice and ethics
649,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy","All of the following are core concepts of distress tolerance in DBT, EXCEPT:",A pros and cons list,Thought stopping,Self-soothing,TIPP,"(A): A pros and cons list
(B): Thought stopping
(C): Self-soothing
(D): TIPP",Thought stopping,B,"Thought stopping is a CBT technique that is focused on stopping unhelpful thoughts before they affect functioning. TIPP (temperature, intense exercise, paced breathing, and paired muscle relaxation) is a method that helps support management of the physical symptoms of distress, therefore building distress tolerance. A pros and cons list supports the decision-making process and is part of building distress tolerance in DBT. The ability to self-soothe is also important in building distress tolerance in DBT because it involves coping with present emotions and feelings. Therefore, the correct answer is (D)",counseling skills and interventions
650,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","   Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication.  You would like to use ADHD interventions consistent with evidence-based practices (EBP)",You would like to use ADHD interventions consistent with evidence-based practices (EBP). Components of EBP include all of the following EXCEPT:,"The clinician’s knowledge, skills, and expertise",Research evidence with the least probability of bias,Cost-effectiveness and duration of treatment,"The client’s culture, preferences, and values","(A): The clinician’s knowledge, skills, and expertise
(B): Research evidence with the least probability of bias
(C): Cost-effectiveness and duration of treatment
(D): The client’s culture, preferences, and values",Cost-effectiveness and duration of treatment,C,"Cost-effectiveness and duration of treatment are not components of EBP. Instead, EBP includes three factors: (1) the clinician’s knowledge, skills, and expertise; (2) the client’s culture, preferences, and values; and (3) research evidence with the least probability of bias (ie, the best available research evidence). Experts including Norcross and Wampold (2011) have advocated for incorporating the therapeutic relationship into the definition of EBP. Therefore, the correct answer is (C)",treatment planning
651,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.  Tenth session It's been two and a half months since you first started seeing the client for weekly therapy sessions. Today, your client appears calm and relaxed. You review her progress and highlight her areas of growth since the start of therapy. The client states that she feels more empowered to challenge her negative thoughts and is able to recognize when her anxiety is beginning to spiral. She has been using the coping skills she learned in the previous sessions to manage her stress levels more effectively. The client also reports a weight loss of 5 pounds since beginning therapy, which she is pleased with and attributes to the mindfulness techniques she has been practicing. You discuss her weight loss and the importance of mindful eating practices. You explain to the client that weight loss is a secondary outcome of therapy and that it is more important to focus on living a healthy lifestyle than a number on a scale. The client expresses her understanding and appreciation for the guidance.    When you ask her to rate her level of anxiety, she indicates that she is much less anxious than when she first started therapy. Her preoccupation with illness has decreased, though it has not gone away completely. She reports that her colleagues have noticed the change in her attitude and confidence. She is able to stay present and focus on her job, without constantly worrying about negative judgement from her co-workers. She tells you that she has been keeping up with the journaling homework that you assigned in a previous session and it has been a helpful outlet for her to express her thoughts. She has also been practicing progressive muscle relaxation during her breaks at work and after she gets home in the evenings. The client is still drinking wine to help her relax, but you have determined that her alcohol use does not warrant clinical intervention. You discuss spacing out your sessions and she agrees to try meeting with you twice a month. At the end of the session, she asks if you could email her a copy of her therapy records so that she can refer back to them periodically in order to continue making progress.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",What is the most appropriate response to the client's request for her therapy records?,"I'm sorry, I don't think it is a good idea for you to have access to your records.""","""I'm sorry, but that's confidential information and cannot be shared with you. Do you have any specific concerns that we could discuss in session?""","""Due to privacy and confidentiality laws, I'm not able to email them to you, but I can make a copy for you and give them to you in person or by mail.""","""I'm happy to provide you with a copy of your therapy records. I just need to verify that I have your current email address and I can send your records to you later today.""","(A): I'm sorry, I don't think it is a good idea for you to have access to your records.""
(B): ""I'm sorry, but that's confidential information and cannot be shared with you. Do you have any specific concerns that we could discuss in session?""
(C): ""Due to privacy and confidentiality laws, I'm not able to email them to you, but I can make a copy for you and give them to you in person or by mail.""
(D): ""I'm happy to provide you with a copy of your therapy records. I just need to verify that I have your current email address and I can send your records to you later today.""","""Due to privacy and confidentiality laws, I'm not able to email them to you, but I can make a copy for you and give them to you in person or by mail.""",C,"You explain to the client that due to privacy and confidentiality laws, you are not able to email her a copy of her therapy records. You offer to make a copy for her and provide it in person or by mail. You discuss the importance of confidential communication between therapist and client and how you will handle any requests for information relating to her therapy. Therefore, the correct answer is (C)",professional practice and ethics
652,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.","Based on the current information you have available, why should hospitalization be given strong consideration?",The client is actively at risk of harming herself. She should be hospitalized.,"The client has a strong attachment to her boyfriend, and his absence is causing her extreme distress.",The client does not need to be hospitalized.,The client is actively at risk of harming herself. She does not have a strong social support system and a history of impulsive behavior.,"(A): The client is actively at risk of harming herself. She should be hospitalized.
(B): The client has a strong attachment to her boyfriend, and his absence is causing her extreme distress.
(C): The client does not need to be hospitalized.
(D): The client is actively at risk of harming herself. She does not have a strong social support system and a history of impulsive behavior.",The client is actively at risk of harming herself. She does not have a strong social support system and a history of impulsive behavior.,D,"The client's lack of a strong social support system is particularly troubling. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
653, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.",Which objective best supports Leah's application of her treatment plan goal for anxiety reduction?,Leah will write an essay on underlying reasons for anxiety and read it aloud,Leah will report successful daily application of 3+ coping skills within 6 months,Leah will learn 5 new coping skills for reducing anxiety within 6 months,Leah will engage in weekly mindfulness meditation to reduce anxiety,"(A): Leah will write an essay on underlying reasons for anxiety and read it aloud
(B): Leah will report successful daily application of 3+ coping skills within 6 months
(C): Leah will learn 5 new coping skills for reducing anxiety within 6 months
(D): Leah will engage in weekly mindfulness meditation to reduce anxiety",Leah will report successful daily application of 3+ coping skills within 6 months,B,"This objective assumes Leah has already learned and understands several coping skills to use for anxiety reduction, as per her career knowledge and previous counseling experience; yet it challenges her to apply them in accordance with SMART goals (specific, measurable, achievable, relevant, and timely). Answer a) is not specific enough nor is it timely. Answer c) is unnecessary because Leah already knows coping skills but is just unable to apply them, and answer d) is a supportive objective towards the same goal but does not best support application. Therefore, the correct answer is (B)",treatment planning
654,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.","When considering an adjustment disorder versus a depressive disorder, what are the most important differentiating factors to assess?",Duration and client's self-report,Duration and parent's report,Duration and assessment scores,Duration and number of symptoms,"(A): Duration and client's self-report
(B): Duration and parent's report
(C): Duration and assessment scores
(D): Duration and number of symptoms",Duration and number of symptoms,D,"Duration should always be considered when a person is diagnosed with an adjustment disorder. Adjustment disorders are brief in nature. Symptom endorsement/count (either subjectively or objectively) is central, especially when considering a major depressive disorder or an adjustment disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
655,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex."," Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother",Which of the following would be the most helpful area to explore to determine the course of treatment for this client?,Determine if the premature ejaculation is based on medical limitations.,Identify the client’s personal goals for treatment.,Explore the effects of sexual dysfunction on the client’s relationship with his girlfriend.,Determine the effect of the client’s anxiety’s on daily functioning in all settings.,"(A): Determine if the premature ejaculation is based on medical limitations.
(B): Identify the client’s personal goals for treatment.
(C): Explore the effects of sexual dysfunction on the client’s relationship with his girlfriend.
(D): Determine the effect of the client’s anxiety’s on daily functioning in all settings.",Determine if the premature ejaculation is based on medical limitations.,A,"It is most important to determine what medical limitations the client might have because it is possible that the client’s penis may be excessively sensitive and the premature ejaculation may not be improved through cognitive and behavioral interventions. Identifying the client’s goals, exploring the sexual dysfunction’s effects on his relationship, and identifying the effects that his anxiety has on his daily functioning are all important, but these factors do not matter if biological factors inhibit his progress. Therefore, the correct answer is (A)",treatment planning
656,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",The client reports that a worker from the local child protective services office met with her and that she is worried about what the coach will do in response when he finds out that she reported him. The client says that she has not returned to school but that the school has provided the classwork and homework needed to keep up; she feels like the school is supporting her well enough to not fall behind. The client confirms that all of the symptoms that she described during her last session are still present,Which of the following would be the most appropriate diagnosis based on the client’s presenting symptoms?,"Adjustment disorder, with depressed mood","Post-traumatic stress disorder, with depersonalization","Post-traumatic stress disorder, with delayed expression","Acute stress disorder, with depressed mood","(A): Adjustment disorder, with depressed mood
(B): Post-traumatic stress disorder, with depersonalization
(C): Post-traumatic stress disorder, with delayed expression
(D): Acute stress disorder, with depressed mood","Post-traumatic stress disorder, with delayed expression",C,"The symptomatology is consistent with post-traumatic stress disorder, with delayed expression due to presenting symptoms and the 6 months it took for symptoms to reach full post-traumatic stress disorder criteria. Post-traumatic stress disorder with depersonalization is the feeling of experiencing the trauma from the perspective of an outside observer, which is not consistent with reported symptoms. Acute stress disorder would require a time period of 30 days or less, so this would not be an appropriate diagnosis. Adjustment disorder presents as difficulty managing adjustment to life’s stressors; this is not an appropriate diagnosis due to the presenting symptoms. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
657,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,Destiny's treatment goals should include?,Look for other placement alternatives,Reviewing past negative experiences,Keeping Destiny from other children for now,Building new attachment relationships between the child and caregiver,"(A): Look for other placement alternatives
(B): Reviewing past negative experiences
(C): Keeping Destiny from other children for now
(D): Building new attachment relationships between the child and caregiver",Building new attachment relationships between the child and caregiver,D,"Destiny and Ms Maze would benefit from some work on their relationship and this may help destiny develop a sense of emotional security. Reviewing past negative experiences may increase the guilt and tension that is already present. Although Ms Maze appears frustrated, it is not necessary yet to look at other placement alternatives. Destiny is acting the way that she is because of her early attachment experiences. Finally, it would be beneficial to provide Destiny with positive social experiences so she can see the value of supportive relationships and practice social skills. Keeping Destiny from other children would not allow her to have these experiences. Therefore, the correct answer is (C)",treatment planning
658,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","You work with the client and their parents to help the parents understand how the client conceptualizes their gender identity. You use the client’s self-identified, gender-affirming pronouns and praise the client for taking a brave first step. The client’s mother is fearful and anxious, particularly when thinking about the client’s safety. The client’s father expresses an overall lack of understanding and thinks it could be a phase. You recognize the father’s efforts to understand and help the client explain the distressing emotions associated with coming to terms with their gender identity, including an increase in severity since the onset of adolescence. The father states that he is unsure if he can accept the client’s transgender identity but says that he is committed to the counseling process.  You provide ongoing assessment for any associated mental disorders that may further complicate the client’s coming out process","You provide ongoing assessment for any associated mental disorders that may further complicate the client’s coming out process. According to the DSM-5-TR, gender dysphoria is comorbid with all of the following EXCEPT:",Anxiety disorders,Depressive disorders,Attention-deficit/hyperactivity disorder (ADHD),Autism spectrum disorder,"(A): Anxiety disorders
(B): Depressive disorders
(C): Attention-deficit/hyperactivity disorder (ADHD)
(D): Autism spectrum disorder",Attention-deficit/hyperactivity disorder (ADHD),C,"According to the DSM-5-TR, gender dysphoria is associated with all of the answer choices except ADHD. Per the DSM-5-TR, adolescents that are referred with gender dysphoria most commonly present with anxiety and depressive disorders, while children that are referred with gender dysphoria commonly present with autism spectrum disorder. For most males, adolescence starts between the ages of 10 and 14. Identifying comorbid diagnoses or symptoms can help counselors select appropriate interventions and address any additional barriers affecting the client. For example, considerations for gender-diverse individuals on the autism spectrum may require a tailored approach for effectively handling social transitions and interpersonal relationships. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
659,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.",ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report,All of the following are appropriate treatment objectives for reactive attachment disorder EXCEPT:,"Assist the foster parents with demonstrating expectations, feedback, and structure to demonstrate that they are in control.",Assist the foster parents with reframing the client’s problem behaviors as opportunities to support and love their foster child.,Instruct the client on cognitive reframing on anxiety about being with the foster parents.,Develop trust and comfort with the client.,"(A): Assist the foster parents with demonstrating expectations, feedback, and structure to demonstrate that they are in control.
(B): Assist the foster parents with reframing the client’s problem behaviors as opportunities to support and love their foster child.
(C): Instruct the client on cognitive reframing on anxiety about being with the foster parents.
(D): Develop trust and comfort with the client.",Instruct the client on cognitive reframing on anxiety about being with the foster parents.,C,"The client is too young to have a cognitive focus in therapy because she will have trouble processing thoughts and feelings about her situation. Developing trust and comfort with the client is important because she is unengaged in therapy and may need help feeling comfortable with adults in order to engage in therapy. The foster parents would benefit from learning to reframe problem behaviors as opportunities to build their relationship with their foster child. They would also benefit from providing expectations, feedback, and structure on a consistent basis, which shows the client that her caregivers are in control and have her best interests in mind, which might help her manage strong emotions. Therefore, the correct answer is (D)",counseling skills and interventions
660,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","   tion. Family History: The client has been married for 25 years. He has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together",Which of the following would be considered a positive attending trait for a therapist?,Using hand gestures to appear engaged,"Saying “yes,” “right,” and “uh huh” or using head nods to show that you are listening","Speaking in a slow, soft, gentle tone",Turning your body 45 degrees away from the client to minimize a seemingly aggressive body posture,"(A): Using hand gestures to appear engaged
(B): Saying “yes,” “right,” and “uh huh” or using head nods to show that you are listening
(C): Speaking in a slow, soft, gentle tone
(D): Turning your body 45 degrees away from the client to minimize a seemingly aggressive body posture","Speaking in a slow, soft, gentle tone",C,"Speaking in a slow, soft, gentle tone can encourage thought and engagement from the client and is a positive attending trait that can be used by the therapist (Sommers-Flanagan & Sommers-Flanagan, 2015, p 64). Using hand gestures and frequently stating “yes” or “uh huh” along with head nods can interrupt the client by making them think that you have more to say, or it may make them avoid eye contact in order to avoid the distraction of seeing frequent head nodding (Sommers-Flanagan & Sommers-Flanagan, p 65). Turning your body slightly away from the client may come across as being disengaged, whereas facing the client with an open body posture is more engaging. Therefore, the correct answer is (A)",core counseling attributes
661,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.","You have empathy for Taylor and her situation, but you do not want to cross boundary lines by providing services for her brother with autism while in session with Taylor. You assess it best that her brother is given a referral for a different provider. This approach encompasses which counseling trait?",knowledge of group therapeutic factors,sensitivity to disability issues,awareness of self and impact on clients,non-judgmental stance,"(A): knowledge of group therapeutic factors
(B): sensitivity to disability issues
(C): awareness of self and impact on clients
(D): non-judgmental stance",awareness of self and impact on clients,C,"Having an awareness of your boundaries and whether your prior knowledge will affect your delivery of services for your client is paramount in being an effective counselor. Regardless of your sensitivity to Taylor's brother's autism, it is important that if you feel you are crossing a boundary in supporting her brother at the same time as Taylor that you respect this decision by following through and then offer alternative options for support. It is always expected that you have a non-judgmental stance and unconditional positive regard towards your clients. Knowledge of group therapy factors is important but not relevant here. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
662,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week","Which one of the following CBT terms most accurately defines the counselor’s encouragement of the client to try to ask his parents for something in a calm, polite manner to see if there is a different outcome than when he yells and curses?",Behavioral experiment,Guided discovery,Exposure therapy,Role play,"(A): Behavioral experiment
(B): Guided discovery
(C): Exposure therapy
(D): Role play",Behavioral experiment,A,"A behavioral experiment is when the client engages in a behavior to see if it results in their expected outcomes or to see if the outcome changes. This can be helpful in treating anxiety because the client can see that their predicted outcomes are often worse than the actual outcomes. Role playing involves acting out different situations in order to prepare for a future situation. Exposure therapy is used for anxiety and phobias and involves exposing a client to their fears/phobias. This is done in small increments in order to increase the client’s comfort and confidence in those situations and to show the client that the threat is not as extreme as anticipated. Guided discovery involves exploring different perspectives and providing evidence for and against certain beliefs. Therefore, the correct answer is (A)",counseling skills and interventions
663,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","The client comes to the session, sits down, and is quiet. The parents report that prior to the session he was playing an online game and became so upset that he threw his video game console. The parents express frustration that they do not know what to do when this happens. You provide psychoeducation to the client regarding coping skills to manage frustration. You find out that the parents respond by removing access to video games, and this usually results in yelling back and forth with the parents and the client. The parents do typically encourage the client to listen to music because this appears to be very effective in calming him down. The client expresses frustration with the people that he was playing with by saying that they “cheated and are lying about it.” You support the client with cognitive reframing","All of the following are helpful therapeutic modalities for behavioral problems related to autism spectrum disorders, EXCEPT:",Applied behavior analysis,Behavior therapy,Speech-language therapy,Cognitive behavioral therapy (CBT),"(A): Applied behavior analysis
(B): Behavior therapy
(C): Speech-language therapy
(D): Cognitive behavioral therapy (CBT)",Speech-language therapy,C,"Speech-language therapy is an essential component of treatment for autism spectrum disorder that focuses on enhancing the ability to communicate with others, but it is not focused on the behavior problems related to autism spectrum disorder. Cognitive behavioral therapy (CBT), behavior therapy, and applied behavior analysis are all beneficial in treating behavior issues related to autism. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
664,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","In addition to assessment, what other interventions would be most helpful for you in understanding the client's presenting issues?",Family session including the client and his husband,"Family session including the client, his husband, and their children",Family session including the client and his brother,Family session including the client and his parents,"(A): Family session including the client and his husband
(B): Family session including the client, his husband, and their children
(C): Family session including the client and his brother
(D): Family session including the client and his parents",Family session including the client and his husband,A,"Clients present for counseling with a limited perspective of the problem as they understand and interpret it. Inviting the client's spouse into the session provides an understanding of how the interpersonal relationship between the two is navigated and allows the counselor to have an additional dimension in understanding of the client's concerns. While inviting the client's children to session would provide an understanding of how he interacts with them, this is not the presenting concern. While the client has a good relationship with his brother, the relationship with his spouse is the one experiencing problems at this time. The client is emotionally and physically cut off from his parents so inviting them into session at this time during therapy would be inappropriate. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
665,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Psychodynamic therapy is helpful because clients with OCPD tend to focus more on which of the following?,Delegating rather than self-completion,Emotions rather than the end results of a task,Task completion rather than perfection,Logic rather than emotions,"(A): Delegating rather than self-completion
(B): Emotions rather than the end results of a task
(C): Task completion rather than perfection
(D): Logic rather than emotions",Logic rather than emotions,D,"Clients with OCPD focus more on logic and orderliness, rather than emotions. Emotions and expressions of emotionality interfere with the rigidity of the OCPD client. The need to control one's self and environment requires the OCPD client to use logic rather than emotions as the latter leave the OCPD individual vulnerable to rejection if he or she does not respond with perfection. This can lead to individuals with OCPD appearing socially awkward, cold, and unfeeling about others' needs. Psychodynamic therapy helps the OCPD client learn to identify, explore, and express their emotions through increasing self-awareness and insight. Individuals with OCPD do not focus on emotions over the end results of a task and the individual will be more focused on perfection than task completion (Criterion 2). Additionally, individuals with OCPD rarely delegate tasks to others, instead completing themselves, unless the other agrees to do a task exactly how the individual with OCPD has instructed (Criterion 6). Therefore, the correct answer is (B)",counseling skills and interventions
666,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","   ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake.  You are nearing the end of your initial intake session",You are nearing the end of your initial intake session. Which of the following actions would best help improve treatment compliance for this client?,"Summarize the client’s presenting problem, barriers to treatment, and associated risks of prolonged alcohol use.",Facilitate the negotiation of agreed-upon treatment goals.,Teach basic relaxation and mindfulness techniques to help improve insomnia.,Provide the client with information for online and in-person 12-step recovery meetings.,"(A): Summarize the client’s presenting problem, barriers to treatment, and associated risks of prolonged alcohol use.
(B): Facilitate the negotiation of agreed-upon treatment goals.
(C): Teach basic relaxation and mindfulness techniques to help improve insomnia.
(D): Provide the client with information for online and in-person 12-step recovery meetings.",Facilitate the negotiation of agreed-upon treatment goals.,B,"The therapeutic alliance is associated with instilling hope, optimism, and motivation—all of which are related to improved treatment compliance. One way to establish a therapeutic alliance is to negotiate agreed-upon treatment goals for therapy. This client-counselor collaborative relationship is also strengthened by having confidence in the methods used to attain these identified goals. Due to the client’s previous dissatisfaction with Alcoholics Anonymous, providing the client with 12-step recovery information would not be beneficial at this time. The therapist’s communication skills, including summarization, can positively affect the therapeutic alliance; however, summarizing the client’s problems, barriers, and risks is problem-oriented rather than solution-oriented. Providing problem-focused feedback can prevent the client from joining with the therapist. Relaxation and mindfulness are evidence-based approaches for improving insomnia. Teaching these skills does not ensure successful mastery of the client’s alcohol use, and the client may want to prioritize other issues. Therefore, the correct answer is (D)",treatment planning
667,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.  Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior.    Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships.",,What would be the most objective way to assess your counseling effectiveness with the client?,Discuss openly with the client whether he believes he is making progress,Review your therapy notes to compare the client's current issues with the intake,Measure the client's progress in therapy using an outcomes assessment,Ask the client to self-monitor using therapist-generated criteria,"(A): Discuss openly with the client whether he believes he is making progress
(B): Review your therapy notes to compare the client's current issues with the intake
(C): Measure the client's progress in therapy using an outcomes assessment
(D): Ask the client to self-monitor using therapist-generated criteria",Measure the client's progress in therapy using an outcomes assessment,C,"An example would be using the Interpersonal Relationship Inventory (IPRI) to evaluate how his relationships with his children might have improved overall. Find assessments which measure what you are looking for. Determine which counseling outcomes assessment you are most comfortable using. As effective as a tool may be, if you do not utilize it regularly to solicit client feedback, you will not realize the benefits. Therefore, the correct answer is (A)",treatment planning
668,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","   bile. Family History: The client has two younger brothers who are 6 and 7 years old. The client often engages in physical fights and arguments with his younger siblings and often will break or steal their toys. The client takes advantage of his 6-year-old sibling by conning him out of items and activities by convincing him that a certain trade or decision is better for him, when it is usually better for the client. The client’s parents report that these behaviors occur at school and that the client does not have any friends as far as they are aware. The client’s parents state that the client is adopted and that he was in foster care from when he was 2 until he was 4 years old. The client’s parents state that his basic needs were neglected because his birth mother was heavily using drugs.  It will be important to build rapport with this client to provide effective counseling",It will be important to build rapport with this client to provide effective counseling. Which of the following would most effectively promote therapeutic rapport with this client?,"The client is young; therefore, the parents will likely be the ones using interventions so it is more important to have rapport with the parents.",Spend a few sessions trying to play with the client.,"Rapport will be built over time, so continue to be consistent and creative with your sessions.",Empathize with the client’s view of why he engages in these behaviors.,"(A): The client is young; therefore, the parents will likely be the ones using interventions so it is more important to have rapport with the parents.
(B): Spend a few sessions trying to play with the client.
(C): Rapport will be built over time, so continue to be consistent and creative with your sessions.
(D): Empathize with the client’s view of why he engages in these behaviors.",Empathize with the client’s view of why he engages in these behaviors.,D,"The client is likely often in trouble with his parents, and teachers and other adults likely side with his parents when he is in trouble. It would be beneficial to your counseling relationship to show the client that you understand why he engages in these behaviors and why he might be frustrated or angry or why he may feel misunderstood. Rapport will be built over time, but coming alongside your client by helping him feel like you are on his side and that you want him to be happy and enjoy himself will be much more beneficial and more proactive. Providing enjoyable activities or playing with your client might increase rapport; however, the client is old enough to engage in cognitive therapeutic work, which might be more beneficial. Although it is important to support the parents, you are the client’s therapist and you need to promote his interests and help him engage in them in a more appropriate manner. Therefore, the correct answer is (B)",counseling skills and interventions
669,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past",Which one of the following drugs has been proven beneficial in treating anorexia nervosa?,Amitriptyline (a tricyclic antidepressant),Olanzapine (an antipsychotic),Fluoxetine (a selective serotonin reuptake inhibitor [SSRI]),Diazepam (a benzodiazepine),"(A): Amitriptyline (a tricyclic antidepressant)
(B): Olanzapine (an antipsychotic)
(C): Fluoxetine (a selective serotonin reuptake inhibitor [SSRI])
(D): Diazepam (a benzodiazepine)",Olanzapine (an antipsychotic),B,"The only medication with evidence-based proof of effectiveness in treating anorexia nervosa is olanzapine, a second-generation antipsychotic that has proven to be effective in the case of severe illness associated with drastic weight loss in anorexia. Olanzapine has shown the ability to aid in weight gain in this scenario. Antidepressants such as SSRIs and tricyclic antidepressants have not shown evidence of improving the negative behaviors associated with anorexia or in improving negative thoughts and distorted self-image, although antidepressants, specifically fluoxetine, have been recommended and are proven effective in the treatment of bulimia nervosa. Benzodiazepines slow down the information traveling between the brain and body and are not an effective treatment of anorexia nervosa. Therefore, the correct answer is (D)",treatment planning
670,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.",use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends.  The client inquires about his counseling records when you are explaining informed consent,The client inquires about his counseling records when you are explaining informed consent. Which of the following statements is the most accurate with regard to the client’s records?,"The counselor must make reasonable precautions to ensure the privacy of client records in the event of termination, incapacity, or death.",Client records must be kept for at least 5 years before being appropriately destroyed.,You can share session notes with your counseling resident for educational purposes because they are practicing under your license.,"When the client requests his records, you must provide full access to the records and support their interpretation as needed.","(A): The counselor must make reasonable precautions to ensure the privacy of client records in the event of termination, incapacity, or death.
(B): Client records must be kept for at least 5 years before being appropriately destroyed.
(C): You can share session notes with your counseling resident for educational purposes because they are practicing under your license.
(D): When the client requests his records, you must provide full access to the records and support their interpretation as needed.","The counselor must make reasonable precautions to ensure the privacy of client records in the event of termination, incapacity, or death.",A,"The most factual statement regarding client records is with regard to making reasonable precautions in case you are suddenly unable to continue services. Even if a counseling resident is practicing under your license, you still need to obtain written consent for release of information to your resident. When a client requests records, if there is a risk of foreseeable harm, you can restrict access to some or all of the client’s chart. You should keep the client’s records within the bounds of the state’s laws within which you practice, which is typically a certain number of years, but the length of time varies based on the state in which you are licensed. Some clients have situations that might suggest that you keep records longer such as those having court involvement or abuse/neglect allegations. Therefore, the correct answer is (D)",professional practice and ethics
671,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.","You and the client meet 4 days after the initial intake session due to truancy because she has missed several days of school. For about half of the session, the client seems to be withdrawn. She asks you what you are required to report, and you remind her of the limits of confidentiality. The client says that she understands, and then says she is going to talk about what happened anyway. She says that her volleyball coach asked to meet with her after practice about 7 months ago and when she entered his office, he asked to look at her right thigh following a fall during practice. She continues to state that when she showed him, he started to touch her genital area from the outside of her pants. She states that she ran out of the room and went home. She explains that after this event she quit the team and told her parents that she did not want to play anymore, but recently she has started to experience distressing memories of the sexual abuse; she refuses to go to school because she would see the man daily; she has difficulty feeling happiness; and she is experiencing feelings of shame, insomnia, and difficulty concentrating. You praise the client for disclosing this information and empathize with her about how hard it must have been to share this experience",Which of the following would be the most appropriate next step due to the information provided during this session?,"Invite the parents into the session to discuss the information provided, and report the information to the appropriate local government agency.",Invite the parents into the session to discuss the information provided.,You are a mandated reporter and will report this to the appropriate local government agency.,"Invite the parents back into the session to discuss the information that was provided, and receive a release of PHI to report this to the school.","(A): Invite the parents into the session to discuss the information provided, and report the information to the appropriate local government agency.
(B): Invite the parents into the session to discuss the information provided.
(C): You are a mandated reporter and will report this to the appropriate local government agency.
(D): Invite the parents back into the session to discuss the information that was provided, and receive a release of PHI to report this to the school.","Invite the parents into the session to discuss the information provided, and report the information to the appropriate local government agency.",A,"As a therapist, you are a mandated reporter and must report all incidents of abuse or neglect to the local government agency that investigates those reports, such as the local child protective services office. It is also important to make the parents aware of what happened, and, although the client does not need to consent to this, you already know that she is okay with this because she said so earlier in the session. The client does not need to consent, but it is beneficial to the counseling relationship that she has consented to you breaking confidentiality. A release of PHI to talk with the school may be helpful but is not required to ensure the client’s safety. It may be helpful to create a safety plan with the family to ensure that the client is not in a position to be sexually abused by this individual again at school. Reporting the incident to the local government agency and collaborating with the parents are the minimal steps needed at this point in therapy. Therefore, the correct answer is (D)",professional practice and ethics
672,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.","Your agency's intake procedure involves a mental status exam as well as a self-reported history. How does this information, along with your immediate observations of the client's mental state inform the next steps in treatment?",Treatment should focus on providing immediate stabilization.,Treatment should focus on developing positive affirmations to improve self-esteem.,The client should be encouraged to increase social activities and build relationships.,The client should be admitted to an in-patient facility for evaluation of possible self-harm.,"(A): Treatment should focus on providing immediate stabilization.
(B): Treatment should focus on developing positive affirmations to improve self-esteem.
(C): The client should be encouraged to increase social activities and build relationships.
(D): The client should be admitted to an in-patient facility for evaluation of possible self-harm.",Treatment should focus on providing immediate stabilization.,A,"The client is in a vulnerable mental state, and it is important to take steps to ensure his safety. Treatment should focus on providing immediate stabilization. Therefore, the correct answer is (B)",treatment planning
673,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",How would you use positive reinforcement after the client tells you how he handled the incident at school?,"""You did a great job taking a deep breath and walking away when you felt angry. Let's choose a fun activity or game to play at the end of our session today.""","""You did a great job handling your anger at school! You should be proud of yourself for making that choice.""","""It sounds like you worked hard this week to stay in control, even when it was difficult.""","""You managed the situation at school really well. Let's see if you can respond in the same way the next time you feel angry, okay?""","(A): ""You did a great job taking a deep breath and walking away when you felt angry. Let's choose a fun activity or game to play at the end of our session today.""
(B): ""You did a great job handling your anger at school! You should be proud of yourself for making that choice.""
(C): ""It sounds like you worked hard this week to stay in control, even when it was difficult.""
(D): ""You managed the situation at school really well. Let's see if you can respond in the same way the next time you feel angry, okay?""","""You did a great job taking a deep breath and walking away when you felt angry. Let's choose a fun activity or game to play at the end of our session today.""",A,"Positive reinforcement is a powerful tool for motivating someone to continue desirable behaviors. In this case, you can use positive reinforcement by offering the client a fun activity or game as a reward for using appropriate strategies for managing his emotions. By doing so, you are providing him with an incentive to keep up the good work. Therefore, the correct answer is (C)",counseling skills and interventions
674,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","By the end of the session, you have identified several issues that the client will need to work on in therapy. Which of the following has the most potential to affect the client's engagement and long-term therapeutic progress?",Feeling overwhelmed and stressed,Strained Family relationships,Lack of a support network,Time constraints,"(A): Feeling overwhelmed and stressed
(B): Strained Family relationships
(C): Lack of a support network
(D): Time constraints",Time constraints,D,"The client appears to have difficulty making it to her scheduled appointments and showing up on time, which could significantly impact her engagement with therapy and her long-term progress. Time constraints can be a major barrier for many clients in seeking help, and the fact that this client is already struggling to make time for therapeutic sessions indicates that she may need additional support or encouragement to prioritize her own wellbeing. Therefore, the correct answer is (D)",treatment planning
675,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""  Tenth session The couple enters in better spirits than previously. They have been speaking with each other in the lobby while waiting. They enter laughing. Ruth reports that the communication techniques you shared seem to have helped. She no longer feels the need to leave her husband. They report that the 16-year-old daughter arrived home from her time at the crisis center somewhat subdued by the experience, although still showing challenging behaviors. They also say that the five-year-old still exhibits defiant behaviors at home and school.    The couple had worked hard to repair their communication and marriage, which is paying off. The husband and wife have found a new understanding and mutual respect. They have developed newfound patience and empathy for one another, helping to create a more harmonious environment at home. The couple had also applied the communication techniques they had learned to their interactions with their children. As a result, Ruth and her husband are now workings together to find a way to better understand and respond to their children's needs. They have set up a school conference to determine how to handle their children's behavior.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",Which is not considered ethical concerning records and documentation?,The client has the right to access his/her own record.,The therapist does not need to store records for more than seven years after termination.,The therapist must obtain permission from a client to record a session.,The therapist will take precautions to maintain confidentiality of the client records if the therapist leaves or is terminated from a practice.,"(A): The client has the right to access his/her own record.
(B): The therapist does not need to store records for more than seven years after termination.
(C): The therapist must obtain permission from a client to record a session.
(D): The therapist will take precautions to maintain confidentiality of the client records if the therapist leaves or is terminated from a practice.",The therapist does not need to store records for more than seven years after termination.,B,"This is not an ethical statement. You must take care to store client records after termination for a period of time that is determined by federal or state laws, not just seven. In addition to taking care of client confidentiality, careful deliberation should be taken before destroying any documents which could be needed in court (ie, child abuse, violence, and sexual harassment). Therefore, the correct answer is (C)",professional practice and ethics
676,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","   bile. Family History: The client has two younger brothers who are 6 and 7 years old. The client often engages in physical fights and arguments with his younger siblings and often will break or steal their toys. The client takes advantage of his 6-year-old sibling by conning him out of items and activities by convincing him that a certain trade or decision is better for him, when it is usually better for the client. The client’s parents report that these behaviors occur at school and that the client does not have any friends as far as they are aware. The client’s parents state that the client is adopted and that he was in foster care from when he was 2 until he was 4 years old. The client’s parents state that his basic needs were neglected because his birth mother was heavily using drugs",Which of the following is an appropriate assessment tool to confirm the client’s diagnosis of conduct disorder?,Diagnostic Interview for Children and Adolescents,Child Behavior Checklist,Conners Continuous Performance Test,Delinquent Activities Scale,"(A): Diagnostic Interview for Children and Adolescents
(B): Child Behavior Checklist
(C): Conners Continuous Performance Test
(D): Delinquent Activities Scale",Diagnostic Interview for Children and Adolescents,A,"The Diagnostic Interview for Children and Adolescents tests for many different DSM-5-TR disorders including conduct disorder. This can be helpful in ensuring that the diagnosis is accurate and that it is not a different disorder. There is also a version that can be given to the parents to validate the assessment results given to their child. The Conners Continuous Performance Test can provide supporting information to validate the conduct disorder diagnosis, but it is geared more toward impulsivity in the test-taking environment. The Child Behavior Checklist assesses for many behaviors and can support the diagnosis, but it would not specifically lead to a diagnosis of conduct disorder. The Delinquent Activities Scale does diagnose conduct disorder specifically but only for incarcerated adolescents. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
677,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,"A non-projective assessment that measures emotional symptoms, functioning, social behavior and hyperactivity is?",Stanford Binet,Thematic Apperception Test (TAT),The Strengths and Difficulties Questionnaire (SDQ),House-Tree-Person (HTP),"(A): Stanford Binet
(B): Thematic Apperception Test (TAT)
(C): The Strengths and Difficulties Questionnaire (SDQ)
(D): House-Tree-Person (HTP)",The Strengths and Difficulties Questionnaire (SDQ),C,"The Strengths and Difficulties Questionnaire is used to measure emotional symptoms, functioning, social behavior, and hyperactivity. The Stanford Binet is an intelligence test with an age range of 2 years through adulthood. The house-tree-person test (HTP) is a projective test intended to measure different aspects of personality. Test takers are asked to draw a house, a tree, and a person. The interpretation of these drawings is used to create a picture of the person's cognitive, emotional, and social functioning. The Thematic Apperception Test (TAT) is a projective test comprised of ambiguous pictures of scenes. The subject is asked to describe what is happening in the scene. Similar to the House-Tree-Person, the interpretation of the drawings is used to determine current problems and functioning. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
678,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","   ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake.  You ask your client the following: “On a 1-10 scale, with 10 being the highest, How confident are you that you can stop drinking altogether?” The client states, “I would say a 6","You ask your client the following: “On a 1-10 scale, with 10 being the highest, How confident are you that you can stop drinking altogether?” The client states, “I would say a 6.” Using motivational Interviewing, which response would best elicit change talk?",“Tell me more about how you decided you are a 6.”,“Why are you not a 10?”,“What would your life look like if you were at a 7?”,“Why are you a 6 and not a 0?”,"(A): “Tell me more about how you decided you are a 6.”
(B): “Why are you not a 10?”
(C): “What would your life look like if you were at a 7?”
(D): “Why are you a 6 and not a 0?”",“Why are you a 6 and not a 0?”,D,"Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET) are evidence-based treatment practices that employ a person-centered, strengths-based approach to reduce ambivalence and evoke lasting behavioral change. The confidence ruler is an MI strategy that uses scaling questions to determine the client’s desire to change. By asking, “Why are you a 6 and not a 0?” the client may then respond by providing reasons why she feels confident in her ability to stop drinking, such as abstinence attained during her three pregnancies. This technique helps initiate a conversation about the client’s perceived ability to change. Asking, “Why are you not a 10?” shifts the conversation to one that is problem-based rather than strengths-based. “Tell me more about how you decided to be a 6” may elicit some degree of change talk, but it is not as precise as the response produced when using the MI confidence ruler technique. Lastly, asking the client what her life would look like if she had greater confidence in her ability to stop drinking does not help reduce ambivalence in the same way answer B does. Therefore, the correct answer is (B)",counseling skills and interventions
679,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","You learn that the client withheld information during the intake interview because of a negative experience with psychiatric treatment. Two years previously, the client presented at the emergency room with symptoms of depression and suicidal ideation. The emergency department clinician recommended hospitalization, and the client complied. During his hospital stay, he was placed on an antipsychotic medication for paranoia and was diagnosed with schizoaffective disorder. Although the client admits to suicidal ideation, he denies ever experiencing paranoia. He reports having side effects from the medication and immediately discontinued it after discharge. The client states that he has been very depressed since the breakup with his girlfriend and was willing to give counseling another try before his depression “hit rock bottom",Which of the following would you select to evaluate the client’s cognitive distortions by testing them against sound logic and reason?,Socratic questioning,Counterconditioning,Assuming responsibility,Forceful disputing,"(A): Socratic questioning
(B): Counterconditioning
(C): Assuming responsibility
(D): Forceful disputing",Socratic questioning,A,"Cognitive therapists use Socratic questioning to help challenge cognitive distortions and evaluate their automatic thoughts by testing them against sound logic and reasoning. For example, the counselor may ask, “What is the evidence for or against this thought?” The client then learns to recognize automatic thoughts and their associated cognitive distortions independently, which is all part of a process known as cognitive restructuring. Counterconditioning is an unrelated term used by behavioral therapists to refer to an experimental procedure in which a subject is trained to respond to a stimulus incompatible with a previously learned response to the same stimulus. Forceful disputing is a rational-emotive behavioral therapy technique used to challenge irrational thoughts and beliefs. Assuming responsibility is a gestalt therapy technique. Gestalt therapists using this technique ask clients to add the phrase, “and I take responsibility for it,” to statements to help promote personal responsibility for their thoughts, actions, and feelings. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
680,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","During the previous session, the client committed to controlled drinking and agreed on a limit of two drinks per night. She admits to having limited success with this goal and concedes to over-indulging when feeling “stressed out.” You learn she ran into a woman from her church who she discovered was a recovering alcoholic. She agreed to meet the woman at an AA meeting, and the client was surprised she could relate to other alcoholics. The client’s affect brightened as she reported that she has had seven days of continuous sobriety. She continues to have a strained relationship with her now ex-husband. Her youngest child is home on spring break, which has helped improve her mood and kept her accountable for staying sober. She is able to use relaxation and mindfulness techniques for insomnia, which have been effective at times at improving her sleep pattern.  You continue your discussion with the client, stating, “You’ve mentioned your ex-husband knows how to push your buttons, and you feel he has caused you to increase your alcohol consumption in the past","You continue your discussion with the client, stating, “You’ve mentioned your ex-husband knows how to push your buttons, and you feel he has caused you to increase your alcohol consumption in the past. Can you tell me more about what your mood is like right after those interactions?” What is the value in asking this question within the context of cognitive-behavioral therapy?",To help create a subjective units of disturbance (SUD) scale,To convey genuineness and unconditional positive regard,To uncover unconscious forces that drive behavior,To help guide the development of a functional analysis,"(A): To help create a subjective units of disturbance (SUD) scale
(B): To convey genuineness and unconditional positive regard
(C): To uncover unconscious forces that drive behavior
(D): To help guide the development of a functional analysis",To help guide the development of a functional analysis,D,"The value in posing this question is to help guide the development of a functional analysis. A functional analysis increases the effectiveness of cognitive-behavioral therapy (CBT) by using the ABC model to examine and understand the sequence of thought patterns and behaviors. The ABC model examines antecedents (A), or what comes before the behavior, the actual behavior (B), and the consequence of that behavior (C). Establishing what the client’s mood is like right after interacting with her ex-husband helps connect the behavior, antecedents, and consequences. Person-centered therapy, rather than CBT, is characterized by genuineness and unconditional positive regard. Psychoanalytic theorists focus on uncovering unconscious forces that drive behavior. Counterconditioning, a form of classical conditioning, uses a subjective unit of disturbance scale (SUDs) to assess levels of distress so events with lower levels of arousal can counteract these events. Biofeedback is an example of counterconditioning that incorporates the use of SUDs. Therefore, the correct answer is (A)",counseling skills and interventions
681,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",What short-term goal would you work on first with this client?,Discuss communication strategies with the teacher,Learning simple relaxation techniques,Teach the parents how to assist the child with math homework,Reviewing math homework before class,"(A): Discuss communication strategies with the teacher
(B): Learning simple relaxation techniques
(C): Teach the parents how to assist the child with math homework
(D): Reviewing math homework before class",Learning simple relaxation techniques,B,"The client is clearly anxious and frustrated. Teaching him some relaxation techniques which he can use to calm down is appropriate as a short-term goal. Therefore, the correct answer is (A)",counseling skills and interventions
682,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","   ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression","Given the client’s clinical presentation, how would you structure the first individual session with the client?",Identify maladaptive cognitions.,Establish treatment plan goals.,Engage her in a therapeutic art activity.,Process grief and loss issues.,"(A): Identify maladaptive cognitions.
(B): Establish treatment plan goals.
(C): Engage her in a therapeutic art activity.
(D): Process grief and loss issues.",Engage her in a therapeutic art activity.,C,"Given the client’s clinical presentation, the best approach for your first session is to engage her in a therapeutic art activity. During the initial intake, the client proudly shared that her artwork came in 1st place. Focusing on the client’s strengths rather than the client’s clinical pathology helps establish a therapeutic alliance. The client has little to no contact with her parents, exhibits ODD behaviors at home and school, and is academically below grade level. Thus, the client’s social, emotional, and academic needs likely contribute to strained relationships with authority and have a higher probability of eliciting negative feedback. Identifying maladaptive cognitions is incorrect due to the client’s cognitive functioning. Establishing treatment plan goals is best accomplished after collecting relevant information from the client’s teacher and grandmother. Processing grief and loss issues, as it pertains to separation from her parents, is important but will likely be more effective after establishing the therapeutic alliance. Therefore, the correct answer is (D)",counseling skills and interventions
683, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.",You discuss here-and-now functioning. What data would indicate Acute Stress Disorder?,avoidance of her phone's photo album,recurrent distressing dreams and dissociative amnesia,changes in appetite,crying when her siblings ask where mom is,"(A): avoidance of her phone's photo album
(B): recurrent distressing dreams and dissociative amnesia
(C): changes in appetite
(D): crying when her siblings ask where mom is",recurrent distressing dreams and dissociative amnesia,B,"The presence of recurrent distressing dreams and the inability to remember an important aspect of a traumatic event are both symptoms that indicate a stress reaction is advancing to disorder. While avoidance is also a disorder symptom, it can also be considered a normal and healthy reaction to a trauma of this severity. Changes in appetite are concerning and should be monitored but are to be expected with extreme stress, and an emotional reaction to a sibling's unfulfilled need to see their mother is clinically appropriate. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
684,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ","Which of the following REBT techniques would have you employed to help Logan recognize that his self-worth is not dependent on the opinions of his bullies, and that he does not deserve to be mistreated?",Role-playing,Rational emotive imagery,Rebutting irrational beliefs,Systematic desensitization,"(A): Role-playing
(B): Rational emotive imagery
(C): Rebutting irrational beliefs
(D): Systematic desensitization",Rebutting irrational beliefs,C,"Disputing irrational beliefs is an effective REBT technique that involves challenging and replacing unhelpful, self-defeating beliefs with healthier, more rational ones. By disputing the irrational belief that his self-worth depends on others' opinions, Logan can learn to recognize that his value is inherent and not tied to external judgments, allowing him to develop a healthier self-image and reduce the impact of bullying. Therefore, the correct answer is (D)",counseling skills and interventions
685,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ","Given the client's passive thoughts of death but denial of suicidal ideation, how might you proceed to help the client with the ongoing effects of her trauma?",Work with the client on reframing and coping skills,Contact necessary authorities to request a wellness check on the client after the session,Immediately create a safety plan,Shift the focus away from the trauma to the client’s presenting symptoms,"(A): Work with the client on reframing and coping skills
(B): Contact necessary authorities to request a wellness check on the client after the session
(C): Immediately create a safety plan
(D): Shift the focus away from the trauma to the client’s presenting symptoms",Work with the client on reframing and coping skills,A,"The client feels overwhelmed by the challenge that the recent trauma has made to her current worldview. Consolidation of the meaning of the trauma and reworking her schemas about the world are essential for this client. Additional recommendations include giving the client a list of contacts she can utilize if she feels in crisis in the future and continually monitoring the client’s passive thoughts of death during sessions. Therefore, the correct answer is (A)",counseling skills and interventions
686, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,Carl's statement of realizing he has a problem is which of the Prochaska and DiClemente's stages of change?,Precontemplation,Action,Contemplation,Preparation,"(A): Precontemplation
(B): Action
(C): Contemplation
(D): Preparation",Contemplation,C,"Carl's statement indicates that he is in the contemplation stage in which he is aware that he has a problem but has not yet committed to change. Precontemplation is a stage when a person does not see that he/she has an issue and has no intention of changing his/her behavior. In the preparation stage, the individual is determined to make changes and believes that he/she is capable of change. In the action stage, the person is taking the established steps to make change. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
687,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","   iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents.  The client states, “My parents suck! They only care about my younger sister","The client states, “My parents suck! They only care about my younger sister.” Which one of the following statements would best be defined as a reflection of feeling by the counselor?",“I can see how you might be frustrated or sad if you feel like they don’t care about you.”,“That sounds like it could feel very lonely or that maybe you feel overlooked.”,“It sounds like you don’t like your parents very much because you feel like they only care about your sister.”,"“You seem bothered by their attention at times, but do you wish you had a different kind of attention?”","(A): “I can see how you might be frustrated or sad if you feel like they don’t care about you.”
(B): “That sounds like it could feel very lonely or that maybe you feel overlooked.”
(C): “It sounds like you don’t like your parents very much because you feel like they only care about your sister.”
(D): “You seem bothered by their attention at times, but do you wish you had a different kind of attention?”",“That sounds like it could feel very lonely or that maybe you feel overlooked.”,B,"Expressing that the client might feel lonely or overlooked is a reflection of feeling, which is a method of deducing and acknowledging the emotions behind what the client has stated. Sometimes, this technique is beneficial because the client may not be aware of the roots of his feelings. Responding to the client’s statement with a question about how he might be bothered by attention or may want different attention would be the use of clarification. Relating to the client’s feelings by saying that you can understand how he might feel sad or frustrated is an expression of empathy. Identifying that you hear the client saying that he does not like his parents because they prefer his sister is an example of paraphrasing. Therefore, the correct answer is (B)",counseling skills and interventions
688,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","In connection with the client speaking about her boyfriend leaving her, the client made the statement, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it"". You recognize that the client is asking for help in dealing with her possibly overwhelming feelings concerning this emotional loss. Which tool would you select to evaluate the client further?",Keirsey Temperament Sorter (KTS),Columbia Suicide Severity Rating Scale (C-SSRS),Hamilton Anxiety Rating Scale (HAM-A),Mini Mental State Examination (MMSE),"(A): Keirsey Temperament Sorter (KTS)
(B): Columbia Suicide Severity Rating Scale (C-SSRS)
(C): Hamilton Anxiety Rating Scale (HAM-A)
(D): Mini Mental State Examination (MMSE)",Columbia Suicide Severity Rating Scale (C-SSRS),B,"The Columbia Suicide Severity Rating Scale (C-SSRS) assesses the risk of suicide. There are three different versions of this assessment available to best suit the client's situation: the ""lifetime/recent template,"" the ""since the last visit"" template, and the ""screener"" template. This instrument is appropriate to assist you in evaluating the client for suicidality. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
689,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","   Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication",ADHD is grouped under which DSM-5-TR classification?,Disruptive disorders,Neurodevelopmental disorders,Impulse-control disorders,Social engagement disorders,"(A): Disruptive disorders
(B): Neurodevelopmental disorders
(C): Impulse-control disorders
(D): Social engagement disorders",Neurodevelopmental disorders,B,"The DSM-5 classifies ADHD as a neurodevelopmental disorder. A separate DSM-5-TR classification is entitled Disruptive and Impulse-Control Disorders. This classification includes oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, pyromania, and kleptomania. In addition, The DSM-5-TR classifies disinhibited social engagement disorder as a trauma- and stressor-related disorder. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
690,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,"To assess cognitive and adaptive functioning in Nadia, the counselor may use all of the following, except?",SIB-R (scales of Independent Behavior- Revised),CBCL,ABAS,Vineland,"(A): SIB-R (scales of Independent Behavior- Revised)
(B): CBCL
(C): ABAS
(D): Vineland",CBCL,B,"The Child Behavior Checklist (CBCL) is used to detect emotional or behavioral problems in children and adolescents. This would not be an appropriate test for Nadia as she is 18 years old. The Vineland Adaptive scales are used as a tool to diagnose intellectual and developmental disabilities and other disorders, ages birth-90. The scales of independent behavior revised is for individuals 3 months to 80 + years old and measures functional independence and adaptive functioning. The adaptive behavior assessment system is used to evaluate those with developmental delays, autism spectrum disorder, intellectual disability, etc. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
691,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.","    her. Family History: The client says that she has a good relationship with her parents. She says that they are encouraging and supportive of her. The client says that she has a younger brother who is 6 years old and an older brother who is 16 years old. The client states that she has a good group of friends and spends time with them regularly.  Following the session, the client’s parents ask you for the details of your session with their daughter","Following the session, the client’s parents ask you for the details of your session with their daughter. What would be both the most ethical and clinically appropriate response?",You respect your client’s right to privacy and tell the parents you do not think it would be best for treatment to share information without the client’s consent.,"You ask the client if you can talk with the parents, and she says “no,” but you are able to talk with them anyway because she is a minor.","First, you ask if you can talk with the client for permission and encourage the parents to provide their daughter with the space to speak freely during sessions.","The parents have a right to all information because the client is a minor, so you meet with them to discuss the details of the session.","(A): You respect your client’s right to privacy and tell the parents you do not think it would be best for treatment to share information without the client’s consent.
(B): You ask the client if you can talk with the parents, and she says “no,” but you are able to talk with them anyway because she is a minor.
(C): First, you ask if you can talk with the client for permission and encourage the parents to provide their daughter with the space to speak freely during sessions.
(D): The parents have a right to all information because the client is a minor, so you meet with them to discuss the details of the session.","First, you ask if you can talk with the client for permission and encourage the parents to provide their daughter with the space to speak freely during sessions.",C,"You are balancing ethical and clinical concerns, and, in this situation, it is best for the client to be willing for you to talk with her parents and for the parents to accept a level of confidentiality for the client. If the client feels that she can talk with a level of confidentiality in the counseling sessions, then she is most likely to engage fully in treatment. The parents do have a right to all of the information, but this would not necessarily be clinically beneficial because the client may not trust you if you share all of the given information with her parents. If the client declines that you share information with the parents and the parents continue to request it, they do have a right to information, but it may not benefit treatment to do so. It is important to note that different states have different laws regarding the rights of minors in treatment. Therefore, the correct answer is (C)",professional practice and ethics
692,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.",Which of the following would be the most appropriate next intervention to consider?,Couple's session to work on communication,Continue to work on client's substance abuse recovery,Individual counseling referral for spouse,Continue to work on client's attachment,"(A): Couple's session to work on communication
(B): Continue to work on client's substance abuse recovery
(C): Individual counseling referral for spouse
(D): Continue to work on client's attachment",Couple's session to work on communication,A,"The client has made progress in his alcohol recovery and in forming new attachments that encourage growth in his self-esteem. The presenting problem has always been the client's relationship with his spouse and this relationship, and while the roles are now reversed, it is still the presenting problem. It would be most helpful at this time to meet with the client and his husband to process the recent changes that the client has made and how these have impacted the couple. Counselors do not make referrals for people who are not clients so referring the client's spouse to individual therapy would be unethical. The counselor and client are able to continue work on his recovery and attachment while including the client's spouse as the relationship is tied to each of these. Therefore, the correct answer is (B)",treatment planning
693, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.","You run into one of Jonny's teachers in the breakroom shortly after session and he says to you, ""I hear you are meeting with Jonny, that's good. He really needs it."" He sits down with you and asks, ""Did he ask you to extend his deadlines? He's done that with all the counselors."" How do you respond?","""I remember being stressed in college. These kids have so much to worry about!""","""Yes! He told me he has not done that before. I'll have a talk with him.""","""No, he has not said anything like that. Why do you think he really needs counseling?""","""I cannot comment on things said in session, it is a violation of his trust.""","(A): ""I remember being stressed in college. These kids have so much to worry about!""
(B): ""Yes! He told me he has not done that before. I'll have a talk with him.""
(C): ""No, he has not said anything like that. Why do you think he really needs counseling?""
(D): ""I cannot comment on things said in session, it is a violation of his trust.""","""I remember being stressed in college. These kids have so much to worry about!""",A,"This response gently redirects the subject away from speaking about Jonny while also building rapport with his teacher. As a fellow staff member of the university, you are a team of professionals working together to help the students and may often need input from teachers to support your counseling efforts. Declining to comment out of confidentiality while a co-worker is showing interest and engagement in a fellow student can be viewed defensively, and you may lose your ally in providing Jonny well-rounded care. Lying about what Jonny has said or not said is also unhelpful. Asking a teacher for their input or observations of Jonny may be useful to your needs, but in this case, attempting to obtain input when you did not directly ask for it, is somewhat opportunistic. Also, a public break room during may not be the best time or place to discuss student therapy issues. Breaking Jonny's confidentiality as in answer a) is also unethical towards your therapeutic relationship with him. Therefore, the correct answer is (D)",counseling skills and interventions
694,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","It has been 1 month since you last saw the client because he has canceled many sessions in a row without explanation. You process attendance with him and then ask him for updates regarding how symptoms have been over the last month. The client says that there were many reasons for cancellations, such as going to dinner with friends, being too tired, and forgetting about the session and making other plans. The client says that he got a new job and states that he is doing much better managing his ADHD symptoms in the new position. You and the client process what was difficult about his last position and then identify that these tasks are not present in the current position. A majority of this session was spent assessing the level of symptomatology experienced over the past month and the client reporting on events that occurred since the last session",Which of the following is the most therapeutic manner of determining the root of the client’s inconsistent attendance?,"Asking the client, “What is most important to you for us to be working on in sessions?”","Asking the client, “Why have you been canceling sessions?”",Reviewing progress toward goals,Discussing scheduling to determine if the time or frequency is not working for the client,"(A): Asking the client, “What is most important to you for us to be working on in sessions?”
(B): Asking the client, “Why have you been canceling sessions?”
(C): Reviewing progress toward goals
(D): Discussing scheduling to determine if the time or frequency is not working for the client","Asking the client, “What is most important to you for us to be working on in sessions?”",A,"Identifying goals by determining what is important to the client would likely be the most helpful next step because the client has not been prioritizing his sessions. Refocusing on what is now most important to the client might increase motivation and participation. Over the course of therapy, needs change and therapy needs to be refocused to maintain motivation and to work toward meaningful goals. Asking “why” questions often puts the client in a position in which he feels the need to justify himself and can create defensiveness, which is not helpful in processing the client’s behavior. Reviewing previous treatment goals likely would not help very much because the client does not seem to be finding those goals meaningful anymore. Discussing scheduling likely would not be helpful because the client is actively scheduling other activities over the current scheduled sessions, which demonstrates that he has availability during this time but he is prioritizing other activities. Therefore, the correct answer is (C)",treatment planning
695,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Considering the information provided, which question would be the most appropriate to ask when setting treatment goals for the client?",What might we work on in counseling to help you let go of the things you don't use anymore?,What might we work on in counseling to help your family feel less concerned about you?,What might we work on in counseling that would help you to take better care of yourself?,What might we work on in counseling that would help you to keep living well on your own?,"(A): What might we work on in counseling to help you let go of the things you don't use anymore?
(B): What might we work on in counseling to help your family feel less concerned about you?
(C): What might we work on in counseling that would help you to take better care of yourself?
(D): What might we work on in counseling that would help you to keep living well on your own?",What might we work on in counseling that would help you to keep living well on your own?,D,"When setting goals, it is critical to work with the client and what they want to accomplish. The client views herself as doing well on her own and being pushed by her family to live differently as a means of taking her property away from her. Setting goals that help the client improve what may or may not be a good living situation honors the client's values while creating space to work together. Asking the client about goals for better care suggests that the client is not taking good care of herself now and may create a sense of distrust in the client if she perceives the counselor as not believing her. Goals related to getting rid of possessions is likely to cause distrust in the client as this is not a goal that she has currently alluded to in the intake. Goals to help the family feel better are not appropriate goals for counseling as they are focused on pleasing someone other than the client. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
696,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",Which counselor attribute would not necessarily improve rapport between you and Mary?,congruence,non-judgmental stance,empathic responding,knowledge of widower issues,"(A): congruence
(B): non-judgmental stance
(C): empathic responding
(D): knowledge of widower issues",knowledge of widower issues,D,"All the above responses other than C are evidence-based skills that would help Mary feel understood and connected in session. Your knowledge as a counselor of widower issues or any clinical expertise will be useful in treatment, however, will not be likely support your therapeutic bond in and of itself. Therefore, the correct answer is (C)",core counseling attributes
697,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",In what way does demonstrating unconditional positive regard to the client help her from a clinical standpoint?,This will help her to become more confident in herself and increase her self-esteem.,This will encourage her to be more compliant with treatment recommendations.,This will help her process difficult emotions more quickly and effectively.,This will help her to build trust in the therapeutic relationship and encourage open communication.,"(A): This will help her to become more confident in herself and increase her self-esteem.
(B): This will encourage her to be more compliant with treatment recommendations.
(C): This will help her process difficult emotions more quickly and effectively.
(D): This will help her to build trust in the therapeutic relationship and encourage open communication.",This will help her to build trust in the therapeutic relationship and encourage open communication.,D,"The focus of unconditional positive regard is about acceptance and understanding for the client as an individual. This helps to build trust in the therapeutic relationship so that open communication can occur. Open communication allows for more in-depth exploration of difficult emotions, which can then be addressed in a more meaningful and effective way. In this way, demonstrating unconditional positive regard to the client helps her from a clinical standpoint. Therefore, the correct answer is (B)",core counseling attributes
698,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.","John Gottman refers to the four predictors that a marriage may be in trouble as the ""Four Horseman of the Apocalypse."" Which one of these is not one of the predictors?",Defensiveness,Dishonesty,Criticism,Contempt,"(A): Defensiveness
(B): Dishonesty
(C): Criticism
(D): Contempt",Dishonesty,B,"According to Gottman, this is not a predictor that a relationship is in trouble. The horsemen include Criticism, Defensiveness, Contempt, and Stonewalling. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
699, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",Which factor presents as the most likely underlying issue causing Malik's depression symptoms?,Cultural stress,Dad's criticism,Trauma,"Feeling ""overwhelmed""","(A): Cultural stress
(B): Dad's criticism
(C): Trauma
(D): Feeling ""overwhelmed""",Trauma,C,"Malik's mother reported her presentation of symptoms prior to leaving Hawaii, which follows the same timeline as Malik's report of a traumatic event occurring. Based on Malik's presentation of avoiding discussion of trauma, crying when she thinks of it and then deflecting, trauma is the best choice. Acculturation issues began after she moved, which likely exacerbated her symptoms but are not presenting as most plausible to be the primary cause. In this case, all other stressors reported are more likely contributing to her Anxiety disorder diagnosis. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
700,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.  Fifth session It has been a month and a half since you first met with the client and she has rescheduled multiple therapy appointments, continually citing a busy work schedule. The last time you met with her, she told you that the judge sentenced her to six months probation, provided that she follow through with Alcoholic Anonymous meetings and counseling sessions. She was also required to do 60 hours of community service. Though she was relieved to have the sentencing behind her, she remarked that she still felt shame and humiliation at having gone down that path. During that counseling session, she communicated to you that she tried to go one day without drinking but couldn't do it. She described the idea of quitting drinking as ""impossible"" because ""I have never been strong enough."" You explored the client's motivations and concerns about changing her behavior. You explained to her that while it was normal to feel overwhelmed by the thought of making changes, there were strategies that she could utilize in order to build a support system and make progress towards sobriety.    Based on the client's behavior, you do not believe that outpatient treatment is the best fit for the client at this time, and you plan to discuss alternate options with her today. She is scheduled for an afternoon session but does not show. When you attempt to call her, her phone goes directly to voicemail. You continue to wait in your office even though the client does not respond to your calls or appear for the session. You are concerned about her because although she has rescheduled appointments before, she has always done so in advance and has never been a ""no show."" You take the appropriate ethical actions to check on her.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.",The client has missed several sessions and has shown a lack of commitment to therapy. What is the best way to introduce alternate options for the client's care?,"""Based on your current needs, outpatient treatment may not be the best fit for you at this time, so I'd like to discuss some other options with you that might be more beneficial.""","""You seem to have difficulty following through with your appointments, so let's talk about some different treatment options that may be more helpful to you.""","""You have obviously been struggling with this, so let's explore some different options to see what could work better for you.""","""I need to be honest with you. Your commitment to these sessions has been lukewarm. Individual counseling is not enough for your situation. I'd like to explore more intensive options.""","(A): ""Based on your current needs, outpatient treatment may not be the best fit for you at this time, so I'd like to discuss some other options with you that might be more beneficial.""
(B): ""You seem to have difficulty following through with your appointments, so let's talk about some different treatment options that may be more helpful to you.""
(C): ""You have obviously been struggling with this, so let's explore some different options to see what could work better for you.""
(D): ""I need to be honest with you. Your commitment to these sessions has been lukewarm. Individual counseling is not enough for your situation. I'd like to explore more intensive options.""","""Based on your current needs, outpatient treatment may not be the best fit for you at this time, so I'd like to discuss some other options with you that might be more beneficial.""",A,"This response is sensitive and appropriate because it acknowledges the client's current needs, while still allowing room for discussion of alternative options. It also emphasizes that the client has a choice in her care plan, which can help build trust and mutual respect between the therapist and client. Finally, it avoids any language that could be seen as judgmental or critical of the client. Therefore, the correct answer is (A)",professional practice and ethics
701,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.  Eighth session The client has been seeing you once a week for the last two months. Today, he appears calm, and his thoughts are coherent. The client tells you that he has not completely abstained from alcohol, but his use has significantly decreased. He reports that he went to a virtual AA meeting but did not find it helpful, so he signed off. The client opens up and states, ""I think one of the reasons I am anxious is because I am having an affair. Ever since my wife hurt her back, we have not been intimate."" The client's speech becomes more rapid, and he begins to lose eye contact as he discloses the details of his affair to you. Your client tells you, ""I'm not happy with my wife, either sexually or emotionally. The new woman I'm seeing understands me, and I don't want to drink when I'm around her. She helps me forget everything that causes me stress."" In response to your client focusing on the positives of his affair, you engage the client in a discussion to explore the issue from other perspectives. You ask questions like, ""What do you think would happen if your wife found out about your affair?"" Your client pauses for a moment and looks down, and then says, ""I'm not sure. I care about my wife, but I don't know if she will ever be able to understand me in the way that this other woman does. I feel like I'm trapped."" You listen empathically as your client expresses his feelings of anxiety, despair and confusion. You provide clarification when necessary and strive to help your client gain insight into his thoughts and behaviors.    In the session, you explore the client's anxiety and how it has been related to his affair. You address underlying issues that may be contributing to the anxiety such as unresolved feelings of guilt or fear of being discovered. You emphasize that anxiety is often a sign of trying to avoid uncomfortable emotions and situations, but acknowledging them can help him understand anxiety in a different way. You also talk about the role alcohol has played in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to incorporating strategies to address these issues in his treatment plan, such as scheduling regular self-care activities and exploring the relationship between his thoughts and behaviors. Toward the end of this session, the client appears calmer and confident in his ability to make positive changes. As you are wrapping up the session, the client confides to you that ever since he started having an affair, he has found himself sexually attracted to his daughter. He says, ""It's just kind of exciting to peek in the bathroom and watch her in the bathtub. But I would never touch her! It's just a passing thought. I know that I need to stop. The thrill of my affair is satisfying enough.""","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ","Your client tells you, ""I'm not happy with my wife, either sexually or emotionally. The new woman I'm seeing understands me, and I don't want to drink when I'm around her. She helps me forget everything that causes me stress."" You respond, ""I'm happy to hear that you seem less anxious and refrain from drinking with this partner, but how will this news be helpful for your wife?"" What are you doing by responding in this way?",Reflecting feelings,Suggesting to the client that you believe he is not ready for termination,Exploring the problem,Providing constructive confrontation and redirection,"(A): Reflecting feelings
(B): Suggesting to the client that you believe he is not ready for termination
(C): Exploring the problem
(D): Providing constructive confrontation and redirection",Providing constructive confrontation and redirection,D,"Providing constructive confrontation and redirection is correct. You are letting the client know that although he seems happier in this other relationship as manifested by his lower anxiety and reduced alcohol consumption, he is forgetting about his finances and family. You are pointing out the discrepancies in his thought process and are redirecting his attention to the problems that have not gone away, even though he feels temporary relief from them. Therefore, the correct answer is (D)",counseling skills and interventions
702, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,An effective treatment for anxiety is?,Benzodiazepines,Corticosteroids,Cognitive Behavioral Therapy,Cardiovascular exercises,"(A): Benzodiazepines
(B): Corticosteroids
(C): Cognitive Behavioral Therapy
(D): Cardiovascular exercises",Benzodiazepines,A,"Benzodiazepines have been shown effective for anxiety. Corticosteroids treat conditions such as asthma, allergies, arthritis and bronchitis. They have also been shown to make people anxious. Cardiovascular exercises are not proven to help prevent panic attack. Cognitive behavioral therapy can be used to target irrational thought which may trigger anxiety. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
703,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client is responding well to your therapeutic interventions. School has ended, and her summertime athletic and academic commitments have lessened. The client reports that she is happy to be out of school and spoke again about not fitting in with her peers. She states that there are limited opportunities for sustaining friendships and worries that she will never find a romantic interest. She reports that her mother has suspended her social media account because the client was overly consumed by the number of “likes” that she received for her online posts. You explain that you will be starting a 12-week group of diverse teens who also experience anxiety and would like her to join. She agrees and is eager to participate.  Your responsibility as the group leader is to establish group rules, set limits, and develop a plan for group termination","Your responsibility as the group leader is to establish group rules, set limits, and develop a plan for group termination. In doing so, which leadership skill are you exhibiting?",Fostering autonomy,Emotional stimulation,Meaning attribution,Executive functioning,"(A): Fostering autonomy
(B): Emotional stimulation
(C): Meaning attribution
(D): Executive functioning",Executive functioning,D,"Group leaders demonstrate the skill of executive functioning when establishing rules, setting limits, and developing a group-specific termination (ie, discharge) plan. In other words, the group leader must remain vigilant of the group dynamics and set boundaries appropriately. Members are clear on the number of sessions held, and counselors establish the minimal discharge criteria. Lieberman et al. (1973) identified core group leadership functions as executive functioning, caring, emotional stimulation, and meaning attribution. Fostering autonomy and differentiation are therapeutic considerations for the middle stage of group development. Leaders execute meaning attribution when promoting insight and understanding among group members. Group leaders exhibit emotional stimulation at varying intervals by assessing emotional exchanges and stimulating or controlling levels of emotional expression. Therefore, the correct answer is (C)",professional practice and ethics
704,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",Which of the following is most impacted by the client's pets' drawing her attention away from the therapy session?,The rapport between the client and therapist is impacted.,The client’s mood is affected.,The therapeutic process is impacted.,The client's ability to commit to therapy is impacted.,"(A): The rapport between the client and therapist is impacted.
(B): The client’s mood is affected.
(C): The therapeutic process is impacted.
(D): The client's ability to commit to therapy is impacted.",The therapeutic process is impacted.,C,"The therapeutic process is impacted when the client's pets draw her attention away from the therapy session. The setting is the most challenging part to control in online therapy and can hinder progress with the client. Therefore, the correct answer is (B)",counseling skills and interventions
705, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.","Which of the following statements will be the most appropriate response to the client's statements ""I did just what you suggested""?","""I'm really glad that things worked out for you.""","""Hmm...I don't remember saying that. Let's talk about it?""","""It sounds like you are trying to control me by saying that I said to do that.""","""Counselors try not to give advice, but I'm glad that you were able to use that.""","(A): ""I'm really glad that things worked out for you.""
(B): ""Hmm...I don't remember saying that. Let's talk about it?""
(C): ""It sounds like you are trying to control me by saying that I said to do that.""
(D): ""Counselors try not to give advice, but I'm glad that you were able to use that.""","""Hmm...I don't remember saying that. Let's talk about it?""",B,"Counselors do not give advice or make suggestions for clients because counseling is client-directed and counselors cannot be sure that their own advice or suggestions will be effective for the client or in their world outside of the session. If a counselor gives advice or makes suggestions that do not work out well for the client, the therapeutic bond can be ruptured and the client may feel betrayed. The best response is to acknowledge that this is not something the counselor would do and invite conversation to understand how the client has projected their ideas onto the counselor. Responses a and d are incorrect because counselors should never give advice or suggestions to clients, so, any response that indicates that the counselor did this would be incorrect. Stating that the client is trying to control the counselor is a defensive remark and may cause a rupture in the therapeutic relationship. Therefore, the correct answer is (B)",counseling skills and interventions
706,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What would you ask the client when she is in crisis?,Can you promise me you won't hurt yourself?,Why are you choosing to feel this way?,Do you have access to anything that could potentially harm yourself?,Who would you like me to contact?,"(A): Can you promise me you won't hurt yourself?
(B): Why are you choosing to feel this way?
(C): Do you have access to anything that could potentially harm yourself?
(D): Who would you like me to contact?",Do you have access to anything that could potentially harm yourself?,C,"This is an excellent question for determining whether the client has access to any dangerous means of self-harm. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
707,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. You address her ambivalence to change, as well as obstacles she has experienced in the past. When discussing exercise, the client states, “You don’t understand! I’ve tried exercise, and it never works.” You provide the client with self-monitoring sheets to record the following in real-time: daily food intake, maladaptive eating patterns, and thoughts and feelings that accompany binge eating. She is hesitant but agrees to give it a try for one week","Using motivational interviewing to respond to the client’s attitude towards exercise, which statement represents an amplified reflection?",“You’re done with taking suggestions; there are no options left for you.”,“You’ve tried exercise and don’t think it will ever work for you.”,"“You feel like nothing works, but you remain persistent. Making this change must be really important to you.”","“You’re frustrated at my suggestion, so much so that it seems like you’ve reached a boiling point.”","(A): “You’re done with taking suggestions; there are no options left for you.”
(B): “You’ve tried exercise and don’t think it will ever work for you.”
(C): “You feel like nothing works, but you remain persistent. Making this change must be really important to you.”
(D): “You’re frustrated at my suggestion, so much so that it seems like you’ve reached a boiling point.”",“You’re done with taking suggestions; there are no options left for you.”,A,"The counselor’s response representing an amplified reflection is: “You’re done taking suggestions; it feels like there are no options left for you” Amplified reflections use the client’s original statement and over-emphasize their point or intent. The purpose is to push the client past ambivalence and toward change. A simple reflection is represented in answer A: “You’ve tried exercise and don’t think it will work” A simple reflection validates what the client has said and shows that you are listening to her concerns. Stating that it seems like the client may have reached a boiling point is not entirely accurate and illustrates a communication error, specifically a depth error. This occurs when the therapist reads too much into the client’s statements. Answer B, which states: “You feel like nothing works, but you remain persistent. Making this change must be really important to you,” is an example of reframing. Reframing is used to help the client see the problem from a different and generally more positive perspective. Therefore, the correct answer is (C)",counseling skills and interventions
708,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.",Which planning objective would best support Taylor's stated goal?,Taylor will apply at least one coping method and report successful anxiety reduction.,Taylor will become capable of managing her emotions during stressful transitions.,Taylor will learn at least three new coping methods and apply them within six months.,Taylor will identify and verbalize at least three triggers causing her underlying anxiety.,"(A): Taylor will apply at least one coping method and report successful anxiety reduction.
(B): Taylor will become capable of managing her emotions during stressful transitions.
(C): Taylor will learn at least three new coping methods and apply them within six months.
(D): Taylor will identify and verbalize at least three triggers causing her underlying anxiety.",Taylor will learn at least three new coping methods and apply them within six months.,C,"This is the best answer because it adequately covers SMART goal criteria of being specific, measurable, achievable, realistic, and timely. Answer a is not helpful for Taylor because it does not offer a treatment solution, as she has already presented several concerns causing her anxiety, she will likely be able to easily achieve this objective within the first session based on her presentation and what information you have already gathered. Answers b and d are not specific enough, nor do they offer a timeline for achievement. Therefore, the correct answer is (C)",treatment planning
709,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","The client has arrived 15 minutes late for your scheduled session. When you approach the waiting room, you find her loudly talking on her cell phone. She abruptly ends the call and follows you back to your office. She is visibly shaken and angry. She explains that her soon-to-be ex-husband is a “master manipulator” and is “ruining my life.” She remains confident that she can stop drinking but states she can only do so once her family situation is under control. After all, she states, “You would drink too if you had my problems.” She begins to de-escalate as the session progresses, and she is able to identify and prioritize treatment issues. Her sleep continues to be a concern. Upon further exploration, she indicates she is having nightmares and has been for quite some time. The two of you work together to prioritize treatment plan goals. Her mood and demeanor brighten as the session concludes","When discussing treatment issues, you ask, “How does drinking align or not align with your goal of improving relationships with your family?” What is the value of posing this question?",It allows for the focus to be kept on the client’s alcohol misuse.,It helps create incentive-based interventions used in contingency management.,It helps create a discrepancy between the client’s actions and personal values.,It assists with providing baseline measures for treatment plan goals.,"(A): It allows for the focus to be kept on the client’s alcohol misuse.
(B): It helps create incentive-based interventions used in contingency management.
(C): It helps create a discrepancy between the client’s actions and personal values.
(D): It assists with providing baseline measures for treatment plan goals.",It helps create a discrepancy between the client’s actions and personal values.,C,"According to Miller & Rollnick (2013), developing discrepancy between the client’s values and behaviors helps increase the client’s motivation to change. The onus is on the client, rather than the counselor, to argue for change. In doing so, you help elicit intrinsic motivation by emphasizing the conflict between the client’s drinking and the value she places on familial relationships. This question goes beyond simply focusing on the client’s alcohol use, making answer A incorrect. Developing discrepancy helps the client narrow down treatment plan goals, but it does not provide baseline measures for the treatment plan. Contingency management is a treatment approach that involves presenting clients with tangible rewards for attaining and maintaining abstinence. Therefore, the correct answer is (B)",treatment planning
710,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.",You have been working with the client weekly and are meeting with the mother today to discuss interventions that she can use at home. She relays that her husband does not support the diagnosis of ADHD and has reached out to their faith community instead. The mother is conflicted about counseling and explains that it is viewed as a sign of weakness in her community. She continues to voice concern over the school’s lack of diversity and her belief that the client is being treated differently because of his race,Which statement accurately reflects the ACA Code of Ethics guideline for working with culturally diverse populations?,Counselors consider the client’s cultural background when providing assessment results and only use bias-free instruments.,"Counselors seek supervision when they are at risk of a client imposing their values, attitudes, beliefs, and behaviors onto the counselor.",Counselors recognize existing historical and social prejudices in the misdiagnosis and pathologizing of certain individuals.,"Counselors practice only within the boundaries of their competence based on their education, experience, and ability to engage with diverse client populations.","(A): Counselors consider the client’s cultural background when providing assessment results and only use bias-free instruments.
(B): Counselors seek supervision when they are at risk of a client imposing their values, attitudes, beliefs, and behaviors onto the counselor.
(C): Counselors recognize existing historical and social prejudices in the misdiagnosis and pathologizing of certain individuals.
(D): Counselors practice only within the boundaries of their competence based on their education, experience, and ability to engage with diverse client populations.",Counselors recognize existing historical and social prejudices in the misdiagnosis and pathologizing of certain individuals.,C,"The ACA Code of Ethics states, “Counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain groups and strive to become aware of and address such biases in themselves or others” (ACA, 2014, Section E5c). Section C2 addresses professional competence, stating, “Multicultural counseling competency is required across all counseling specialties, [and] counselors [must] gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor working with a diverse client population” (ACA, 2014, Section C2a). Regarding assessment instruments, counselors must “use assessment as one component of the counseling process, taking into account clients’ personal and cultural context” (ACA, 2014, Section E). Because there is the potential for bias in nearly all assessments, counselors must consider using multiple methods and multiple informants to reduce cultural biases. Finally, counselors avoid imposing their values, attitudes, beliefs, and behaviors onto the client, making option D incorrect. Therefore, the correct answer is (A)",professional practice and ethics
711,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","This session is occurring in the client’s home in order to observe behaviors in his natural environment. The client’s parents and 8-year-old brother are present. You are observing during this session in order to gather information and then to provide psychoeducation at the end of the session to the parents. The client and his brother are sitting on the floor playing with a building toy, which the client’s parents report is often a toy that causes him frustration because he plays very specifically with it and his brother does not want to play how he does. After about 5 minutes, the client becomes visibly frustrated as he is telling his brother to put a brick in a certain place because it is the same color and his brother says he is not going to and goes to build on his own. The client continues to build and asks for the piece repeatedly over a few minutes. The client then picks up what he is building and throws it against the wall and leaves the room",Which of the following would be the most appropriate intervention with regard to providing treatment for this client’s diagnosis?,Prompt the client to take a break and listen to music to calm down.,Prompt him to play with another toy.,Remind him of appropriate social skills.,Encourage the client and his brother to play separately.,"(A): Prompt the client to take a break and listen to music to calm down.
(B): Prompt him to play with another toy.
(C): Remind him of appropriate social skills.
(D): Encourage the client and his brother to play separately.",Prompt the client to take a break and listen to music to calm down.,A,"Prompting the client to calm down when you see that he is visibly upset, but before he throws the toy, is the most helpful intervention because it addresses the client’s difficulty with frustration management. Although social skills are helpful for individuals who have autism, the client was being very rigid in his thinking and needed to calm down prior to using appropriate social skills. Prompting the client to play with something else or separating the client from his brother would be avoiding dealing with the client’s difficulties with frustration management. Therefore, the correct answer is (D)",counseling skills and interventions
712,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.",ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself.  Psychodynamic therapy has proven to be effective in the treatment of dependent personality disorder,Psychodynamic therapy has proven to be effective in the treatment of dependent personality disorder. Which one of the following is a defining principle of psychodynamic therapy?,Childhood experiences and unconscious wishes and fears greatly shape an adult’s personality,Changing the narrative from “I’m a loser” to “my anxiety sometimes makes me think I’m a loser”,Focusing on the present moment using mindfulness techniques to accept thoughts and feelings without judgment,Using free association and dream interpretation to investigate conscious and unconscious thoughts,"(A): Childhood experiences and unconscious wishes and fears greatly shape an adult’s personality
(B): Changing the narrative from “I’m a loser” to “my anxiety sometimes makes me think I’m a loser”
(C): Focusing on the present moment using mindfulness techniques to accept thoughts and feelings without judgment
(D): Using free association and dream interpretation to investigate conscious and unconscious thoughts",Childhood experiences and unconscious wishes and fears greatly shape an adult’s personality,A,"The psychodynamic approach involves investigating childhood experiences and underlying wishes and fears because they often affect an adult’s personality and functioning. Focusing on the present and accepting thoughts and feelings are principles of acceptance and commitment therapy. Changing the narrative from “I’m a loser” to “my anxiety sometimes makes me think I’m a loser” is a principle of narrative therapy, which strives to externalize anxiety as not being part of the client. The use of free association and dream interpretation as well as investigating conscious and unconscious thoughts are parts of psychoanalysis. Therefore, the correct answer is (A)",counseling skills and interventions
713,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes to this session, sits down, and starts talking about how she met a man and talked to him for about an hour and was frustrated at the end of the conversation because she feels that he is “like everyone I’ve been with before.” The client continues to explain that she knows these men are not good for her and that she wants something different, but she is still talking to him. The client becomes frustrated talking about this and begins crying and breathing heavily, stating that, “I am broken and can’t have a healthy relationship.” You support the client through her strong emotions and provide empathetic listening","Based on the client’s emotional reaction to talking about her relationship with this new man, which of the following would be the most clinically indicated response based on the client’s stage of change?",Validate the client’s emotions and support her in engaging in coping skills.,Empathize with the client to build rapport.,Validate the client’s emotions and support her beliefs because she has had difficult relationships and this would be the most genuine response.,Challenge the client’s cognitive distortion of labeling because the client is labeling herself based on past situations.,"(A): Validate the client’s emotions and support her in engaging in coping skills.
(B): Empathize with the client to build rapport.
(C): Validate the client’s emotions and support her beliefs because she has had difficult relationships and this would be the most genuine response.
(D): Challenge the client’s cognitive distortion of labeling because the client is labeling herself based on past situations.",Validate the client’s emotions and support her in engaging in coping skills.,A,"Validating your client’s emotions and engaging in coping skills is the most appropriate response because the client is in the preparation stage of change and knows what the problem is but is not able to make changes yet. Validating emotions and helping the client cope in the moment deals with the client’s presenting emotions. Challenging cognitive distortions would be part of the action stage, and the client is not ready to engage in this step yet. Simply empathizing with the client may build rapport but will not help the client develop skills to manage strong emotions. Validating the client’s emotions and beliefs based on her past experiences may reinforce her labeling of herself and may also demonstrate that you think the client is incapable of changing her future experiences. Therefore, the correct answer is (A)",counseling skills and interventions
714,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps.  Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, ""I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?"" You remain calm and acknowledge the client's frustration. You reply, ""You're angry with me because you feel that I'm not listening. Am I hearing you right?"" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety.    The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but ""she just doesn't get how hard it is for me."" He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, ""It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?"" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support.  Sixth session It has been one and a half months since you began seeing the client for therapy. He followed up on the referral you gave him to see a psychiatrist and he is currently taking medication for his anxiety, but he reports that ""the pills aren't really helping."" He says he loves cheerleading and gymnastics and will never give them up. He reports he is still eating and exercising to excess but refuses to stop. He continues, ""I'm aware of the dangers, but I don't care. All athletes go through pain to be successful."" You assess the client's internal and external motivation as a strategy to separate the client from his denial that he has an illness."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ","You state, ""When I was in high school, I also had an eating disorder. It was not until I realized I needed professional help that my life changed."" What did you do here as the therapist?",Self disclosed your personal history,Crossed a boundary with the client,Encouraged the client to continue treatment,Focused on yourself over the client,"(A): Self disclosed your personal history
(B): Crossed a boundary with the client
(C): Encouraged the client to continue treatment
(D): Focused on yourself over the client",Self disclosed your personal history,A,"You are showing the client that you understand what he is going through. Self-disclosure can be very powerful in therapy when used appropriately. Therefore, the correct answer is (D)",professional practice and ethics
715,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",How does the client's level of insight affect your treatment plan?,Activities for the client should be haptically-oriented and developmentally appropriate.,Insight is a teachable skill which should be a top priority in your treatment plan.,The client should determine the direction of your treatment plan.,The client's level of insight should not affect your treatment plan.,"(A): Activities for the client should be haptically-oriented and developmentally appropriate.
(B): Insight is a teachable skill which should be a top priority in your treatment plan.
(C): The client should determine the direction of your treatment plan.
(D): The client's level of insight should not affect your treatment plan.",Activities for the client should be haptically-oriented and developmentally appropriate.,A,"A ""hands on"" approach will work better with a client with low insight and judgment. Therefore, the correct answer is (A)",treatment planning
716,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.",,"Using rational emotive behavior therapy as a framework, what would you focus on in your work with the client?",Exploring the client's beliefs about being rejected by her husband and how they are contributing to her emotional distress,Helping the client find meaning in life by encouraging her to explore her sense of freedom and responsibility,Teaching the client mindfulness and emotion regulation skills to help her manage intense emotions,Focusing on the client's interpersonal relationships and helping her to become more aware of herself in the present moment,"(A): Exploring the client's beliefs about being rejected by her husband and how they are contributing to her emotional distress
(B): Helping the client find meaning in life by encouraging her to explore her sense of freedom and responsibility
(C): Teaching the client mindfulness and emotion regulation skills to help her manage intense emotions
(D): Focusing on the client's interpersonal relationships and helping her to become more aware of herself in the present moment",Exploring the client's beliefs about being rejected by her husband and how they are contributing to her emotional distress,A,"REBT focuses on exploring the client's irrational beliefs that contribute to their emotional distress. The goal is to challenge and replace irrational beliefs with more balanced, rational beliefs. In this case, it would be helpful to explore the client's beliefs about being rejected by her husband and how those beliefs are contributing to her distress. Therefore, the correct answer is (B)",counseling skills and interventions
717,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.  15th session You have been seeing the client regularly for the past four months. He states that he is feeling ""better"" these days, and he is doing better at work. He has been taking his antidepressant medication as prescribed and feels therapy has been helpful. You review the treatment plan and discuss the progress he has made and the termination process.    Near the end of the session, he tells you, ""Well, there is one more thing. I'm worried that my wife might be having an affair. I know it's probably crazy, but I can't help but think that she's seeing someone else. And you know what, I wouldn't blame her. I haven't been the best husband with my constant depression. I just think about her leaving me, and it makes me feel afraid."" You express understanding and validate his feelings, noting that it's not uncommon for people to have affair-related thoughts when feeling insecure in their relationship. You inquire whether he has been spending time with his wife and how he and his wife have been communicating. He reports that they have been talking more and that he has been trying to be more present when he is with her. You remind him of his progress in therapy and how much better he has been feeling overall, which has likely contributed to him being able to engage more in his marriage. You suggest that as he continues to work on himself and generally feels better, his worries about his wife cheating on him will likely lessen. In the meantime, you caution against drinking to cope with his anxiety, as it can lead to further problems down the road.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",What is the best way to respond to the client's belief that his wife is having an affair?,Validate the client's concerns and suggest that his fear is based on past abandonment issues,Suggest that he continue to investigate his wife's activities further,Continue to explore the client's fears,Recommend that the client join a support group,"(A): Validate the client's concerns and suggest that his fear is based on past abandonment issues
(B): Suggest that he continue to investigate his wife's activities further
(C): Continue to explore the client's fears
(D): Recommend that the client join a support group",Continue to explore the client's fears,C,"This is the first time the client mentioned worrying that his wife is having an affair. At this point, you should explore these feelings further with the client to determine the most appropriate next step. Therefore, the correct answer is (D)",counseling skills and interventions
718,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,An appropriate response by the counselor would be?,"What if she chose to go with a girl, what harm is that?",Why don't you both tell me more.,"Yes, I can see the issue. I am glad you brought her in.",I see that there seems to be conflict between you both- let's talk about it.,"(A): What if she chose to go with a girl, what harm is that?
(B): Why don't you both tell me more.
(C): Yes, I can see the issue. I am glad you brought her in.
(D): I see that there seems to be conflict between you both- let's talk about it.",Why don't you both tell me more.,B,"This choice is a neutral statement which prompts more information from both parties. Choice a seems to side with Nadia and choice b seems to side with Shar. When working with families it is important to remain objective and to also discourage splitting among family members. Choice c focuses on the negative by highlighting conflict. Therefore, the correct answer is (D)",counseling skills and interventions
719,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex.  The client asks to meet via online video for the next session",The client asks to meet via online video for the next session. All of the following are practical and ethical problems with video sessions EXCEPT:,Increased ability for a client to misrepresent themselves,Limitations to confidentiality,Access to nonverbal cues,Provision of interventions for a CBT approach,"(A): Increased ability for a client to misrepresent themselves
(B): Limitations to confidentiality
(C): Access to nonverbal cues
(D): Provision of interventions for a CBT approach",Provision of interventions for a CBT approach,D,"A CBT approach is still possible via telehealth; therefore, this is not a practical or ethical consideration. Access to nonverbal cues is limited when counseling is provided via telehealth. The client’s ability to misrepresent themselves is heightened when services are accessed via telehealth because the client’s identity can be manipulated in the case of audio-only sessions. Confidentiality is more difficult to guarantee when sessions are virtual because it cannot be guaranteed that the conversation is not being overheard on the client’s end and because general privacy settings may be breached. Therefore, the correct answer is (A)",professional practice and ethics
720,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Which of the following would be most helpful during this session?,Exploring how the client will do it differently next time,Exploring why the client delegated a task that had such importance to him,Exploring earliest memories of trying to be perfect,Exploring the client's anger and sadness,"(A): Exploring how the client will do it differently next time
(B): Exploring why the client delegated a task that had such importance to him
(C): Exploring earliest memories of trying to be perfect
(D): Exploring the client's anger and sadness",Exploring earliest memories of trying to be perfect,C,"OCPD requires the client to gain insight into his rigid and inflexible nature if he wishes to make personality changes. Exploring his earliest memories of trying to be perfect will help him link his past experiences with his present thoughts and behaviors, which can help him develop greater insight and self-awareness. Exploring the client's anger and sadness is not helpful in the session because clients with OCPD struggle with emotionality. Until the client has built sufficient insight and self-awareness, the client will avoid emotionality as it conflicts with his logic and rule adherence. Asking the client why he didn't do the job himself perpetuates the idea that the client should not delegate tasks without the assurance that his rules will be followed. This is not helpful in reducing the client's OCPD thoughts and behaviors. Exploring how the client will do it differently next time is not a helpful intervention because the client has not yet learned that the rigid and inflexible nature of his rules is what causes his dilemma, rather than other people who refuse to follow them. Therefore, the correct answer is (B)",counseling skills and interventions
721,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","Viewing this client through a cognitive behavioral theoretical (CBT) lens, which of the following best describes his current problem?",Client is experiencing reactive attachment issues related to his frequent moves,Client is experiencing an emotional cutoff because of family enmeshment,Client holds a core belief that friendships should not be trusted,Client holds a core belief that it is better to be lonely than to lose people,"(A): Client is experiencing reactive attachment issues related to his frequent moves
(B): Client is experiencing an emotional cutoff because of family enmeshment
(C): Client holds a core belief that friendships should not be trusted
(D): Client holds a core belief that it is better to be lonely than to lose people",Client holds a core belief that it is better to be lonely than to lose people,D,"CBT focuses on core beliefs that individuals hold and which may impact their emotional well-being. The client appears to believe that not attempting to make friends protects him from loss, although it leaves him lonely and without support. There is no information provided that suggests his past friends were hurtful or harmful to him and it is the loss of the friendship that is painful, rather than them being untrustworthy. Reactive attachment is a trauma-stressor related disorder often seen in children. The client evidences no history related to criteria of the disorder such as consistent emotional withdrawal from adult caregivers, social unresponsiveness or unexplained emotionality during unthreatening interactions with adult caregivers, or a history of social or emotional deprivation from caregivers, or frequent changes in caregivers limiting the opportunity to form stable emotional relationships with adult caregivers. Emotional cutoffs and family enmeshment are constructs from a family systems theoretical lens and are not used in CBT. Therefore, the correct answer is (D)",counseling skills and interventions
722,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client comes to the session reporting that he and his girlfriend attempted to have sex the past week, and he wrote down some thoughts he was having on his CBT thought log. The client and the clinician reviewed his thoughts and engaged in cognitive reframing to support him in creating new scripts to use when engaging in sex. The client also wrote down physical responses to anxiety that he was experiencing before and during sex that included muscle tension and increased heart rate.  The client states that he thinks that his girlfriend would be better off without him and that he should break up with her so she can find what she wants in a man. You decide to use the counseling skill of confrontation to challenge him",The client states that he thinks that his girlfriend would be better off without him and that he should break up with her so she can find what she wants in a man. You decide to use the counseling skill of confrontation to challenge him. Which of the following would demonstrate the most beneficial use of confrontation based on what you know about the client?,You tell the client that this is not an appropriate response because he is using all-or-nothing thinking and extrapolating his thinking about his own worth as a man as equated to her feelings about him.,You tell the client that responding to these feelings by breaking up might be risky because the client’s girlfriend has not shown that she is bothered by his sexual performance.,You tell the client that he would be making a big mistake by breaking up with his girlfriend because he might be able to improve their relationship.,You tell the client that he should continue to be with his girlfriend because although he has these thoughts it does not mean that they are the reality.,"(A): You tell the client that this is not an appropriate response because he is using all-or-nothing thinking and extrapolating his thinking about his own worth as a man as equated to her feelings about him.
(B): You tell the client that responding to these feelings by breaking up might be risky because the client’s girlfriend has not shown that she is bothered by his sexual performance.
(C): You tell the client that he would be making a big mistake by breaking up with his girlfriend because he might be able to improve their relationship.
(D): You tell the client that he should continue to be with his girlfriend because although he has these thoughts it does not mean that they are the reality.",You tell the client that responding to these feelings by breaking up might be risky because the client’s girlfriend has not shown that she is bothered by his sexual performance.,B,"It would be most helpful to support the client with identifying that his feelings are risky because he does not have evidence to support his thoughts to break up. Telling the client that his thoughts are not an appropriate response is an aggressive response that has not been proven to be a helpful confrontation technique. Although the focus of improving the relationship is helpful, it would validate the client’s thoughts and would not confront them. Telling the client that he should continue to be in this relationship just because he has thoughts about breaking up and how these may not be true would be more directive than confrontational. Therefore, the correct answer is (B)",counseling skills and interventions
723, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",Which approach should you try first to help Malik talk about her trauma with you?,Use caring confrontation with her about how unaddressed trauma increases depression.,Tell her the details about mistakes you have made in the past and that its normal.,"Use reflecting, paraphrasing, silence and empathic attunement.",Remind her the purpose of her counseling is to get better by talking about it.,"(A): Use caring confrontation with her about how unaddressed trauma increases depression.
(B): Tell her the details about mistakes you have made in the past and that its normal.
(C): Use reflecting, paraphrasing, silence and empathic attunement.
(D): Remind her the purpose of her counseling is to get better by talking about it.","Use reflecting, paraphrasing, silence and empathic attunement.",C,"These basic counseling skills are non-judgmental, evidence-based techniques that build rapport and trust, and most effectively help clients feel heard and understood without feeling pressured. The mentioned trauma is possibly sexual in nature so using techniques in answer d are the best way to be sensitive to Malik's comfort level, respect the establishment of her boundaries, and honor the timeline of her willingness to share. Using these techniques may also support her in sharing about all things that are contributing to her emotional distress, leading her to discuss what she is most willing to address first. Helping her to understand that unaddressed trauma may lead to increase of depression. Educating Malik about how trauma can increase symptoms of depression as well as reflecting together on your treatment plan goals are both valuable interventions, however, it may be better to address this earlier in the session. Alternatively, it may be more effective to discuss these issues after all other interventions have been exhausted. Using self-disclosure techniques such as in answer c are to be considered on a case-by-case basis, and while this approach can support a teenager in therapy, it is important not to blur the lines of the counselor-client relationship by any actions that might mimic the dynamics of a peer-to-peer relationship. Therefore, the correct answer is (D)",counseling skills and interventions
724,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.",ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself.  Some ethical standards can be altered based on the situation,Some ethical standards can be altered based on the situation. Which of the following ethical standards would you likely not compromise on with this client?,Release of the client’s records to her,Fees,Boundaries,Interpretation of assessment results,"(A): Release of the client’s records to her
(B): Fees
(C): Boundaries
(D): Interpretation of assessment results",Boundaries,C,"This client will need you to establish very clear boundaries because she is likely to become somewhat dependent on you and your sessions with her. With other clients, small amounts of self-disclosure or answering emails outside of sessions may have benefits, but with this client, you may need to insert more explicit guidelines for them. Fees should be appropriate and negotiable as needed. Release of the client’s records is up to the counselor’s discretion if it might cause harm; otherwise, it is the client’s right to have access to her chart. If an assessment is provided, the client should be supported in interpreting the results. Therefore, the correct answer is (B)",professional practice and ethics
725, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.","Based on the information given, which would be the most effective intervention with this client at this time?",Reframing,Self-disclosure,Highlighting here-and-now interactions,Reflection and paraphrases,"(A): Reframing
(B): Self-disclosure
(C): Highlighting here-and-now interactions
(D): Reflection and paraphrases",Reflection and paraphrases,D,"Based on the client's cultural information provided, reflection and paraphrases are the most effective intervention because they allow the client freedom to choose what is or is not discussed, let the client know that the counselor is listening, and provides the opportunity for the counselor to share with the client the thoughts and emotions that the client has been expressing. These techniques are non-directive and allow the client to feel listened to and valued. Reframing with this client is not likely to be effective at this time as she wrestles with cultural expectations. Reframing allows the counselor to provide a different perspective of a problem, but when culture is involved, the counselor is more likely to offer a perspective that may not take culture into account. Self-disclosure is one of the least used interventions because counselors must weigh whether the self-disclosure is more for the counselor's benefit or the client's. With this client, self-disclosure would not be appropriate, particularly if the counselor and client do not share the same culture, as any comparisons would not be similar due to differing cultural beliefs. Here-and-now interactions are useful when working on process versus content as they focus on metacommunication. In this case, the counselor must be careful not to make assumptions about what is said or not said because of the cultural differences between the client and the counselor. Therefore, the correct answer is (A)",counseling skills and interventions
726, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.","Now that Malik is reporting no suicidal thoughts, how should you update her treatment plan?","Add ""codependency"" to her treatment plan goals.","Resolve SI treatment plan goal and add ""monitor SI"" as an objective under depression goal.","Mark SI treatment plan goal as ""resolved"" and focus more on other goals.",Continue to monitor SI using C-SSRS for the remaining duration of the SI treatment plan.,"(A): Add ""codependency"" to her treatment plan goals.
(B): Resolve SI treatment plan goal and add ""monitor SI"" as an objective under depression goal.
(C): Mark SI treatment plan goal as ""resolved"" and focus more on other goals.
(D): Continue to monitor SI using C-SSRS for the remaining duration of the SI treatment plan.",Continue to monitor SI using C-SSRS for the remaining duration of the SI treatment plan.,D,"You must continue to monitor for suicidal thoughts using a Suicidal Ideation specific treatment plan goal for its minimum duration required as defined by your agency or state laws. Following that period, if SI has been evidenced to be ""low risk"" or ""very low risk"" it would then be appropriate to mark the goal as ""resolved"" and add an SI monitoring goal underneath a depression goal as answer c states. Answer b is not correct as the client had a temporary change in affect for 1-2 weeks and she may still be suicidal. Answer d is a great option for this client but it is best practice to discuss the goal with your client first and ensure they understand it prior to adding it to their treatment plan. Most agencies and state laws also require that a parent sign a consent form for any major updates or changes to their child's treatment plan. Therefore, the correct answer is (A)",treatment planning
727,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",What would provide you with the most direct and reliable data indicating that therapy sessions have improved your client's outlook and self-acceptance?,The parents report noticing positive changes in the client's behavior at home.,Administer a written assessment specifically tailored to gender dysphoria.,The client's anxiety and depression symptoms decrease.,The client reports increased confidence and comfort expressing their gender identity.,"(A): The parents report noticing positive changes in the client's behavior at home.
(B): Administer a written assessment specifically tailored to gender dysphoria.
(C): The client's anxiety and depression symptoms decrease.
(D): The client reports increased confidence and comfort expressing their gender identity.",The client reports increased confidence and comfort expressing their gender identity.,D,"The client self-reporting increased confidence and comfort with their gender identity provides the most direct and reliable data on improved outlook and self-acceptance because it comes straight from the client, focuses specifically on their viewpoint of their gender identity, and captures internal changes in their feelings and perspective over the course of therapy. Therefore, the correct answer is (B)",counseling skills and interventions
728,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,The counselor's statement is an example of?,Confrontation,Congruence,Reflection of feeling,Engagement,"(A): Confrontation
(B): Congruence
(C): Reflection of feeling
(D): Engagement",Congruence,B,"The counselor is showing congruence as he is being honest in his feedback regarding the client's progress and demeanor. The client's inconsistency may be because of his awareness and bringing this to the client's attention can be a turning point. Confrontation is the client confronting something within themselves, not the therapist confronting the client. Engagement is prompting or encouraging the client to actively participate. Therefore, the correct answer is (A)",counseling skills and interventions
729,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","Taking into account the session's content, what should be your primary focus initially?",Process his feelings and thoughts regarding his wife and their relationship.,Continue to evaluate his level of lethality and update his safety plan.,Begin the psychoanalytic process of dealing with his past traumas,Encourage the client to explore productive ways he can express his frustrations.,"(A): Process his feelings and thoughts regarding his wife and their relationship.
(B): Continue to evaluate his level of lethality and update his safety plan.
(C): Begin the psychoanalytic process of dealing with his past traumas
(D): Encourage the client to explore productive ways he can express his frustrations.",Continue to evaluate his level of lethality and update his safety plan.,B,"The statement of feeling like giving up is ambiguous and needs to be explored and acted on. It is critical to know precisely to what extent this client will or will not act on these thoughts and to mutually agree in writing to not act on those feelings or thoughts. Determining his level of lethality provides a baseline determination of his current suicidal status. It simultaneously gives you a standard to compare when there is progress in the future. This also provides you with documentation of his verbal commitment to avoid self-harm as legal confirmation that you have addressed this concern professionally. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
730,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",What is irrelevant to consider when gathering data to establish a treatment plan for the client?,Is he averse to taking medication for depression?,What kind of support group does he have?,How willing is he to change his profession?,How often does he drink?,"(A): Is he averse to taking medication for depression?
(B): What kind of support group does he have?
(C): How willing is he to change his profession?
(D): How often does he drink?",How willing is he to change his profession?,C,"He has already stated being ready to retire, and after 20 years, this would be too big a change to consider unless specifically expressed as a priority for the client. Therefore, the correct answer is (B)",treatment planning
731,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”","You discover from the receptionist Lottie's mother has been complaining about you to your practice's front desk staff, that you told Lottie what she has learned about her parents' personal life is ""inappropriate,"" and further that you are ""pushing medication"" on her. How should you handle this?",Inform your supervisor and have them speak with Lottie's mom on your behalf.,Explain to Lottie that you were not trying to offend her mother.,Request to have a discussion with mom after processing with your supervisor.,Ignore these comments due to the possibility of her attempting to split staff.,"(A): Inform your supervisor and have them speak with Lottie's mom on your behalf.
(B): Explain to Lottie that you were not trying to offend her mother.
(C): Request to have a discussion with mom after processing with your supervisor.
(D): Ignore these comments due to the possibility of her attempting to split staff.",Request to have a discussion with mom after processing with your supervisor.,C,"Issues such as complaints by clients should be processed with your immediate supervisor and/or licensure supervisor to ensure you are protected by their knowledge and support. Processing with them can help you to proceed mindfully and with the best clinical approaches suggested to handle whatever situation you are in. Ignoring these comments might harm your therapeutic relationship with Lottie, despite that they could very well be out of motivation to split staff or out of a histrionic response to feeling defensive or frustrated. However, prior knowledge of the mother's personality disorder should not deter you from addressing her very real concerns. Speaking directly with the child about this is inappropriate, and asking a supervisor to deal with the parent for you is unprofessional. Therefore, the correct answer is (B)",professional practice and ethics
732,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintain appropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but they participate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","   ully. Family History: Several clients report coming from a single-parent home, whereas others are from a two-parent home. All clients report that they have siblings. Several clients reported having parents that were or are involved in the justice system",Which of the following would be unethical for you regarding group counseling?,Confidentiality cannot be guaranteed because you cannot control what the clients share outside of sessions.,"You do not have experience regarding incarceration, but you have been a therapist for 15 years and have experience in counseling.",You cannot force the clients to participate in sessions even though therapy is mandatory.,"You are also the case manager for each individual; therefore, this is a dual relationship.","(A): Confidentiality cannot be guaranteed because you cannot control what the clients share outside of sessions.
(B): You do not have experience regarding incarceration, but you have been a therapist for 15 years and have experience in counseling.
(C): You cannot force the clients to participate in sessions even though therapy is mandatory.
(D): You are also the case manager for each individual; therefore, this is a dual relationship.","You do not have experience regarding incarceration, but you have been a therapist for 15 years and have experience in counseling.",B,"The most common unethical situation in the group setting is a counselor that does not have the knowledge or skills to lead the group. There are many positions that require a counselor to be a group counselor and to have another role with the client such as in this juvenile detention facility, in group homes, or in other community mental health roles. Often, dual relationships cannot be avoided in group counseling and at times are part of therapy such as dialectical behavior therapy, which is often a mixture of group and individual counseling. It is true that, when multiple clients are present such as in group, family, or couples counseling, you cannot guarantee confidentiality from all members, but you should encourage all clients to maintain confidentiality for the benefit of the group process. Although the clients may be forced to be in the group, you cannot force anyone to do anything against their will, which includes participation in mandatory therapy. Therefore, the correct answer is (C)",professional practice and ethics
733,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family",Which one of the following statements reflects a person-centered approach to the client’s retirement?,“Your heart is heavy after leaving a career that was once everything to you.”,"“You’re grieving a heavy loss. How does that affect your present-day, here-and-now experiences?”",“Your sadness and the person you are today are likely the results of unconscious processes.”,“You have a deep conviction that some of your best years were before retirement.”,"(A): “Your heart is heavy after leaving a career that was once everything to you.”
(B): “You’re grieving a heavy loss. How does that affect your present-day, here-and-now experiences?”
(C): “Your sadness and the person you are today are likely the results of unconscious processes.”
(D): “You have a deep conviction that some of your best years were before retirement.”",“Your heart is heavy after leaving a career that was once everything to you.”,A,"A person-centered approach is reflected in the statement “Your heart is heavy after leaving a career that was once everything to you” Person-centered therapists facilitate unconditional positive regard, empathy, and genuineness. The aforementioned statement is an expression of empathy. The statement “You have a deep conviction that some of your best years were before retirement,” is an example of a cognitive-behavioral approach, with the client’s thoughts expressed as deep convictions. Psychoanalytic therapy is reflected in the statement “Your sadness and the person you are today are likely the results of unconscious processes” Person-centered therapists focus on the conscious rather than the unconscious. Finally, the statement, “You’re grieving a heavy loss. How does that affect your present-day, here-and-now experiences?” characterizes gestalt therapy. Therefore, the correct answer is (B)",counseling skills and interventions
734,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",What are considered symptoms of the client's diagnosis?,Depressed mood for most of the day,Sleep disturbances,Obsessions and compulsions,Severe recurrent temper outburst,"(A): Depressed mood for most of the day
(B): Sleep disturbances
(C): Obsessions and compulsions
(D): Severe recurrent temper outburst",Severe recurrent temper outburst,D,"This is a symptom of Disruptive Mood Dysregulation Disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
735,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes to this session, sits down, and starts talking about how she met a man and talked to him for about an hour and was frustrated at the end of the conversation because she feels that he is “like everyone I’ve been with before.” The client continues to explain that she knows these men are not good for her and that she wants something different, but she is still talking to him. The client becomes frustrated talking about this and begins crying and breathing heavily, stating that, “I am broken and can’t have a healthy relationship.” You support the client through her strong emotions and provide empathetic listening.  The client identifies that she has reasons to change and has a plan to change how she approaches relationships",The client identifies that she has reasons to change and has a plan to change how she approaches relationships. Which of the following identifies the client’s stage according to the transtheoretical model of change?,Preparation,Contemplation,Action,Precontemplation,"(A): Preparation
(B): Contemplation
(C): Action
(D): Precontemplation",Preparation,A,"The transtheoretical model of change proposes six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. This client is in the preparation stage of change because she understands her problem and has a plan in place to address it. The client is not currently taking actions to make changes; therefore, she is not in the action phase of change. The precontemplation phase occurs prior to the client identifying the problem when the client may not have any intention of addressing her behavior. The contemplation phase involves the client knowing that there is a problem but not yet having a plan for action. Therefore, the correct answer is (A)",counseling skills and interventions
736,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,"To establish an effective therapeutic relationship, the counselor must?",Collaborate with others to support the client,Have clinical knowledge,Be able to establish trust,Write an appropriate treatment plan,"(A): Collaborate with others to support the client
(B): Have clinical knowledge
(C): Be able to establish trust
(D): Write an appropriate treatment plan",Be able to establish trust,C,"One of the most important qualities that the counselor should have to establish an effective therapeutic relationship with a client is the ability to establish trust. This is especially important with a client who is suffering from delusions and hallucinations. Clinical knowledge and the ability to write appropriate plans are important skills to have but will not determine whether the counselor will be able to form a positive therapeutic relationship. Collaboration with others is also an important part of being a therapist. There may be family members or other providers who are integral in the care of the client. However, if the trust is not established, the client may be skeptical of the counselor speaking with others. Therefore, the correct answer is (B)",treatment planning
737, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,A symptom of Panic Disorder is?,Symptoms are only precipitated by social situations,Persistent worry about panic attacks and maladaptive change for 2 weeks,Caused by separation from home or attachment figures,Recurrent panic attacks,"(A): Symptoms are only precipitated by social situations
(B): Persistent worry about panic attacks and maladaptive change for 2 weeks
(C): Caused by separation from home or attachment figures
(D): Recurrent panic attacks",Recurrent panic attacks,D,"Panic Disorder is characterized by recurrent panic attack with symptoms such as sweating, trembling, nausea, dizziness or derealization. Persistent worry about panic attacks and or maladaptive changes must be present for at least a month. If panic attacks are caused by separation from home or attachment figures, this would be separation anxiety disorder. Additionally, if symptoms are only precipitated by social situations, this is indicative of social anxiety disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
738,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","In working with this client, which of the following counseling characteristics will be most needed during your time together?",Congruence,Empathy,Positive regard,Respect and acceptance for diversity,"(A): Congruence
(B): Empathy
(C): Positive regard
(D): Respect and acceptance for diversity",Congruence,A,"Each of these qualities are needed during counseling with this client and all clients. At the same time, because the client struggles with ambivalent attachment, congruence will be of the utmost importance in working with him. Those with ambivalent attachment experienced inconsistency from parental figures during childhood, never knowing if they would experience emotional availability or rejection. Congruence demonstrates authenticity or consistency between the counselor's internal and external self. Empathy allows the counselor to understand the client's feelings as he experiences them, which allows the client to feel heard and cared for. Positive regard allows the client to feel safe that he is not being judged when opening himself up to the counselor. Respect and acceptance for diversity is always imperative and will be demonstrated through the counselor's congruence, empathy, and positive regard. Therefore, the correct answer is (D)",counseling skills and interventions
739,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","You and the client review his safety plan. The client believes the antidepressant has helped decrease his feelings of hopelessness and suicidality. Despite the hot and humid conditions, the client arrives at his counseling session in a hoodie. He explains that he has been getting out of the house “some” but continues to avoid social situations because of overwhelming thoughts of others staring at him and mocking his appearance. The client was a no-show for his appointment last week and has requested distance counseling to avoid anxiety experienced when leaving the house. You and the client work together to set appropriate treatment plan goals; however, this is difficult due to poor insight into his presenting problem. You provide psychoeducation about BDD and ask about his goals for the future.  You have discussed the client’s request for distance counseling with your supervisor, considered the potential risks and benefits, and have determined that honoring the client’s request is the best course of action","You have discussed the client’s request for distance counseling with your supervisor, considered the potential risks and benefits, and have determined that honoring the client’s request is the best course of action. Before implementation, which of the following “test” questions would you ask yourself to help finalize this decision according to the American Counseling Association’s (ACA)Practitioner’s Guide to Ethical Decision-Making?",Would I want my behavior reported in the press?,Can I faithfully fulfill this obligation?,Are there legal implications to this decision?,Would this decision harm the client?,"(A): Would I want my behavior reported in the press?
(B): Can I faithfully fulfill this obligation?
(C): Are there legal implications to this decision?
(D): Would this decision harm the client?",Would I want my behavior reported in the press?,A,"Asking yourself if you want your behavior reported in the press (publicity) best helps finalize this decision. The American Counseling Association’s (ACA)Practitioner’s Guide to Ethical Decision-Makingprovides a framework emphasizing the following steps, “1. Identify the problem. 2. Apply the ACA Code of Ethics. 3. Determine the nature and dimensions of the dilemma. 4. Generate potential courses of action. 5. Consider the potential consequences of all options and determine a course of action. 6. Evaluate the selected course of action. 7. Implement the course of action (Forester-Miller & Davis, 2016)” When evaluating the selected course of action, there are three tests to help ensure the action is appropriate. The tests honor the principles of justice, publicity, and universality. According to the framework: “Justice: In applying the test of justice, assess your sense of fairness by determining whether you would treat others the same in this situation. Publicity: For the test of publicity, ask yourself whether you would want your behavior reported in the press. Universality: The test of universality asks you to assess whether you could recommend the same course of action to another counselor in the same situation (Forester-Miller & Davis, 2016)” Asking if there are legal implications to this decision is a consideration for step 1 of the decision-making model. The question regarding faithful fulfillment (fidelity) of this obligation is reviewed in step 3. According to the ACA’s decision-making framework, step 3 uses the core principles of autonomy, justice, beneficence, nonmaleficence, and fidelity to examine the dimensions of the dilemma. Asking if this decision would harm the client applies the principle of nonmaleficence. Therefore, the correct answer is (D)",professional practice and ethics
740,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","   k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress.”  You ask the client to tell you about a time when her problem did not exist or was less severe",You ask the client to tell you about a time when her problem did not exist or was less severe. Which one of the following approaches reflects this stance?,Solution-focused brief therapy,Gestalt therapy,Freudian psychoanalysis,Transactional analysis,"(A): Solution-focused brief therapy
(B): Gestalt therapy
(C): Freudian psychoanalysis
(D): Transactional analysis",Solution-focused brief therapy,A,"One technique of solution-focused brief therapy is to ask the client about a time when her problem did not exist or was less severe; this technique is known as the exception question. Solution-focused brief therapy is a short-term, solution-oriented best practice used to help clients establish and reach goals by improving motivation and creating measurable behavioral change. Freudian psychoanalysis focuses on how a client’s unconscious influences affect how they think, act, and feel. Eric Berne, credited with developing transactional analysis, used techniques such as script analysis to explore the interaction of ego states (eg, parent, adult, and child). Gestalt therapists emphasize the integration of mind and body through an awareness of the present moment. Therefore, the correct answer is (B)",counseling skills and interventions
741,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",Which of the following would be most helpful for the client?,Helping her discern the barriers that are keeping her from reaching her goals,Helping her find equanimity with living with her mother,Helping her live more harmoniously with her adoptive sister.,Helping her to come to terms with her relationship with her father.,"(A): Helping her discern the barriers that are keeping her from reaching her goals
(B): Helping her find equanimity with living with her mother
(C): Helping her live more harmoniously with her adoptive sister.
(D): Helping her to come to terms with her relationship with her father.",Helping her discern the barriers that are keeping her from reaching her goals,A,"In order to realistically move toward her goals, the client needs to have a good sense of the things that stand in her way. Therefore, the correct answer is (B)",counseling skills and interventions
742,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.",Which of the following cognitive behavioral therapy (CBT) interventions will be most helpful for the counselor to encourage the client to complete in between sessions?,Utilize relaxation and stress reduction techniques prior to drinking alcohol,Utilize a daily journal to process feelings of depression and anxiety,Utilize behavioral experiments with classmates for social interaction,Utilize role playing to practice social skills to help build relationships with others,"(A): Utilize relaxation and stress reduction techniques prior to drinking alcohol
(B): Utilize a daily journal to process feelings of depression and anxiety
(C): Utilize behavioral experiments with classmates for social interaction
(D): Utilize role playing to practice social skills to help build relationships with others",Utilize behavioral experiments with classmates for social interaction,C,"Behavioral experiments are a CBT intervention that the client can use at school and work to determine whether his beliefs (predictions) about his ability to make friends and that others have no time to socialize are true or whether these predictions keep him isolated. Using a journal and relaxation exercises are good homework assignments for clients and can be beneficial for this client; however, the client's current alcohol use does not present as inappropriate or anxiety-based and he presents as dealing well with his emotions with the help of medication. Role playing to practice social skills is a good intervention to use within sessions but given the client's current isolation, would be an unlikely intervention to assign for between session practice. Therefore, the correct answer is (B)",counseling skills and interventions
743,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day.  During the session, the client states, “I don’t think I can provide for my family like I need to, so I’m worthless","During the session, the client states, “I don’t think I can provide for my family like I need to, so I’m worthless.” Which one of the following areas needs to be explored following this statement?",Anxiety,Self-esteem,Depression,Work skills,"(A): Anxiety
(B): Self-esteem
(C): Depression
(D): Work skills",Self-esteem,B,"As evidenced by his frustration with unemployment and feelings of worthlessness, the client’s self-esteem is affected by his current situation. This would be important to investigate further. The client’s depression and depressed mood have already been identified and are therefore not new symptoms. The client has demonstrated that he has work skills, and although it is within your role to support the client in finding new opportunities that match his skill set, the focus should be on the underlying root of the client’s statement. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
744,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,What source of information is least important at this time?,Behavioral observation from teacher,Relationship with birth parents,Traumatic life events,Current household members,"(A): Behavioral observation from teacher
(B): Relationship with birth parents
(C): Traumatic life events
(D): Current household members",Current household members,D,"Information about current household members may not be as important at this time. Foster homes are screened and there is no indication or mention of issues surrounding the foster home or anyone living in it. A main problem area for Destiny is her interaction with other children. What happens in a school setting can provide great information. It is important to understand Destiny's relationship with her birth parents to see what the short term and long-term permanency goals are. Finally, it is important to get a comprehensive trauma history to better understand Destiny's early experiences. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
745,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,"In determining the course of treatment, the counselor should first consider?",What treatment would take the shortest amount of time because of the client's financial situation.,A holistic view of the client.,What has worked in the past for similar clients.,What treatment has been successful with this client thus far.,"(A): What treatment would take the shortest amount of time because of the client's financial situation.
(B): A holistic view of the client.
(C): What has worked in the past for similar clients.
(D): What treatment has been successful with this client thus far.",A holistic view of the client.,B,"In determining the course of treatment, it is important for the counselor to not look at just fragments of the clinical picture. By looking at the client's history, culture and physical and mental health, an effective treatment plan can be more effectively established. Although what has worked in the past with similar cases can be helpful, each person is unique. In addition, although the client may have tried things in the past that did not work, does not mean they may not be successful in trying it again. Finally, putting a short timeframe on the course of treatment because of monetary constraints is not ethical. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
746,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,The least important area to focus on currently is?,Helping Shar develop coping skills,Psychoeducation on Shar's diagnosis,Shar's relationship with their mother,Shar's decline in school functioning,"(A): Helping Shar develop coping skills
(B): Psychoeducation on Shar's diagnosis
(C): Shar's relationship with their mother
(D): Shar's decline in school functioning",Shar's decline in school functioning,D,"Although Shar's academic functioning has suffered, this is likely a result of other symptoms Shar is experiencing. Once those are addressed, Shar's grades are likely to improve. Shar and Nadia used to have a positive relationship. Nadia can be a support to Shar as they go through this difficult time. Shar needs some coping skills as evident by their feelings of anger and hopelessness. It would also be beneficial for Shar to receive psychoeducation on their diagnosis, so they understand that their feelings of not belonging are not unique to them. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
747,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,The best modality of therapy to utilize with Molly would be?,Gestalt Therapy,Psychoanalysis,Cognitive Behavioral Therapy,Humanistic Therapy,"(A): Gestalt Therapy
(B): Psychoanalysis
(C): Cognitive Behavioral Therapy
(D): Humanistic Therapy",Cognitive Behavioral Therapy,C,"Cognitive Behavioral Therapy would be beneficial for Molly at this time as it is short term, structured and task oriented. It can address her irrational/rational thoughts and help her to examine the narrative she has in her head surrounding her father's death. Psychoanalysis is a long-term therapy which examines how the past influences current issues. In this case, we know that the factor which influenced Molly's symptoms is the death of her father. Also because of her recent hospitalization and consideration of cutting, it is important to address those things immediately. Some techniques in Gestalt therapy may be beneficial, such as the empty chair technique. However, it is important to address Molly's declination in functioning as well as the consideration of cutting which requires more immediate interventions. Additionally, the therapist's role in Gestalt therapy is more of a facilitator and it seems that Molly needs a more directive modality at this time. Although Humanistic Therapy is a positive approach which could be beneficial, it is typically unstructured and may not provide immediate relief of specific complaints. Currently Molly needs a short term, directive form of therapy. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
748, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,The ACA code of ethics states that counselors should consider diversity when assessing and diagnosing a client. A possible diversity factor which may have been overlooked in the intake/assessment process is?,Darrel's feelings about his assertiveness,Darrel's desire to not allow his parents to make decisions in his life,Darrel's stage of Racial identity,Darrel's lack of eye contact during the intake,"(A): Darrel's feelings about his assertiveness
(B): Darrel's desire to not allow his parents to make decisions in his life
(C): Darrel's stage of Racial identity
(D): Darrel's lack of eye contact during the intake",Darrel's lack of eye contact during the intake,D,"Darrel's lack of eye contact during the assessment process can be misconstrued as being evasive, when it is often a sign of respect in Asian cultures. It is important for counselors to take into consideration verbal and non-verbal behavior with a multi-cultural lens. Darrel's dissonance about his desire to not allow his parents to make decisions in his life is developmentally appropriate considering the life stage he is in. This idea was also openly stated by Darrel when he questioned why he had to do what they wanted anyway. Issues regarding racial identity and Darrel's feelings about assertiveness were shared in the second therapy session, so they were not relevant during the intake/assessment process. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
749,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ","As part of your post doctoral research, you have quantified the severity of the client's depressive episodes and found that the highest value is the same as 60% of your other samples. Which measure of central tendency have you found?",Median,Mean,Mode,Range,"(A): Median
(B): Mean
(C): Mode
(D): Range",Mode,C,"The mode is the most common number in a data set. The median is the middle of the set of numbersThe mean is the average of a data set. Therefore, the correct answer is (C)",professional practice and ethics
750,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.  10th session You have been seeing Gregory for therapy every week for the past three months. You have worked to improve the parent-child relationship and incorporated parent-management training into his treatment plan. You have taught Gregory's mother techniques to improve his behavior and support his emotional functioning. Also included in Gregory's treatment plan is improving impulse control, learning problem-solving skills, and improving social skills. You have used CBT interventions, structured activities, games, and role-playing exercises with Gregory to achieve these goals.    Today, Gregory begins the session by taking a paper from his backpack and handing it to you. You see that he received a high grade on his mid-term in Global Studies. You praise him for his hard work. Then, you ask him how it felt to get his grades back up. There is a long silence. Gregory is fidgeting with the string on his backpack. He turns, looks out the window, and whispers, ""Good, I guess."" You notice the client has tears in his eyes. You draw his attention to his behavior and affect and ask, ""Why are you upset after being successful with your exam?"" He shrugs his shoulders, looks at you, says, ""Would you stop asking me so many questions?"" and walks out of the office. You follow him into the waiting room and hear him tell his mom, ""I'll be in the car."" His mom looks confused. You say to her, ""Is something going on or did something happen with Gregory that I should know about? He seemed upset after showing me his good exam grades."" She thinks for a moment and tells you that he found a box of old family pictures and has been going through them. She wonders if this is related to his reaction today.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.","Using a Gestalt approach, what could you have done differently when you noticed that Gregory appeared sad and withdrawn?",Remained empathic,Used an exercise in locating his emotions,Introduced the empty chair technique,Engaged in a role-playing exercise,"(A): Remained empathic
(B): Used an exercise in locating his emotions
(C): Introduced the empty chair technique
(D): Engaged in a role-playing exercise",Used an exercise in locating his emotions,B,"Using this technique, you would ask the client to name the emotion they are feeling and identify where they feel the emotion in their body. This is particularly helpful with clients who don't know how or why they are responding in the moment. Therefore, the correct answer is (A)",counseling skills and interventions
751,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ",Which of the following would be an example of an exposure response prevention exercise?,To sit in the cafeteria with teammates during lunch and eat a small portion of food,To avoid interactions that trigger anxiety,To bring a lunch to eat by herself after basketball practice,To visit with teammates while they eat but refrain from eating during this time,"(A): To sit in the cafeteria with teammates during lunch and eat a small portion of food
(B): To avoid interactions that trigger anxiety
(C): To bring a lunch to eat by herself after basketball practice
(D): To visit with teammates while they eat but refrain from eating during this time",To sit in the cafeteria with teammates during lunch and eat a small portion of food,A,"Exposure involves facing or confronting one's fears repeatedly until the fear subsides, called habituation. Response prevention consists in refraining from compulsions, avoidance, or escape behaviors. Therefore, the correct answer is (A)",treatment planning
752,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",What detail shared by the client meets one of the diagnostic criteria for her diagnosis?,The client's lack of confidence in her abilities,The client's difficulty maintaining eye contact during the session,The client's intense anxiety about gaining weight,The client's strained relationship with her parents,"(A): The client's lack of confidence in her abilities
(B): The client's difficulty maintaining eye contact during the session
(C): The client's intense anxiety about gaining weight
(D): The client's strained relationship with her parents",The client's intense anxiety about gaining weight,C,"According to the DSM-5-TR, the criteria for Anorexia Nervosa are: (1) a persistent restriction of energy intake leading to significantly low body weight; (2) intense fear of weight gain or becoming fat, or persistent behavior that interferes with weight gain despite having a significantly low body weight; (3) disturbance in the individual’s perception of their body shape and size. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
753,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What would be considered operating outside your scope of practice as a school counselor when working with this client?,Providing a professional opinion regarding medication for the client,Encouraging the client's family to be involved in the process,Assisting with the Individualized Education Plan process,Collaborating with student support professionals,"(A): Providing a professional opinion regarding medication for the client
(B): Encouraging the client's family to be involved in the process
(C): Assisting with the Individualized Education Plan process
(D): Collaborating with student support professionals",Providing a professional opinion regarding medication for the client,A,"Providing opinions about medication is outside your scope of practice as a therapist. This would be done a professional who can perform medication evaluations such as a physician, psychiatrist, etc. Therefore, the correct answer is (C)",professional practice and ethics
754, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",What would be the best technique to use with Bob as you continue this discussion of him leaving?,confrontation,empathic validation,motivational interviewing,reality therapy,"(A): confrontation
(B): empathic validation
(C): motivational interviewing
(D): reality therapy",motivational interviewing,C,"The best technique to use with clients who disagree with course of treatment or in this case decide to leave a clinical program against medical advice (AMA) is motivational interviewing through conversation. This strategy employs a person-centered perspective that attempts to move an individual away from a specific negative behavior or maladaptive decision and towards using their own motivations to make positive changes. Using nonjudgmental, empathic questioning, you are more likely to uncover Bob's underlying motivations and help him develop a better safety plan. Validating Bob's feelings empathically as with answer a) is always appropriate; however, Bob is hyper-focused on making an unhealthy choice and is not currently sharing his feelings. Furthermore, validating Bob's stated choices can be confusing and render ineffective any attempts at getting him to stay in treatment. Reality therapy is also a client-centered form of CBT that focuses on improving present relationships and circumstances, but its intention is to avoid discussion of past events which is not ideal in the situation of trying to help Bob build insight into how past events have led him to where he is now. While its key concepts focus on choice, responsibility, and commitment to change, it is an exploration of processing what behaviors a client is displaying and whether it is interfering with them meeting their needs. It is an excellent choice of strategies for longer-term therapeutic techniques once Bob has decided to commit to the counseling program but will meet too many challenges if Bob is resistant and unwilling to engage. Confrontation is the preferred method by operational staff in many treatment facilities as it is usually conducted with appropriate clinical intentions by peers who can help a client in distress feel supported; but it is not an evidence-based method that a mental health counselor would choose in an individual session and especially not with a senior adult presenting as defensive. Confronting a client in this situation when they are within their legal right to leave a voluntary treatment program may result in the client making an even riskier departure which might further cause harm. Therefore, the correct answer is (C)",counseling skills and interventions
755,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client has attended and actively participated in all group therapy sessions. You are preparing the group for termination and discussing a “graduation” ceremony. The client has taken on a leadership role in the group, and you have asked him if he would be your “assistant” for the next group of neurodiverse men. The client approaches you, shakes your hand, and uses eye contact as he politely thanks you for the offer. You state you are pleased he has accepted. He then says, in a matter-of-fact tone, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills.”  You conduct a pre-test and post-test measuring each group member’s social skills and conclude that the group was ineffective","You conduct a pre-test and post-test measuring each group member’s social skills and conclude that the group was ineffective. If COVID-19 occurred between the pre-test and post-test, which factor likely served as a threat to the study’s internal validity?",History,Attrition,Maturation,Statistical regression,"(A): History
(B): Attrition
(C): Maturation
(D): Statistical regression",History,A,"The One Group Pre-test Post-test design is a non-experimental design. Non-experimental designs do not have a control group and lack internal validity due to the possibility for an unaccounted third variable, known as a spurious variable. Internal validity measures the cause-and-effect relationship between the independent variable and the dependent variable. In this study, the independent variable is the group intervention. The dependent variable is the pre-test/post-test outcome measure associated with improved social skills. The spurious variable is known as history. History influences outcomes when an event occurs between the first and second outcome measure. COVID-19 is the event that likely affected outcome variables in this study, particularly one on social skills. Statistical regression occurs when subjects score extremely high (or low) on the pre-test and show improvement simply due to the passage of time between each measure. Maturation affects internal validity when subjects are impacted by the passage of time (ie, in projects lasting several years). Attrition, or subjects dropping out of the study, also serves as a threat to internal validity. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
756,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,"All of the following are relevant areas of information for Molly's assessment, except?",Eating and sleeping habits,Social support,Parent/child relationship issues,Levels of daily stress,"(A): Eating and sleeping habits
(B): Social support
(C): Parent/child relationship issues
(D): Levels of daily stress",Parent/child relationship issues,C,"Although the quality of her relationship with her parents can lend some important information, this does not seem to be an issue at this point. Molly identified anxiety as the reason she came in. It is important to examine Molly's existing supports. Asking about her eating and sleeping patterns can help identify the severity of her symptoms and how they may be affecting her functioning. Stress seems to be a trigger for Molly so asking about her existing levels of stress would be relevant. Therefore, the correct answer is (A)",counseling skills and interventions
757,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,An important part of goal setting in this instance is?,Only setting long term goals,Getting parent approval,Involving the school in goal setting,Ensuring the school counselor agrees,"(A): Only setting long term goals
(B): Getting parent approval
(C): Involving the school in goal setting
(D): Ensuring the school counselor agrees",Involving the school in goal setting,C,"Since Michael's difficulties seem to center around school, it would benefit Michael to have the school involved in his goals. Although the parent may be involved in the planning process, it is not necessary for them to approve of the goals. It is also not necessary for the counselor to agree on the goals, as goals should be client driven. Setting both short term goals and long-term goals allows for the likelihood of success. Therefore, the correct answer is (B)",treatment planning
758,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,Harold is having difficulty thinking of goals that he needs to work on. The counselor should?,Tell Harold some goals that have been successful in similar situations,Terminate sessions with Harold,Ask Harold what are some things he would like to see changed,Ask Harold's supervisor for some suggestions,"(A): Tell Harold some goals that have been successful in similar situations
(B): Terminate sessions with Harold
(C): Ask Harold what are some things he would like to see changed
(D): Ask Harold's supervisor for some suggestions",Ask Harold what are some things he would like to see changed,C,"Asking Harold some things he would like to see changed highlights the standard of client centered therapy. The process of making goals in therapy can be daunting, especially for someone who does not feel like they need to be in therapy. Even though Harold's supervisor and HR recommended counseling, it would not be appropriate for Harold's supervisor to make his goals as goals should be client centered regardless of the reason for counseling. This helps to ensure success and motivation. Although the counselor may have done research in what types of goals can be effective, each person is individual and their goals should be as well. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
759,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which is the most appropriate action when referring a client to another provider?,Make a copy of the client's full chart and give it to the client to take to the provider,Have client contact referral and sign a release of records when completing intake forms,"Telephone the new provider and give client's name, contact information, and request provider reach out to schedule an appointment, but do not give diagnosis",Have client sign release of records then send letter to referring provider with client summary,"(A): Make a copy of the client's full chart and give it to the client to take to the provider
(B): Have client contact referral and sign a release of records when completing intake forms
(C): Telephone the new provider and give client's name, contact information, and request provider reach out to schedule an appointment, but do not give diagnosis
(D): Have client sign release of records then send letter to referring provider with client summary",Have client sign release of records then send letter to referring provider with client summary,D,"Having the client sign a release of records while your office facilitates connection between the referring and referral provider. The referring provider then can send a letter introducing the client, the reason for referral, and contact information. This minimizes miscommunication between the client and referral provider and may facilitate getting John into the provider more quickly. Confidentiality rules require that a counselor never divulges any identifying information about a client, even for referral, without a client's signed consent, so calling without that form would be inappropriate. You can have the client make an appointment and sign a release at the referral source's office, however, without the consent, the process could be delayed. Additionally, having signed the consent, the client is more likely to follow through with scheduling an appointment, particularly if contacted by the referred provider. Counselors do not provide clients with a complete chart. Upon request, clients may review their charts with a counselor and may request copies of progress notes. However, therapy notes are not shared with the client or when records are requested. Therefore, the correct answer is (C)",professional practice and ethics
760,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client.  You are frustrated because the client’s husband does not support her progress",You are frustrated because the client’s husband does not support her progress. Which one of the following is the most appropriate first response?,You support the client in developing communication skills to discuss her progress and health with her husband.,You provide a referral for couples counseling.,You and the client discuss coping skills in order to help her cope with her husband’s expression of frustration.,You encourage the client to invite her husband to another session in order to discuss his frustration with her weight gain.,"(A): You support the client in developing communication skills to discuss her progress and health with her husband.
(B): You provide a referral for couples counseling.
(C): You and the client discuss coping skills in order to help her cope with her husband’s expression of frustration.
(D): You encourage the client to invite her husband to another session in order to discuss his frustration with her weight gain.",You support the client in developing communication skills to discuss her progress and health with her husband.,A,"As your first response, it would be most helpful to support the client in having an effective conversation with her husband regarding her health and progress. If this is unhelpful, providing a referral for couples counseling might be the next best course of action. You would not invite the husband to sessions because you are the client’s individual therapist and would therefore not be an appropriate fit as the couple’s therapist due to the potential for bias. It can be helpful to support the client in coping with her husband’s level of frustration, but this is not the most helpful course of action because it implies acceptance of a situation that is potentially harmful to her progress. Therefore, the correct answer is (B)",professional practice and ethics
761,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","    plan. Family History: The client’s parents are divorced and he lives with his mother and two younger siblings. There is a history of child protective services (CPS) involvement due to reports of domestic violence between his parents. The client witnessed these incidents between that ages of 10 and 12. His parents subsequently divorced and the client has had minimal contact with this father since. The client’s maternal aunt is diagnosed with obsessive-compulsive disorder. His mother previously attended therapy for anxiety and other trauma-related symptoms. The client began experiencing symptoms of body dysmorphic disorder at age 13, with symptoms worsening after starting high school","Which of the following instruments uses a 21-item self-report questionnaire to determine one’s current intensity, frequency, and duration of suicidality?",Hamilton Depression Scale (HDS or HAM-D),Suicide Probability Scale (SPS),Columbia Suicide Severity Rating Scale (C-SSRS),The Beck Scale for Suicide Ideation (SSI),"(A): Hamilton Depression Scale (HDS or HAM-D)
(B): Suicide Probability Scale (SPS)
(C): Columbia Suicide Severity Rating Scale (C-SSRS)
(D): The Beck Scale for Suicide Ideation (SSI)",The Beck Scale for Suicide Ideation (SSI),D,"The Beck Scale for Suicide Ideation (SSI) is a 21-item scale measuring the intensity, frequency, and duration of suicidal attitudes, plans, and behaviors in the last 7 days. Measurements include the number of previous suicide attempts, deterrents to suicide, and the amount of time spent preparing and contemplating the last attempt. In addition to determining a suicide probability score, the Suicidal Probability Scale (SPS) measures suicidal ideation, hopelessness, hostility, and negative self-evaluation. The SPS is a 36-item self-report inventory. The Hamilton Rating Scale for Depression (HRSD) is an interviewer-administered measure of depression and suicidality. Finally, the Columbia Suicide Severity Rating Scale (C-SSRS) calculates suicidal risk, assesses suicidal attitudes and behaviors, and determines risk and protective factors. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
762,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",What information would be most relevant to consider to establish a treatment plan for this client?,"Age range, client's current behavior in class, and client's demeanor during intake","Age range, physical health, and client's behavior during the session","Mother and father's parenting style, current behavior in class, and trauma history","Trauma history, client's demeanor during intake, and social interactions with peers","(A): Age range, client's current behavior in class, and client's demeanor during intake
(B): Age range, physical health, and client's behavior during the session
(C): Mother and father's parenting style, current behavior in class, and trauma history
(D): Trauma history, client's demeanor during intake, and social interactions with peers","Age range, client's current behavior in class, and client's demeanor during intake",A,"Age range would be important to consider for determining age-appropriate treatment goals. In addition, the client's current behavior in class has been noted as one of the presenting problems as the client's demeanor toward the therapist during intake. Therefore, the correct answer is (D)",treatment planning
763,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",What do you need to clarify with the mother based on the session?,Identify who the client is,Whether the ex-husband needs to be involved in the client's therapy,Suggest the mother needs to continue seeing her therapist,The quality of the mother's interactions with her child.,"(A): Identify who the client is
(B): Whether the ex-husband needs to be involved in the client's therapy
(C): Suggest the mother needs to continue seeing her therapist
(D): The quality of the mother's interactions with her child.",Identify who the client is,A,"The daughter is the client, but the mother takes over the session. You may need the parent to come into the session if something is wrong or in danger; however, you need your client's trust to develop rapport. That will not happen if the mother continues to monopolize the session. You must clarify who the client is. Therefore, the correct answer is (A)",professional practice and ethics
764,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,"In developing Molly's treatment plan, which of the following would NOT be included in her short-term goals?",Crisis planning,Organizing a bereavement support group at her school,Development of existing strengths to increase coping skills,Joint sessions between Molly and her mother to help improve their relationship,"(A): Crisis planning
(B): Organizing a bereavement support group at her school
(C): Development of existing strengths to increase coping skills
(D): Joint sessions between Molly and her mother to help improve their relationship",Organizing a bereavement support group at her school,B,"Although this may be a future goal, at this time it seems that this would be a very large step for Molly. She is newly engaged in the therapeutic process and has not yet processed her grief. Molly has given up on one of the things she enjoyed doing- softball. It would help Molly to find other things to help her cope with her grief and building on her strengths would be better than starting a new hobby she has not mastered yet. It is important for Molly to also build her support network. She and her mother may have a tenuous relationship now, but only since her father's death. Bringing Molly's mother into sessions will help identify the cause of the relationship breakdown and find ways to improve it. Crisis planning is important to do with Molly to help her identify her triggers and to establish effective coping skills. If Molly does not have effective coping skills, creating a crisis plan can be a way to start building them. This is especially important since Molly was considering cutting as a way of coping. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
765,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","The client no-showed for her last session without calling to cancel. She arrives today, appearing disheveled and irritable. The client states that she has not been sleeping well. She explains that she was talking to someone on an online dating site and had planned a face-to-face meeting this past weekend. She says she waited at the bar for more than an hour and finally realized that her date had stood her up. She explained that she was in so much shame after the incident that she engaged in self-harm. The client reveals superficial razor cuts on her thigh and upper arm. She says she feels like she is a failure and undeserving of love.  The client has difficulty identifying and differentiating overwhelming emotions",The client has difficulty identifying and differentiating overwhelming emotions. What technique could help her experience gradations of feeling?,Mood monitoring,Affect labeling,Cue identification,Escalation point recognition,"(A): Mood monitoring
(B): Affect labeling
(C): Cue identification
(D): Escalation point recognition",Affect labeling,B,"Affect regulation consists of affect labeling, recognition of escalation points, mood monitoring, and cue identification. Affect labeling helps clients experience gradations of feeling by identifying and differentiating overwhelming emotions. Because individuals with BPD experience black-and-white thinking, there is a tendency to label feelings using polarized terms (eg, “I’m either angry or calm”). Helping clients identify and articulate gradations of feeling (eg, irritated, relieved) allows for the acknowledgment of shades of gray and eventually the client learning to tolerate a range of emotions. Recognition of escalation points breaks down the client’s thinking, acting, and behaving before an unregulated emotional event. Mood monitoring is used to help clients keep track of patterns and changes in moods. Finally, cue identification helps identify problematic behaviors that can be altered. This is done by having the client identify internal cues rather than external triggers. Therefore, the correct answer is (C)",counseling skills and interventions
766,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.  Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms.  Ninth session Rober arrives elated at the session, appearing happy, talkative, and smiling. He states that he has felt this way for four days now, which has not been the typical length of time or the intensity of his positive mood episodes. He reports that his family relationships are satisfactory, and he has been somewhat successful at his part-time job at the local lumberyard. However, he is angry with his manager, who says he has been too distracted this past week and spends more time talking with customers than working. He is still drinking three beers at night to sleep but reports that he has not had to sleep much this past week and feels ""wide awake."" He says he is ready to open his own business but isn't sure what he wants to do yet.  Roger reports feeling energized, creative, and motivated over the past several days. He has come up with many new business ideas that he is eager to pursue, including opening a restaurant, starting a landscaping company, and developing a crypto blockchain. Roger stays up late into the night brainstorming ideas and making extensive plans. He feels compelled to act on his ideas immediately and has already taken steps to register business names and research loans. However, the next day, Roger often changes course, dropping previous ideas for new ones that seem even more exciting. His friends notice his frenzied pace in bouncing from idea to idea, worrying he has taken on too much. But Roger reassures them this surge of creativity allows him to see endless possibilities for his future business success. Though well-intended, their skepticism only pushes him to work harder to bring his visions to life.  Roger also mentions experiencing increased sociability and talkativeness lately. He says he has frequently called and texted friends and family to share his business ideas and other excited thoughts. Roger speaks rapidly, his thoughts racing as he tries to get loved ones as enthused as he feels. Though some gently try to interject realistic concerns, he remains unchecked in his ambitious optimism. A few close friends have expressed concern over Roger's intensified pace and plans, but he brushes them off, feeling very optimistic and self-assured about his ideas. Roger's confidence borders on grandiose as he envisions an incredibly successful entrepreneurial future. Attempts by caring friends and family to restrain his inflated self-assurance are met with irritation, as Roger feels unable to focus on anything but chasing his next big idea. He's optimistic that his new crypto blockchain will rival and surpass Bitcoin in a matter of months.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.","Given the client's altered behavioral presentation and the description of several new symptoms since the last session, what factors should you consider?",The client is presently grappling with thoughts of self-harm or suicide.,The client is currently experiencing a psychotic state.,The client is currently in the midst of a depressive episode.,The client is currently in a hypomanic state.,"(A): The client is presently grappling with thoughts of self-harm or suicide.
(B): The client is currently experiencing a psychotic state.
(C): The client is currently in the midst of a depressive episode.
(D): The client is currently in a hypomanic state.",The client is currently in a hypomanic state.,D,"The client's talkativeness at work, lack of need for sleep, elated mood, increased goal-directed activity, and these symptoms lasting for four days suggest hypomania. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
767,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client reports that he has been sleeping more than usual and that this is affecting his ability to get to work on time. He reports that his boss started noticing his tardiness and has given him a verbal warning. Combined with the fear of losing his job, he expressed worry regarding increased conflict with his girlfriend and feeling more “on edge.”  Due to the client’s difficulty with sleep, you provide psychoeducation on sleep hygiene","Due to the client’s difficulty with sleep, you provide psychoeducation on sleep hygiene. Sleep hygiene involves all of the following foci EXCEPT:",Room temperature,Time of initiation of sleep and time of waking,Maintaining 9 to 12 hours of sleep per 24 hours for a 25-year-old,Mindfulness activities prior to bed,"(A): Room temperature
(B): Time of initiation of sleep and time of waking
(C): Maintaining 9 to 12 hours of sleep per 24 hours for a 25-year-old
(D): Mindfulness activities prior to bed",Maintaining 9 to 12 hours of sleep per 24 hours for a 25-year-old,C,"At age 25, it is recommended to get at least 7 hours of sleep per night. The 9- to 12-hour range is more appropriate for the age range of 6 to 12 years old. Consistent times of sleep initiation and waking are important in improving sleep. The room temperature also impacts the quality of sleep, although temperature needs vary from person to person. Mindfulness and relaxation activities can help calm the body as a means to better prepare him for sleep. Therefore, the correct answer is (C)",treatment planning
768,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",Which assessment tool would be most relevant to use given the client's statements during the Mental Status Examination?,California Psychological Inventory (CPI),Self-Directed Search Form (SDS),Mini Mental Status Exam (MMSE),CAGE Questionnaire,"(A): California Psychological Inventory (CPI)
(B): Self-Directed Search Form (SDS)
(C): Mini Mental Status Exam (MMSE)
(D): CAGE Questionnaire",CAGE Questionnaire,D,"This is a short questionnaire you can present to your client to determine whether your client's alcohol consumption has become hazardous to her health. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
769,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","You have attempted to arrange a family session with the mother, but she is unable to take off work to attend. The client arrives for his second session eager to share that he is “on green” this morning, which means the client’s behavior for the day has been good. You praise him for staying in his seat and keeping his hands and feet to himself. The client responds well to your praise. When engaging in a feelings identification activity, the client identifies feeling unhappy and worried when his father doesn’t show up for scheduled visitation. The client explains that his parents frequently argue about “how to take care of me” and “sometimes push each other.” He quickly abandons the feelings activity and asks if he can go back to class. You deny the client’s request to leave and instead give him the option of selecting another activity. The client refuses to do so and begins to kick your file cabinet repeatedly. He proceeds to knock papers off your desk. When redirected, the client’s behavior escalates. He quickly becomes inconsolable as he cries and yells, “I hate counseling, this school, and everyone in it!”  You arrive at school one morning and find the child’s father in the main office. He is requesting to talk to you about his son",You arrive at school one morning and find the child’s father in the main office. He is requesting to talk to you about his son. What is the best way for you to proceed?,Tell the father that you can listen to his concerns but cannot disclose any information.,Explain to the father that you can only see him if the client’s mother provides written consent.,State that you cannot disclose whether or not the child is your client and cannot meet with him.,Tell the father you only work by appointment and arrange to see him the following week.,"(A): Tell the father that you can listen to his concerns but cannot disclose any information.
(B): Explain to the father that you can only see him if the client’s mother provides written consent.
(C): State that you cannot disclose whether or not the child is your client and cannot meet with him.
(D): Tell the father you only work by appointment and arrange to see him the following week.",Tell the father you only work by appointment and arrange to see him the following week.,D,"You can arrange to meet with the father by appointment, which would not breach confidentiality as he is the client’s biological father. Since this client’s mother has physical custody, the father also has the right to participate in counseling when clinically appropriate. When determining applicable legal and ethical guidelines regarding confidentiality, it is essential for you to first differentiate between legal custody and physical custody. Parents with legal custody can make unilateral decisions regarding their child’s treatment. In cases where the courts have established legal custody, you must obtain a copy of the court order before initiating counseling services. With physical custody, the issue of consent is irrelevant. That is, both parents can make treatment decisions on behalf of their child, and both parents have the right to request their child’s mental health records. By making an appointment with the father, you establish professional boundaries and allow yourself time to seek supervision and consultation for this complex ethical matter. Although state laws vary, if there is a court order (ie, an emergency protective order (EPO) or a domestic violence order (DVO) against the father, then he would be violating this order simply by being at the child’s school. If you believe the father poses an imminent risk to the child at any point in therapy, you are mandated to make child protective services (CPS) report. You may also refuse to see the father if you feel that your safety is compromised or believe your contact with the father is detrimental to the client’s treatment. In these complex cases, you must follow an ethical decision-making model and seek supervision and consultation to determine the best course of action. Therefore, the correct answer is (C)",professional practice and ethics
770,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","   iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents","At this point in counseling, what referrals might be appropriate to consider in addition to individual/family therapy?",Applied behavior analysis,Occupational therapy,Play therapy,Psychiatry for medication management,"(A): Applied behavior analysis
(B): Occupational therapy
(C): Play therapy
(D): Psychiatry for medication management",Play therapy,C,"Play therapy may be beneficial because it can help children to improve communication and explore/express their emotions. Applied behavior analysis would not be indicated because the client is able to engage in cognitive counseling, which means talk therapy would be more beneficial. Medication management may be beneficial at some point, but there are no Food and Drug Administration-approved medications for oppositional defiant disorder, and therapy tends to be more effective than medication. Occupational therapy is not indicated because the individual appears to have no cognitive, physical, or sensory issues that would require skill development. Therefore, the correct answer is (D)",counseling skills and interventions
771,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group, and they appear to be starting to become more comfortable with one another. You noticed that throughout the past week, when you saw your clients on their unit, they were spending more time together and that they are all talking when they come in for the session. During the session, you and the clients discuss past experiences that led to them engaging in the crimes that led to their incarceration. During this conversation, client 1 is talking about his father and how he killed a pedestrian while driving. Client 4 then asserts that client 1’s father is going to hell for killing someone. You cut off client 4 and redirect the attention back to client 1","According to Tuckman’s stages of group development, which stage is this group in?",Performing,Forming,Storming,Norming,"(A): Performing
(B): Forming
(C): Storming
(D): Norming",Storming,C,"The storming phase focuses on group members establishing a hierarchy and often involves conflict even as group cohesion is developing. The forming stage is the initial stage in which the group comes together and becomes acquainted. The storming phase follows the forming stage. The norming phase is when the group members agree on how the group should be run and how individuals should interact. The performing stage is when the group is most productive and is working toward their goals. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
772,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",How might you initiate the first meeting with this client?,"You review the client's chart for accuracy, obtain his informed consent, and proceed with treatment.",You obtain the client's roommate's contact information.,You seek permission from the client's father to proceed with therapy.,You obtain a signed release from the client for case notes from previous treatment.,"(A): You review the client's chart for accuracy, obtain his informed consent, and proceed with treatment.
(B): You obtain the client's roommate's contact information.
(C): You seek permission from the client's father to proceed with therapy.
(D): You obtain a signed release from the client for case notes from previous treatment.","You review the client's chart for accuracy, obtain his informed consent, and proceed with treatment.",A,"The client and his file have been transferred to your caseload. You'll need to do a thorough review of the client's chart, obtain informed consent, and discuss his diagnosis and treatment plan. Therefore, the correct answer is (A)",professional practice and ethics
773,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.",,"Ideally, the initial session of the group should involve:",Reminding members that confidentiality is guaranteed,Urging members to refrain from discussing all of their feelings,Encouraging members to confront others' behavior to build norms,A review of group structure and basic tasks,"(A): Reminding members that confidentiality is guaranteed
(B): Urging members to refrain from discussing all of their feelings
(C): Encouraging members to confront others' behavior to build norms
(D): A review of group structure and basic tasks",A review of group structure and basic tasks,D,"This should be reviewed in the initial stage of the group. Therefore, the correct answer is (C)",treatment planning
774,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",Which of the following meets the criteria for a S.M.A.R.T. goal?,"The client will sleep eight hours at night, increasing her sleep from four hours of sleep at night. She will complete this goal over three months.",The therapist will treat the client’s trauma symptoms.,"The client will sleep eight hours at night, increasing her sleep from four hours of sleep at night. She will complete this goal in two weeks.",The client will challenge her negative thoughts about the world.,"(A): The client will sleep eight hours at night, increasing her sleep from four hours of sleep at night. She will complete this goal over three months.
(B): The therapist will treat the client’s trauma symptoms.
(C): The client will sleep eight hours at night, increasing her sleep from four hours of sleep at night. She will complete this goal in two weeks.
(D): The client will challenge her negative thoughts about the world.","The client will sleep eight hours at night, increasing her sleep from four hours of sleep at night. She will complete this goal over three months.",A,"This goal meets all the criteria of a SMART. Specifying a specific amount of time to achieve this goal focuses on the T (time-sensitive) criteria of a SMART. goal in treatment in particular. Therefore, the correct answer is (B)",treatment planning
775,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.",Which of the following would be most appropriate to say to the client?,It sounds like you have quite a lot more to deal with at home than you told me last time.,"It sounds like your family is worried about taking care of you, not your property",I wonder what it is like for you to hear your DIL share her concerns about you.,I wonder if we need to figure out a way to help you get all that stuff cleaned out.,"(A): It sounds like you have quite a lot more to deal with at home than you told me last time.
(B): It sounds like your family is worried about taking care of you, not your property
(C): I wonder what it is like for you to hear your DIL share her concerns about you.
(D): I wonder if we need to figure out a way to help you get all that stuff cleaned out.",I wonder what it is like for you to hear your DIL share her concerns about you.,C,"Asking the client what it was like to hear her DIL express her concerns about the client and her living space allows the counselor to observe the client's insight, defensiveness, and assess symptoms of paranoid delusions while giving the client the opportunity to hear her family's perspective in a safe environment. This helps build trust in the counselor-client relationship. Statements shown in Options b and d are confrontational as they call attention to the discrepancy between what the client originally presented and what her DIL is now saying. Confrontations or suggestions that the client may not be truthful are not helpful in facilitating trust in the client-counselor relationship. While helping the client reduce and recover from hoarding may be an ultimate goal, suggesting this at this time is likely to cause the client to become anxious and suspicious of the counselor's motives as this has not been discussed between them. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
776,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.",aged. Family History: The client reports that she is close with her parents but that they often have high expectations of her and that she worries about disappointing them. The client has an older brother who is 25 and is a lawyer. The client says some of the pressure is wanting to be as successful as her brother because she thinks her parents are really proud of him,"Although you suspect that the client has panic disorder, all of the following diagnoses or areas should be assessed as differential diagnoses, EXCEPT:",The possibility of generalized anxiety disorder,The possibility of major depressive disorder,Cognitive processes that occur when experiencing a panic attack,"Whether the panic attacks are expected, unexpected, or both","(A): The possibility of generalized anxiety disorder
(B): The possibility of major depressive disorder
(C): Cognitive processes that occur when experiencing a panic attack
(D): Whether the panic attacks are expected, unexpected, or both",The possibility of major depressive disorder,B,"Major depressive disorder is not indicated as a possible differential diagnosis for this client, although depression and anxiety often present together. Generalized anxiety disorder and other anxiety disorders should be assessed because the client might be having panic attacks that are based on underlying anxiety that she is experiencing. Panic disorder is characterized by unexpected panic attacks; therefore, it would be helpful to determine if the attacks are related to other anxious thoughts and cognitive processes or if they occur on their own. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
777,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.",ntly. Family History: The client has an older brother who transports the client to appointments and periodically checks in with the client. Hospital records indicate that the client becomes increasingly agitated during visits with his parents. The hospital social worker noted that his father was critical and dismissive toward the client during family therapy. The client’s mother is diagnosed with generalized anxiety disorder and had to quit her job due to the overwhelming burden of the client’s care. The father blames the client for the excessive toll his illness has placed on the family,How should you respond to the client’s desire to stay off medication and out of the hospital?,Tell him you will work with him to avoid rehospitalization if he agrees to be evaluated for a different medication.,Tell him you will grant an extended trial period off medication and re-assess at his next visit.,Tell him you will work with him to avoid rehospitalization if he agrees to take his medication.,"Tell him you will work with him to avoid rehospitalization, and he is not obligated to take medication.","(A): Tell him you will work with him to avoid rehospitalization if he agrees to be evaluated for a different medication.
(B): Tell him you will grant an extended trial period off medication and re-assess at his next visit.
(C): Tell him you will work with him to avoid rehospitalization if he agrees to take his medication.
(D): Tell him you will work with him to avoid rehospitalization, and he is not obligated to take medication.","Tell him you will work with him to avoid rehospitalization, and he is not obligated to take medication.",D,"The most ethically sound response is to tell him you will work with him to avoid rehospitalization, and he is not obligated to take medication. Counselors have the ethical obligation to abide by the principles outlined in the American Counseling Association Code of Ethics (2014). Answer C honors the principles of autonomy and justice. Autonomy involves allowing individuals to control the direction of their lives. Justice necessitates fair and equitable treatment. At this juncture, the client is oriented and is not a harm to himself or others. Trust is the cornerstone of counseling, and it is the counselor’s responsibility to ensure the counseling environment is safe. All other answer options reflect the notion of a transactional relationship between taking medication and avoiding hospitalization, which creates a power imbalance between the client and counselor and can impede the client’s growth and autonomy. Therefore, the correct answer is (C)",counseling skills and interventions
778,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","You have attempted to arrange a family session with the mother, but she is unable to take off work to attend. The client arrives for his second session eager to share that he is “on green” this morning, which means the client’s behavior for the day has been good. You praise him for staying in his seat and keeping his hands and feet to himself. The client responds well to your praise. When engaging in a feelings identification activity, the client identifies feeling unhappy and worried when his father doesn’t show up for scheduled visitation. The client explains that his parents frequently argue about “how to take care of me” and “sometimes push each other.” He quickly abandons the feelings activity and asks if he can go back to class. You deny the client’s request to leave and instead give him the option of selecting another activity. The client refuses to do so and begins to kick your file cabinet repeatedly. He proceeds to knock papers off your desk. When redirected, the client’s behavior escalates","Given the severity of the client’s emotional and behavioral difficulties, as well as the disruptive behavior displayed during this session, what would be your next best step?",Arrange for an alternative school placement.,Initiate an immediate psychiatric medication evaluation.,Refer the family for intensive in-home family therapy services.,Conduct a crisis risk assessment.,"(A): Arrange for an alternative school placement.
(B): Initiate an immediate psychiatric medication evaluation.
(C): Refer the family for intensive in-home family therapy services.
(D): Conduct a crisis risk assessment.",Conduct a crisis risk assessment.,D,"The client, who initially had a good morning, quickly becomes inconsolable and destructive when recalling his parents’ domestic violence. Conducting a crisis risk assessment prioritizes safety concerns, making it an essential step in providing vital services to a client with multiple risk factors (eg, bullying, trauma, attachment, poor school performance, hopelessness, and mood instability). A comprehensive risk assessment helps determine the intensity of treatment services required to meet the client’s current needs. A referral to a psychiatrist or to an in-home treatment provider would likely be part of a crisis plan of care but are inadequate as stand-alone interventions. An appointment with a psychiatrist may take time to secure, and parental consent is required before placing a child on medication. Also, certain medications take time to build up in the client’s system before symptom reduction occurs. As part of a crisis plan, a referral for intensive in-home therapy may be helpful as the mother’s work schedule compromises her availability. However, wrap-around services, such as intensive-in-home treatment and a referral for case management, are likely to be identified and prioritized after analyzing the risk assessment results. The client is already in the process of being evaluated for special education; therefore, you cannot unilaterally arrange for an alternative school placement. Federal laws require the client to be placed in the least restrictive environment, with specific procedural standards outlined in PL 94-142 (the Individuals with Disabilities Education Act). Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
779,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","   bile. Family History: The client has two younger brothers who are 6 and 7 years old. The client often engages in physical fights and arguments with his younger siblings and often will break or steal their toys. The client takes advantage of his 6-year-old sibling by conning him out of items and activities by convincing him that a certain trade or decision is better for him, when it is usually better for the client. The client’s parents report that these behaviors occur at school and that the client does not have any friends as far as they are aware. The client’s parents state that the client is adopted and that he was in foster care from when he was 2 until he was 4 years old. The client’s parents state that his basic needs were neglected because his birth mother was heavily using drugs",Which one of the following would be considered a differential diagnosis for conduct disorder?,Reactive attachment disorder,Antisocial personality disorder,Major depressive disorder,Autism spectrum disorders,"(A): Reactive attachment disorder
(B): Antisocial personality disorder
(C): Major depressive disorder
(D): Autism spectrum disorders",Major depressive disorder,C,"Major depressive disorders often present in children and adolescents as aggression, irritability, and conduct problems; therefore, it is important to rule out depressive disorders when assessing a child that presents this way. Reactive attachment disorder involves an unstable attachment with caregivers, and it is not considered a differential diagnosis for conduct disorder. Although antisocial personality disorder and conduct disorder both involve the violation of the rights of others, a diagnosis of antisocial personality disorder requires the child to be at least 15 years of age. Autism spectrum disorders are at times characterized by behavioral dysfunction that stems from having difficulty feeling empathy, but they are not defined by an intentional violation of the rights of others. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
780,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","Since the start of counseling and services with the local government mental health agency, the client has maintained sobriety from fentanyl and has been moved into stable housing via assistance from the agency. The client reports that the management of his anxiety has been better, but that he often feels lonely and unengaged. The client states that he is not sleeping well and thinks it is because he does not do much during the day. He continues to participate in Narcotics Anonymous daily in order to have interactions with other people. The client says that he tried to reach out to his children but they would not answer his phone call. You empathize with the client regarding his difficulty reaching out to his children. You and the client use this session in order to review progress and identify new goals",Which of the following would be an appropriate goal to focus on based on this session?,Explore reentering the workforce,Focus on improving hygiene and daily living skills,Continue the current focus,Reconnect with family,"(A): Explore reentering the workforce
(B): Focus on improving hygiene and daily living skills
(C): Continue the current focus
(D): Reconnect with family",Explore reentering the workforce,A,"The client is showing signs that he is prepared to explore reentering the workforce. The client has accomplished 10 weeks of sobriety, consistent participation in all services with the local government agency, and maintained housing for 7 weeks. Engaging in work can provide the client with a sense of purpose, meet some social needs for the client, and is part of adult life that the client will need in order to maintain consistent housing and meet his additional financial needs and desires. The client’s family does not appear to be ready to reengage with him at this point because they do not respond to phone calls. The client’s daily living skills were not mentioned in the session note and are therefore not indicated as an immediate or current need. The current focus of therapy should not be continued because the client’s situation has improved significantly and he has maintained progress. Therefore, the correct answer is (B)",treatment planning
781,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client contacted you to reschedule a session sooner than the one you had originally scheduled. The client reported that he continues to have difficulty getting to work on time and was told that he needs to meet with his supervisor on Friday. The client expresses anxiety surrounding this because he worries about getting fired. The client began to cry during the session when talking about worry regarding being unemployed. The client came to the session in clothes that had stains on them, and his hair was messy and appeared greasy",Which of the following is the least appropriate way to support a client who is crying during a therapy session?,Using immediacy,Using empathy,Providing self-disclosure so the client does not feel alone,Normalizing the client’s emotions,"(A): Using immediacy
(B): Using empathy
(C): Providing self-disclosure so the client does not feel alone
(D): Normalizing the client’s emotions",Providing self-disclosure so the client does not feel alone,C,"Although self-disclosure may be appropriate at times in order to connect, it should only be used when it is relevant to the subject at hand. Because of the sensitivity and specificity required in using self-disclosure, it is the least appropriate way to support a client who is crying. Rather, this moment should be used to provide space for the client to experience their emotions and process their feelings. Empathy helps a client feel heard, and normalizing emotions assists clients with feeling that their feelings are valid. Immediacy focuses on inviting the client to evaluate what is happening internally in the moment when an emotion is experienced. Therefore, the correct answer is (B)",professional practice and ethics
782,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",Which action would be least effective when formulating an effective treatment plan?,Create SMART long-term goals and assess any difficulties in your treatment plan,"Examine safety plans, which may include medication management",Develop short-term objectives designed to address the client's behavior deficits,Generate short-term goals using the SMART format and assess any barriers in your treatment plan,"(A): Create SMART long-term goals and assess any difficulties in your treatment plan
(B): Examine safety plans, which may include medication management
(C): Develop short-term objectives designed to address the client's behavior deficits
(D): Generate short-term goals using the SMART format and assess any barriers in your treatment plan",Develop short-term objectives designed to address the client's behavior deficits,C,"Treatment plans are designed to be strength-based to help empower the client to prioritize goals. Highlighting the client's areas of weakness is counterproductive to moving forward in therapy. Therefore, the correct answer is (A)",treatment planning
783,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","   e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination",Which one of the following is an accurate depiction of gender identity?,"One’s conception of being either male, female, or something else","Congruence between one’s gender identity, gender expression, and gender assigned at birth",Incongruence between one’s experienced/expressed gender and gender assigned at birth,"One’s outward expression as being either male, female, or something else","(A): One’s conception of being either male, female, or something else
(B): Congruence between one’s gender identity, gender expression, and gender assigned at birth
(C): Incongruence between one’s experienced/expressed gender and gender assigned at birth
(D): One’s outward expression as being either male, female, or something else","One’s conception of being either male, female, or something else",A,"Gender identity is a person’s conception of being either male, female, or something else. Gender expression is defined as one’s outward expression as being either male, female, or something else. Cisgender is the congruence between one’s gender identity, gender expression, and gender assigned at birth. Cisgender can be described as a cisgender man or a cisgender woman. Gender dysphoria occurs when there is incongruence between one’s experienced/expressed gender and their gender assigned at birth. Gender dysphoria also includes possible destress from the incongruence between one’s experienced and assigned genders. All conceptions of gender are culturally determined. Therefore, the correct answer is (A)",professional practice and ethics
784,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.",Your client has expressed concern that you appear so young and questions your professional experience since you are not licensed. What is the best response to the client’s concerns?,"""I understand your concern about my age. This is my last week of internship, and I've already passed my licensing exam. I'm sure I can address your problem regardless of how young I may appear.""","""I understand your concern. I'm a supervised intern and have been trained in the same way as the other therapists at the agency.""","""I understand your concern, but I'm a qualified Registered Mental Health Counselor Intern. I'm certain I can help you, regardless of the fact that I haven't been at the agency as long as other therapists working here.""","""I understand your concern, but age doesn't make a difference in my ability to help you. I'm confident I will provide you with the quality of care you need.""","(A): ""I understand your concern about my age. This is my last week of internship, and I've already passed my licensing exam. I'm sure I can address your problem regardless of how young I may appear.""
(B): ""I understand your concern. I'm a supervised intern and have been trained in the same way as the other therapists at the agency.""
(C): ""I understand your concern, but I'm a qualified Registered Mental Health Counselor Intern. I'm certain I can help you, regardless of the fact that I haven't been at the agency as long as other therapists working here.""
(D): ""I understand your concern, but age doesn't make a difference in my ability to help you. I'm confident I will provide you with the quality of care you need.""","""I understand your concern. I'm a supervised intern and have been trained in the same way as the other therapists at the agency.""",B,"This is the most appropriate response. You have acknowledged the client’s concern and emphasized your qualifications and training. Therefore, the correct answer is (B)",counseling skills and interventions
785, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,Li should be referred to?,Care manager,A group for human trafficking survivors,All of the above,Employment counselor,"(A): Care manager
(B): A group for human trafficking survivors
(C): All of the above
(D): Employment counselor",All of the above,C,"All of the above would be helpful for Li. Being part of a group for human trafficking survivors can provide support for Li while helping her to see that she is not alone. An employment counselor can help her target a job congruent with her skills and interests. A care manager can help Li to coordinate her services. Therefore, the correct answer is (D)",professional practice and ethics
786,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",Which of Malia's observable behaviors presented as diagnostic of ADHD?,impaired ability to follow multi-step directions,impulsivity and inability to sit still,All behaviors give diagnostic impression of ADHD.,impulsivity and defiance,"(A): impaired ability to follow multi-step directions
(B): impulsivity and inability to sit still
(C): All behaviors give diagnostic impression of ADHD.
(D): impulsivity and defiance",All behaviors give diagnostic impression of ADHD.,C,"The DSM-5 classifies ADHD as a Neurodevelopmental disorder and requires criteria from several categories be met to diagnose ADHD. Malia's symptoms of impulsivity, inattention, hyperactivity, defiance, inability to follow multi-step directions are all symptoms present in children with ADHD. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
787, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Attention and concentration deficits 
Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",Which type of therapy encompasses teaching emotion regulation and distress tolerance that would be helpful for Avery in case of future behavioral outbursts?,Holistic Therapy,Cognitive Behavioral Therapy,Applied Behavior Analysis,Dialectical Behavioral Therapy,"(A): Holistic Therapy
(B): Cognitive Behavioral Therapy
(C): Applied Behavior Analysis
(D): Dialectical Behavioral Therapy",Dialectical Behavioral Therapy,D,"Emotion regulation and distress tolerance are taught facets from the school of Dialectical Behavioral Therapy (DBT) which would be helpful for Avery in learning how to manage his emotions, tolerate frustration and regulate his affect. This is especially a good choice for a client who has little insight into their problem (either from a maturity standpoint, age, cognitive ability, or to help with personality disorder) and needs help controlling their bodily reactions immediately without necessarily understanding the underlying reasons why they react the way they do. Cognitive behavioral therapy (CBT) approaches will also be useful for Avery but focus on identifying and changing negative beliefs and thought patterns that contribute to maladaptive behaviors, which is critical for long term change. Applied Behavior Analysis (ABA) is the preferred intervention for autism, and holistic therapies can be considered to provide additional support but are not all clinically evidence-based and do not directly apply to the interventions listed in the question. Therefore, the correct answer is (B)",counseling skills and interventions
788,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",Which of the client's symptoms best supports her diagnosis?,"Her tumultuous relationships with co-workers, friends, and family",Her excessively talkative behavior,Her desire to be liked,"Comments of her being ""like an emotional roller coaster""","(A): Her tumultuous relationships with co-workers, friends, and family
(B): Her excessively talkative behavior
(C): Her desire to be liked
(D): Comments of her being ""like an emotional roller coaster""","Comments of her being ""like an emotional roller coaster""",D,"Cyclothymia causes emotional ups and downs, but they are not as extreme as those seen in Bipolar I or II Disorder. With Cyclothymia, the client experiences periods when the mood noticeably shifts up and down from the baseline. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
789, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.",Which of the following interventions will be most beneficial during termination when the client and client's mother object to your not working with them?,Offer to talk with the supervisor and see if a change can be made to your caseload,Tell them that the counselor they will be going to is better than you so they shouldn't worry,Acknowledge the trust they have in you and focus on the new counselor's trustworthiness,Explain that you understand their pain but this is company policy and has to be done,"(A): Offer to talk with the supervisor and see if a change can be made to your caseload
(B): Tell them that the counselor they will be going to is better than you so they shouldn't worry
(C): Acknowledge the trust they have in you and focus on the new counselor's trustworthiness
(D): Explain that you understand their pain but this is company policy and has to be done",Acknowledge the trust they have in you and focus on the new counselor's trustworthiness,C,"Termination can be frightening for clients who have built trust in a provider. Acknowledging that trust and helping the new clinician build that same trust will be important. This may include focusing on times you and the clinician have worked together and your trust in that individual or focusing on the skills that the clients used to build trust with you which they can, in turn, use with the new provider. It is never helpful to position the agency as unyielding or uncaring and that a client's care is just a matter of policy. This engenders distrust of the agency. Additionally, offering to see if the termination can be stopped demonstrates a lack of objectivity on the part of the counselor. When a counselor loses objectivity with a client, a referral is helpful for the client's continued growth. Telling clients that another counselor is better than you, is likely to be received as untruthful, superficial and/or patronizing. Therefore, the correct answer is (A)",professional practice and ethics
790,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.",Which is an accurate statement when providing psychoeducation about NCDs and medication?,Research indicates that effective medication management can address symptoms and decelerate the advancement of NCDs.,Medication management can help prevent the development of NCDs.,Medication management is a risky treatment choice due to the unwanted side effects.,Research has indicated that medication management can potentially reverse the effects of NCDs.,"(A): Research indicates that effective medication management can address symptoms and decelerate the advancement of NCDs.
(B): Medication management can help prevent the development of NCDs.
(C): Medication management is a risky treatment choice due to the unwanted side effects.
(D): Research has indicated that medication management can potentially reverse the effects of NCDs.",Research indicates that effective medication management can address symptoms and decelerate the advancement of NCDs.,A,"This response is accurate and provides the client with hope while not overpromising the likely effects of medication. Therefore, the correct answer is (C)",counseling skills and interventions
791,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,The approach the counselor chose is consistent with?,Cognitive Behavioral therapy,Behavior therapy,Adlerian therapy,Feminist therapy,"(A): Cognitive Behavioral therapy
(B): Behavior therapy
(C): Adlerian therapy
(D): Feminist therapy",Cognitive Behavioral therapy,A,"The approach described above is cognitive behavior therapy. The focus in cognitive behavior therapy is to demonstrate to the client their faulty beliefs. It is short term and directive. Adlerian therapy is longer term and looks at childhood experiences and family constellations. Behavior therapy does not look at the causes of behavior but focuses on repeating positive behaviors and extinguishing negative. Since there are no gender specific issues that Elaine would like to work on, Feminist therapy would not be an ideal modality. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
792,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","You are on maternity leave, and your supervisor is covering your cases while you are out of the office. The supervisor meets with the client and daughter for the first time today and discusses the client’s progress and her treatment plan goals. The client and her daughter report measurable improvements with symptoms of depression and apathy. During today’s session, the supervisor also learns that you and the daughter went to high school together and share multiple acquaintances. There is no documentation in the client’s chart indicating that the risks and benefits of multiple relationships were reviewed with the client. At the end of the session, the supervisor asks the client for her copay. The daughter and the client state that you have “always just waived the copay,” indicating that the final bill would eventually be “written off by the agency.”  Which of the following statements best reflects the supervisor and counselor’s ethical responsibility for collecting the client’s agreed-upon fees (i\. e","Which of the following statements best reflects the supervisor and counselor’s ethical responsibility for collecting the client’s agreed-upon fees (i.e., copays)?",Collecting copays is not permissible because there was a verbal agreement that the fees would be “written off.”,Waiving copays is permissible only if a predetermined fee-splitting contract exists between the counselor and the supervisor.,Collecting copays through a collection agency is permissible if the client was originally informed of this possibility and previous efforts were made to collect copays.,Waiving copays is permissible when it contributes to the public good (pro bono publico.),"(A): Collecting copays is not permissible because there was a verbal agreement that the fees would be “written off.”
(B): Waiving copays is permissible only if a predetermined fee-splitting contract exists between the counselor and the supervisor.
(C): Collecting copays through a collection agency is permissible if the client was originally informed of this possibility and previous efforts were made to collect copays.
(D): Waiving copays is permissible when it contributes to the public good (pro bono publico.)",Collecting copays through a collection agency is permissible if the client was originally informed of this possibility and previous efforts were made to collect copays.,C,"In terms of the supervisor’s and counselor’s ethical guidelines for collecting outstanding copays, standard A10d of the ACA Code of Ethics states, “If counselors intend to use collection agencies or take legal measures to collect fees from clients who do not pay for services as agreed upon, they include such information in their informed consent documents and also inform clients in a timely fashion of intended actions and offer clients the opportunity to make payment”Pro bono publicorefers to providing services with little or no financial return. Applying this concept to eliminating a client’s copay after billing insurance is prohibited when billing the Centers for Medicare & Medicaid Services and is ethically risky otherwise. Fee splitting is listed as an unacceptable business practice in sanction A10b of the ACA Code of Ethics. Lastly, verbal agreements about the copays being written off may be a consideration, but this is not the best reflection of the supervisor’s or counselor’s ethical responsibility. Therefore, the correct answer is (C)",professional practice and ethics
793,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","The client comes to the counseling center during walk-in hours. The client is continuing to experience a manic episode. She reports that she went out to dance with friends the previous evening and ended up buying a gram of cocaine for $100 and reported doing several lines throughout the night. The client says that she has never used any drugs before and that it scared her that she would spend that much money on drugs and that she used drugs at all. You empathize with the client’s frustration with her behavior and provide psychoeducation on impulse control to support her. The client appears tired as evidenced by her affect and slow movements, and she also appears to have poor hygiene because her clothes have visible stains and she has a slight body odor.  The client has not followed up with psychiatry referrals that you provided and is continuing to struggle with managing her manic symptoms",The client has not followed up with psychiatry referrals that you provided and is continuing to struggle with managing her manic symptoms. Which would be the most appropriate next step?,Respect the client’s personal decision not to follow up.,Provide psychoeducation on the benefits of a combination of medicine and therapy for bipolar disorders.,Encourage or remind the client to follow up with the referrals.,Evaluate cognitive barriers or reservations about medication.,"(A): Respect the client’s personal decision not to follow up.
(B): Provide psychoeducation on the benefits of a combination of medicine and therapy for bipolar disorders.
(C): Encourage or remind the client to follow up with the referrals.
(D): Evaluate cognitive barriers or reservations about medication.",Evaluate cognitive barriers or reservations about medication.,D,"The most appropriate answer is to evaluate the client’s cognitive barriers and reservations about medication. This opens up a conversation about what makes it hard for the client to follow up and to address the anxiety or other barriers caused by manic behavior. The client’s personal decision to not take medication is very important and should be respected; however, this is the second session and you have not fully processed the client’s feelings about medication. It might help to provide psychoeducation about the benefits of medication and therapy, but this should have been done when you provided the referral, and it may feel like nagging to the client. You can encourage or remind the client to follow up, but this may not address what kept her from following up and therefore may not provide any practical solutions or support. Therefore, the correct answer is (A)",professional practice and ethics
794,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","   k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress",Adjustment disorders are associated with an increased risk of which of the following?,Completed suicide,Panic attacks,Drug and alcohol misuse,Poor concentration,"(A): Completed suicide
(B): Panic attacks
(C): Drug and alcohol misuse
(D): Poor concentration",Completed suicide,A,"According to DSM-5-TR, adjustment disorders are associated with an increased risk of suicide attempts, both successful and unsuccessful. Poor concentration often accompanies anxiety-related disorders, but individuals with adjustment disorders are not at an increased risk of poor concentration. Individuals with neurocognitive disorders and individuals with substance/medication-induced sexual dysfunction may be at an increased risk for drug and alcohol misuse. Panic attacks are symptoms of anxiety and other mental disorders and are not a risk factor for adjustment disorders. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
795,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","With the information gained about this client and her diagnosis, which of the following concurrent treatment services would not be the most appropriate referral to recommend at this time.",Participating in a suicide prevention support group,Participating in family therapy sessions,Participating in a skills building group,Participating in an interpersonal growth group,"(A): Participating in a suicide prevention support group
(B): Participating in family therapy sessions
(C): Participating in a skills building group
(D): Participating in an interpersonal growth group",Participating in a suicide prevention support group,A,"This client has a past history of suicide attempts that appear to be related to real or imagined feelings of abandonment. A group like this can be supportive for clients who are currently struggling with suicidal ideation; however, this client appears to be stable in this area. Interpersonal growth groups for individuals with BPD are helpful as they recreate their interpersonal relations within the group and receive feedback on how their interactions impact others. Skills building groups are often used in combination with individual therapy when applying a dialectical behavioral approach for BPD. Family therapy sessions have been shown to have some value in working with clients experiencing BPD as it helps the family to understand the obstacles the client faces and helps the family and client develop strategies for working with BPD. Therefore, the correct answer is (A)",treatment planning
796,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,Harold is showing symptoms of?,Unspecified Personality Disorder,Antisocial personality disorder,Histrionic Personality Disorder,Narcissistic personality Disorder,"(A): Unspecified Personality Disorder
(B): Antisocial personality disorder
(C): Histrionic Personality Disorder
(D): Narcissistic personality Disorder",Narcissistic personality Disorder,D,"Harold meets the criteria of narcissistic personality disorder as evidenced by his grandiose sense of self-importance, belief that he is irreplicable at his company, his sense of entitlement, bullying of others and the belief that others envy him. Antisocial personality disorder is ruled out as there is no evidence of aggression, disregard for safety or failure to conform to social norms. Histrionic personality disorder is ruled out as it is characterized by attention seeking behavior with symptoms such as inappropriate sexualized behavior, shallow expressions of emotions, dramatic in the expression of emotion and the use of physical appearance for attention. Unspecified personality disorder is used when one does not meet the full criteria for a specific personality disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
797, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",Which of the following interventions support the objective to improve Avery's ability to identify positive traits and talents about himself?,Develop with Avery a list of positive affirmations about himself and assign him to read it daily,Reinforce verbally Avery's use of confidence and positive affirmations about himself,Present Avery with a piece of candy for each positive trait he can identify every session,Watch a video with Avery about a character who defeats his struggle with schoolwork,"(A): Develop with Avery a list of positive affirmations about himself and assign him to read it daily
(B): Reinforce verbally Avery's use of confidence and positive affirmations about himself
(C): Present Avery with a piece of candy for each positive trait he can identify every session
(D): Watch a video with Avery about a character who defeats his struggle with schoolwork",Reinforce verbally Avery's use of confidence and positive affirmations about himself,B,"Verbal reinforcement is the best way to help Avery remember how it feels to reflect positively on himself as it signals an immediate praise-based reward each time he uses a positive affirmation on his own. Making a list is a great way to remember his positive traits however assigning him to read on his own might only exacerbate his frustrations with reading and cause aversion towards the content since reading is what is making him feel bad. Use of prizes may cause immediate compliance and increased alertness with activities in session however is only reinforcing extrinsic or external motivation to do so and will not provide lasting change. Videos with engaging content are helpful tools to use occasionally, however this is not an optimal choice with this child's low attention span and hyperactivity. Therefore, the correct answer is (B)",counseling skills and interventions
798,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.",,"During the screening/intake for this group, which would be an advantageous step to take to ensure that group therapy is successful?",Request that each member present a detailed autobiography,Only hold individual screening appointments,Suggest the members participate in a mindfulness exercise,Encourage clients interview the group leaders about their experience and how they run groups,"(A): Request that each member present a detailed autobiography
(B): Only hold individual screening appointments
(C): Suggest the members participate in a mindfulness exercise
(D): Encourage clients interview the group leaders about their experience and how they run groups",Encourage clients interview the group leaders about their experience and how they run groups,D,"This empowers clients to become more active participants of their therapy experiences rather than just being passive interviewees. It sets a positive atmosphere for the group experience to come. Therefore, the correct answer is (D)",counseling skills and interventions
799,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest",What is the logical error demonstrated when the client is asked to identify anger triggers?,Polarized thinking,Overgeneralization,Emotional reasoning,Personalization,"(A): Polarized thinking
(B): Overgeneralization
(C): Emotional reasoning
(D): Personalization",Overgeneralization,B,"The client attributes his angry feelings to his “mother always” bothering him and “everybody always” picking on him—both untrue statements. This is an example of overgeneralization. Overgeneralization is a faulty belief system that occurs when general assumptions are made based on one or two experiences. The wordsalwaysandneverare often a part of an overgeneralized statementPersonalization occurs when individuals erroneously attribute external events to their own actions. (“My behavior caused the entire class to lose recess; I ruined everyone’s day!”)Polarized thinking happens when one engages in black-and-white or dichotomous thinking. (“If I can’t be the best, then I’m nothing”)Emotional reasoning is the result of believing that one’s feelings are facts, despite conflicting evidence. (“I feel worthless, so I must be”). Therefore, the correct answer is (D)",counseling skills and interventions
800,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.","Which of the following questions would be irrelevant when considering a diagnosis of Bipolar I Disorder, Moderate, Most Recent Episode Depressed?",Have you ever found yourself not knowing or remembering your name?,Has anyone commented on how quickly you talk? Have they stated that it is hard to follow?,Have you felt that you have needed much less sleep than usual?,Have you experienced pleasure-seeking behaviors which have negative consequences?,"(A): Have you ever found yourself not knowing or remembering your name?
(B): Has anyone commented on how quickly you talk? Have they stated that it is hard to follow?
(C): Have you felt that you have needed much less sleep than usual?
(D): Have you experienced pleasure-seeking behaviors which have negative consequences?",Have you ever found yourself not knowing or remembering your name?,A,"Dissociative symptoms are NOT part of Bipolar I Disorder criteria and would be irrelevant for this client. This would be a question more consistent with the criteria of Dissociative Amnesia. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
801,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.","During the intake, your client talks frequently about her husband and the difficulties that his sexual drive and lack of concern for her worries causes in the marriage. Aware of being in the early stages of the therapeutic relationship, which of the following is your most appropriate response?",Offer support with reading materials for relating to a partner with a personality disorder,Gently redirect the client to focus on her own emotional concerns,"Demonstrate empathy by normalizing the impact of living with someone who is uncaring, and focus on boundaries",Offer to help the client by providing counseling referrals for her husband's issues,"(A): Offer support with reading materials for relating to a partner with a personality disorder
(B): Gently redirect the client to focus on her own emotional concerns
(C): Demonstrate empathy by normalizing the impact of living with someone who is uncaring, and focus on boundaries
(D): Offer to help the client by providing counseling referrals for her husband's issues",Gently redirect the client to focus on her own emotional concerns,B,"Counselors must facilitate the therapeutic relationship while working objectively. The ACA Code of Ethics provides the counselor's primary responsibility is to promote the welfare of the client. This would require the counselor and client to focus on her concerns rather than her husband's. The Code additionally requires counselors to provide proper diagnosis only with appropriate assessment. Since the counselor has not met with the client's spouse, it would be inappropriate to provide referrals or to make assumptions about his feelings, issues, or personality. Therefore, the correct answer is (C)",counseling skills and interventions
802,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","Considering the information shared, which of the following assessment instruments would be most helpful in understanding the client's presenting issues?",Beck Anxiety Inventory (BAI),Family genogram,Clinical Anger Scale (CAS),Yale Brown Obsessive Compulsive Scale (YBOCS),"(A): Beck Anxiety Inventory (BAI)
(B): Family genogram
(C): Clinical Anger Scale (CAS)
(D): Yale Brown Obsessive Compulsive Scale (YBOCS)",Family genogram,B,"The client's presenting issues include alcohol use and difficulty in interpersonal relationships. A family genogram will help the counselor and client identify patterns of interaction within the client's family of origin that may still be operating today. While irritability is a criterion for anxiety, there is little information provided that suggests the client is dealing with anxiety. The client admits to angry outbursts and the CAS may be helpful in tracking treatment efficacy in this area, but will not explore the reasons for his anger. The YBOCS measures obsessions and compulsions, however the client does not indicate these types of disturbances. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
803,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",You discuss limits to confidentiality in terms that the client can understand. Under what condition would you be required to breach the client's confidentiality?,If the mother insists you reveal what is discussed in therapy,When counseling a minor whose parents are in the middle of divorce proceedings,If you discover that the client is sexually active with another minor,When discussing cases while under direct supervision or working with a clinical team,"(A): If the mother insists you reveal what is discussed in therapy
(B): When counseling a minor whose parents are in the middle of divorce proceedings
(C): If you discover that the client is sexually active with another minor
(D): When discussing cases while under direct supervision or working with a clinical team",When discussing cases while under direct supervision or working with a clinical team,D,"This is the correct answer because as a limited permit holder you are being supervised; everything will not remain confidential in all of your cases. Therefore, the correct answer is (B)",professional practice and ethics
804,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling",Which one of the following is a leadership skill used to connect members and facilitate cohesion and universality?,Pacing,Linking,Sculpting,Chaining,"(A): Pacing
(B): Linking
(C): Sculpting
(D): Chaining",Linking,B,"Linking is the leadership skill used to connect members and facilitate cohesion and universality. Leaders promote group cohesion or a group’s sense of solidarity by creating a sense of belonging and connection. Universality involves learning that other people share similar thoughts, feelings, and experiences. Chaining is a behavioral intervention based on operant conditioning and is used to master complex sequences of behaviors. Chaining occurs through the association of responses such that each response acts as the stimulus for the following response. Pacing is a group leadership skill used to attend to the emotional intensity of a group. Sculpting is a human validation process family therapy technique used to position family members in a way that illustrates significant aspects of the family unit. Therefore, the correct answer is (D)",professional practice and ethics
805, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.",Which of these core attributes will help the client identify emotions?,A non-judgmental stance,Conflict tolerance,Active listening and attending skills,"Empathic responding, also called reflection of feelings","(A): A non-judgmental stance
(B): Conflict tolerance
(C): Active listening and attending skills
(D): Empathic responding, also called reflection of feelings",A non-judgmental stance,A,"A non-judgmental stance is the most important core attribute that the counselor will need to employ at this time. The client is just learning to connect emotions and will likely be anxious at trying to explore such uncomfortable material within herself. Active listening and attending skills show the client that the counselor is present and available to them. This is important in all sessions, although listening and attending postures will not indicate acceptance of the client's attempts at identifying emotions as a non-judgmental stance will do. Reflections of feelings are core skills in which the counselor listens to what a client is saying and allows the counselor to name the feeling that corresponds with or underlies the client's statements (ie, ""It sounds like you were sad""). Because the purpose of this intervention is to have the client connect her actions to feelings, it is not helpful for the counselor to take that role on instead. Conflict tolerance is a necessary skill for counselors to possess, however based on the information presented, the counselor and client are unlikely to experience conflict in the therapeutic relationship because helping the client identify emotions is done at the client's pace to facilitate a safe and trusting environment. Therefore, the correct answer is (A)",core counseling attributes
806,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process","To facilitate the client’s progress, which of the following would you use to help access the client’s underlying core beliefs about himself, others, and the world?",The hidden emotion technique,The memory rescripting technique,The scaling technique,The downward arrow technique,"(A): The hidden emotion technique
(B): The memory rescripting technique
(C): The scaling technique
(D): The downward arrow technique",The downward arrow technique,D,"The downward arrow technique helps facilitate the client’s progress by uncovering the client’s underlying core beliefs about himself, others, and the world. Core beliefs, generally rooted in childhood experiences, can drive automatic thoughts and lead to distorted thinking. The downward arrow technique identifies the intermediate beliefs impeding progress. The counselor then draws a downward arrow and challenges each rigidly held belief. For example: Client: “I’m destined to fail in all intimate relationships” Counselor: “And what does that mean?” Client: “I’m a failure” Counselor: “If you’re a failure, what does that suggest?” Client: “That I’m unlovable” Once the core belief is uncovered, it can be further explored and tested against sound logic and reason. Memory rescripting, or imagery rescripting, is a technique used with clients experiencing flashbacks originating from trauma. The goal of memory rescripting is to alter the memories leading to shame and self-blame. The hidden emotion technique brings to the forefront anxiety-provoking situations that are avoided or denied. Counselors who practice solution-focused therapy use scaling questions to help clients track their progress on an identified goal. Therefore, the correct answer is (A)",counseling skills and interventions
807,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ",What long-term goal will guide your overall treatment for the client's presenting issues?,Reduce the client's panic symptoms and her fear so she can drive again,Create an action plan for when the client feels the onset of an anxiety attack,Identify the connection between between panic attacks and internal and external stimuli,Reduce feelings of guilt and shame for not being able to control her anxiety,"(A): Reduce the client's panic symptoms and her fear so she can drive again
(B): Create an action plan for when the client feels the onset of an anxiety attack
(C): Identify the connection between between panic attacks and internal and external stimuli
(D): Reduce feelings of guilt and shame for not being able to control her anxiety",Reduce the client's panic symptoms and her fear so she can drive again,A,"This goal is most important for the client to regain her independence, as she has been relying on her husband to drive her to the session. It will also increase her self-confidence and be helpful in her day-to-day life, such as running errands or attending church. Therefore, the correct answer is (B)",treatment planning
808,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","   ully. Family History: Several clients report coming from a single-parent home, whereas others are from a two-parent home. All clients report that they have siblings. Several clients reported having parents that were or are involved in the justice system.  One goal of the first session is to set a positive tone for the group",One goal of the first session is to set a positive tone for the group. Which of the following would support this goal?,Explain group rules to ensure structure so that everyone can participate equally.,Get everyone to share.,"With this specific group, speaking with authority to maintain control of the group and therefore ensuring that the group members know they do not have to fight for control.",Support the clients with feeling comfortable expressing frustration with the facility.,"(A): Explain group rules to ensure structure so that everyone can participate equally.
(B): Get everyone to share.
(C): With this specific group, speaking with authority to maintain control of the group and therefore ensuring that the group members know they do not have to fight for control.
(D): Support the clients with feeling comfortable expressing frustration with the facility.",Get everyone to share.,B,"Getting everyone to share encourages participation and also makes everyone feel like they are part of the group. You would not want to do this in a forceful way because each client has the right to choose if they will participate, but getting everyone to participate would further the group process. Explaining group rules establishes that the group is about rules and boundaries and not about being open. Although rules are important, this is not a helpful way to start. You should be in control, and a level of control can help members feel more secure; however, speaking with authority would likely feel off-putting to this group due to their setting in the facility. Allowing space for your clients to discuss their frustrations regarding the facility might be helpful in the future, but this would not start the group off on a positive note. Therefore, the correct answer is (D)",counseling skills and interventions
809,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.",book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends.  The client appears uninterested in the session,"The client appears uninterested in the session. Based on what you see, which of the following would be the most appropriate clinical intervention based on the client’s diagnosis and presentation?",You encourage the client to participate so that he can feel better.,You talk with the client about the video game book he is reading.,You attempt to process with the client about why he is not engaging.,You continue talking with the parents because they are providing helpful information and you know that building rapport with the client will be a long process.,"(A): You encourage the client to participate so that he can feel better.
(B): You talk with the client about the video game book he is reading.
(C): You attempt to process with the client about why he is not engaging.
(D): You continue talking with the parents because they are providing helpful information and you know that building rapport with the client will be a long process.",You talk with the client about the video game book he is reading.,B,"You engage with the client about what he is reading because you want to create a connection and this is a very simple one to make. Encouraging the client to participate might work, but it does not create a connection with the client. You have learned a lot about the client from his parents, but you also need to engage him in building a therapeutic relationship. Processing with the client regarding his lack of participation may be helpful, but considering his diagnosis and age, it would be more helpful to talk with him about the video game book. Therefore, the correct answer is (B)",counseling skills and interventions
810,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",Which goal is John least likely to agree upon based on his presentation?,Develop and demonstrate anger management skills,Develop new communication skills to reduce interpersonal conflicts,Resolve the core conflict that is the source of mood dysregulation,Learn how to control impulsive behaviors and cope with frustration,"(A): Develop and demonstrate anger management skills
(B): Develop new communication skills to reduce interpersonal conflicts
(C): Resolve the core conflict that is the source of mood dysregulation
(D): Learn how to control impulsive behaviors and cope with frustration",Resolve the core conflict that is the source of mood dysregulation,C,"It is unlikely based on John's presentation of affect, perspective of blame towards his partners, and lack of insight into his problem, that he would be willing to engage in resolution of deep inner conflict believed to be the cause of his issues. As John's counselor you could work towards inclusion of this goal after successful interventions within his agreed upon goals. Therefore, the correct answer is (B)",treatment planning
811,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family.  The client’s neuropsychological testing scores on a normal distribution place her one standard deviation below the mean",The client’s neuropsychological testing scores on a normal distribution place her one standard deviation below the mean. The client scored as well as or better than approximately what percent of the normed population?,3%,85%,48%,16%,"(A): 3%
(B): 85%
(C): 48%
(D): 16%",16%,D,"The client scored one standard deviation below the mean. This signifies that she scored as well as or better than 16% of the population because the percentage of the normed population that scores plus or minus one standard deviation is 68% and the percentage that scores greater than one standard deviation is an additional 16%. In that case, an individual who scores less than one standard deviation of the mean would be scoring as well as or better than the remaining 16% who scored more than one standard deviation less than the mean. The normal curve is symmetrically distributed. Almost two-thirds of the scores lie one standard deviation from the mean. Roughly 3% of the population tested scored two standard deviations below the mean. Generally, standardized tests have a mean score of 100. With a mean of 100, one standard deviation below the mean would be a score of 85 rather than 85% (whereas one standard deviation above the mean would be a score of 115). If the client scored at least two standard deviations below the mean, she would likely receive the diagnosis of major neurocognitive disorder. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
812,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Since the intake, you have provided professional development training for school staff on transgender and gender nonconforming (TGNC) individuals. The administration supports your recommendations for keeping the client and others safe at school. The client continues to miss school, but they have had fewer absences this month. You learn that the client’s desire to be rid of their male secondary sex characteristics has become more persistent. They say that they have seen media coverage of individuals who have undergone sex reassignment surgeries and wondered what that would be like. The client also states they are confused about their sexual orientation. The client appreciates being an active participant in their treatment, and together you create relevant treatment plan goals. You discuss the upcoming family session with the client’s parents. The client articulates appropriate topics for this session and reports increased anxiety concerning their father’s participation","Based on the client’s diagnosis, which treatment plan goal would you select for the client?",To reduce distress caused by the desire to identify as another gender,To reduce distress caused by sexual orientation uncertainty,To reduce incongruence between gender expression and gender identity,To reduce incongruence between nonbinary and cisgender identity,"(A): To reduce distress caused by the desire to identify as another gender
(B): To reduce distress caused by sexual orientation uncertainty
(C): To reduce incongruence between gender expression and gender identity
(D): To reduce incongruence between nonbinary and cisgender identity",To reduce distress caused by the desire to identify as another gender,A,"Based on the client’s diagnosis, an appropriate treatment plan goal would be to reduce distress caused by the desire to identify as another gender. The DSM-5 replaced the term gender identity disorder with gender dysphoria to avoid pathologizing one’s identity, which was maintained in the most recent version, the DSM-5-TR. Gender expression is defined as the outward expression of one’s gender and may or may not align with one’s gender identity. Gender identity is defined as one’s inner sense of being male, female, a combination of both, or neither. One’s gender at birth may or may not coincide with one’s gender identity or gender expression. Sexual orientation uncertainty is unrelated to gender dysphoria, making this answer option incorrect. Gender dysphoria is defined as the incongruence between one’s expressed or experienced gender and one’s assigned gender. Individuals who are nonbinary do not identify as male or female but instead identify as something in between or no gender at all. Cisgender describes individuals whose gender identity is consistent with their birth identity. Reducing incongruence between nonbinary and cisgender identity is not possible because the two are mutually exclusive. Therefore, the correct answer is (A)",treatment planning
813, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,A modality of treatment that is person centered and focuses on helping the client through the stages of change is called?,Aversion therapy,Medicated assisted treatment,Motivational interviewing,Behavior therapy,"(A): Aversion therapy
(B): Medicated assisted treatment
(C): Motivational interviewing
(D): Behavior therapy",Motivational interviewing,C,"Motivational Interviewing uses unconditional positive regard and empathy to examine the client's motivation to change and helps them progress through the stages to get there. Medicated assisted treatment uses a combination of medication as well as counseling and behavioral therapies. Aversion therapy suppresses unwanted behaviors by associating it with a negative experience and behavior therapy focuses on modifying harmful behaviors associated with psychological distress. Therefore, the correct answer is (B)",treatment planning
814,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.",rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family,Which one of the following controlled substances is also an opioid?,Heroin,Cocaine,Marijuana,LSD,"(A): Heroin
(B): Cocaine
(C): Marijuana
(D): LSD",Heroin,A,"Heroin is an opioid along with morphine, fentanyl, Oxycontin, oxycodone, and many more. Opioids are very effective in treating intense pain but are easily abused due to their effects. Cocaine is a stimulant, and stimulants increase the activity of the central nervous system. Marijuana is a psychoactive drug because it affects the functioning of the nervous system by altering consciousness, mood, perception, behavior, and cognition. LSD is a hallucinogenic drug that affects consciousness, thoughts, and emotions and oftentimes causes hallucinations and distortions in perception. Therefore, the correct answer is (C)",professional practice and ethics
815,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.",You need more information on Melanie's prescriptions to understand her cognitive state of mind prior to treatment planning. Which approach is the most appropriate?,Ask Melanie for her to list her medications and how they are making her feel,Submit a Release of Information to her outside providers requesting documentation,Discuss planning a conference call with all her providers to coordinate her care,You do not need any of this information,"(A): Ask Melanie for her to list her medications and how they are making her feel
(B): Submit a Release of Information to her outside providers requesting documentation
(C): Discuss planning a conference call with all her providers to coordinate her care
(D): You do not need any of this information",Ask Melanie for her to list her medications and how they are making her feel,A,"Simply asking Melanie to share with you the medications she is on and how she is reacting with them is sufficient at this phase of the counseling relationship. The information Melanie can provide will support your understanding of how these medications might be interacting, affecting her diagnosable conditions and helpful for you to be following up with her on maintaining them if you notice any cognitive or behavioral changes. Should you require the medical documentation at some point in your course of care for her, having her sign a release of information with her provider prior to your request will be expected. Discussing Melanie's treatment with all her providers at the same time is highly unlikely to occur and is not necessary. As a counselor you may feel at the time that knowing Melanie's medication list is not important or unnecessary, however medication management is a key component of mental health wellness, and you could be missing vital information about treating your clients without it. Therefore, the correct answer is (A)",treatment planning
816,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.",,"Given the client's age and presenting issues, what stage is she experiencing from an Eriksonian perspective?",Identity vs Role Confusion,Intimacy vs Isolation,Generativity vs Stagnation,Trust vs Mistrust,"(A): Identity vs Role Confusion
(B): Intimacy vs Isolation
(C): Generativity vs Stagnation
(D): Trust vs Mistrust",Generativity vs Stagnation,C,"Stage 7: Generativity versus Stagnation
These are the middle adult years, 40 to 65 years old. If an adult gets stuck in this stage, they may experience several negative consequences. These can include feeling unproductive, unfulfilled, and purposeless. Additionally, they may think that their life is going nowhere and that they are not contributing anything meaningful to society. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
817,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""  Tenth session The couple enters in better spirits than previously. They have been speaking with each other in the lobby while waiting. They enter laughing. Ruth reports that the communication techniques you shared seem to have helped. She no longer feels the need to leave her husband. They report that the 16-year-old daughter arrived home from her time at the crisis center somewhat subdued by the experience, although still showing challenging behaviors. They also say that the five-year-old still exhibits defiant behaviors at home and school.    The couple had worked hard to repair their communication and marriage, which is paying off. The husband and wife have found a new understanding and mutual respect. They have developed newfound patience and empathy for one another, helping to create a more harmonious environment at home. The couple had also applied the communication techniques they had learned to their interactions with their children. As a result, Ruth and her husband are now workings together to find a way to better understand and respond to their children's needs. They have set up a school conference to determine how to handle their children's behavior.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",What would be the best additional service given the disclosures during this session?,Play therapy for their five year old,Family Therapy,Parent support group,Individual therapy for the daughter,"(A): Play therapy for their five year old
(B): Family Therapy
(C): Parent support group
(D): Individual therapy for the daughter",Family Therapy,B,"In this case, there are several issues at hand. You have helped the couple improve communication and trust up to this point. This entire family, however, appears to be struggling to manage their feelings toward each other and mesh as a whole. Family therapy would be the next logical step for your client to improve communication and identify areas of need and structure for the children to focus on their goals. Therefore, the correct answer is (D)",treatment planning
818,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session and reports that he and his wife have been getting along better since the last session following some conversations about what they can do to get through this situation together. The client says that he wants to work on figuring out what he is going to do for work next. You and the client discuss possible options, and he says a friend offered him a job at his restaurant. The client says that he is considering it just for the money but that he has never been a server before and has some reservations. You conduct a career interest assessment and discuss the results.  You encourage the client to use natural supports during this time because it can be helpful to have other people provide support",You encourage the client to use natural supports during this time because it can be helpful to have other people provide support. All of the following would be considered a natural support EXCEPT:,An acquaintance from the client’s Bible study group,A childhood friend,A sibling who the client is close to,The therapist because you meet with the client regularly,"(A): An acquaintance from the client’s Bible study group
(B): A childhood friend
(C): A sibling who the client is close to
(D): The therapist because you meet with the client regularly",The therapist because you meet with the client regularly,D,"A natural support is a relationship that occurs naturally. Although the therapist is a regular support, they are not a naturally occurring support. A childhood friend and a sibling would be strong natural supports because these relationships have lasted for the long term. An acquaintance can also be a natural support. This one is an especially good support because he is in the client’s Bible study and can provide further support for his spiritual needs. Therefore, the correct answer is (D)",counseling skills and interventions
819,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","   sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time","To better understand the client’s behavior and relationship patterns, which of the following would be the most useful?",Conduct a mental status exam during each session.,Request a release of information in order to communicate with the client’s ex-wife to get input on his behavior.,Complete a genogram.,Assign the client homework to complete a thought log regarding inhalant use and his relationships.,"(A): Conduct a mental status exam during each session.
(B): Request a release of information in order to communicate with the client’s ex-wife to get input on his behavior.
(C): Complete a genogram.
(D): Assign the client homework to complete a thought log regarding inhalant use and his relationships.",Complete a genogram.,C,"A genogram would give more information regarding family dynamics, relationship quality and status, family patterns, and family substance use. Genograms are a great tool to use to understand how the client’s family contributed to where he is at currently. Discussing the genogram will give a lot more information because it presents many opportunities to discuss his relationships and history. You will conduct a mental status exam each session, but this will likely not provide much information regarding behavior and is more about the client’s presentation in session. A thought log would be helpful over time to understand how the client processes information and is also helpful for the client to become more aware of how thoughts, feelings, and behaviors affect his functioning, but the genogram would be more helpful in providing information and encouraging conversation regarding his behavior and his past relationships. It might be helpful to communicate with the client’s ex-wife; however, she would likely be a biased party, which could complicate the counseling relationship. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
820,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","  You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown",The client experiences multiple symptoms indicative of BPD EXCEPT which of the following?,Intense anger,Suicidality,Fear of abandonment,Grandiosity,"(A): Intense anger
(B): Suicidality
(C): Fear of abandonment
(D): Grandiosity",Grandiosity,D,"The client does not experience grandiosity as a symptom indicative of BPD. Grandiosity is a symptom of narcissistic personality disorder. BPD is characterized by fear of real or imagined abandonment, suicidality, and intensive anger. According to the DSM-5-TR, BPD is a pervasive pattern of instability in social relationships, self-image, and affect, coupled with marked impulsivity. Recurrent suicidal behavior is a criterion that is separate from desperate attempts to escape real or imagined feelings of abandonment and impulsivity. The client’s fear of abandonment manifests in her romantic and interpersonal relationships. Although suicidal behavior is a separate criterion, worries about separation or abandonment can contribute to acts of suicide or self-harm. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
821,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",What is the most appropriate response to the client's statement?,Acknowledge the client’s feelings and provide support,Reassure the client you will help him learn to control his temper,Ask the client why he thinks the school is being unfair.,Ask the client more questions about the incident.,"(A): Acknowledge the client’s feelings and provide support
(B): Reassure the client you will help him learn to control his temper
(C): Ask the client why he thinks the school is being unfair.
(D): Ask the client more questions about the incident.",Acknowledge the client’s feelings and provide support,A,"Acknowledging the client's feelings and providing support is essential in maintaining trust and rapport with the client. This should be your first response to the client's statement. Therefore, the correct answer is (A)",counseling skills and interventions
822,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.","Given the client's substance use history, you determine that will be important to monitor her for signs of continued drug or alcohol use. What would be most indicative that the client is currently using drugs?","Disheveled appearance, muscle retardation, slow speech, dysphoric affect, and slow thought process","Altered thought process, disorganized speech, poor coordination, and cloudy sensorium","Unkempt appearance with body odor, withdrawn behavior, disorganized speech, flat affect with congruent mood, and nonlinear thought process","Clear sensorium, congruent and organized thought process, good judgement and insight","(A): Disheveled appearance, muscle retardation, slow speech, dysphoric affect, and slow thought process
(B): Altered thought process, disorganized speech, poor coordination, and cloudy sensorium
(C): Unkempt appearance with body odor, withdrawn behavior, disorganized speech, flat affect with congruent mood, and nonlinear thought process
(D): Clear sensorium, congruent and organized thought process, good judgement and insight","Altered thought process, disorganized speech, poor coordination, and cloudy sensorium",B,"This combination of characteristics would infer possible substance use. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
823,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.",Which of the following information is critical to gather prior to determining the treatment plan?,What client has been doing to manage her symptoms to date,All of the above,Previous experiences with death and loss,How client is functioning at work,"(A): What client has been doing to manage her symptoms to date
(B): All of the above
(C): Previous experiences with death and loss
(D): How client is functioning at work",All of the above,B,"Knowing how the client has handled loss in the past, how she is functioning in the professional realm, and what she is doing to manage her symptoms assesses resilience, coping skills, and level of functioning. Many of the client's symptoms could be caused by medical reasons which need to be ruled out. The appropriateness of the court case has not been identified by the client as a counseling concern. Therefore, the correct answer is (D)",treatment planning
824,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.  Eighth session The client has been seeing you once a week for the last two months. Today, he appears calm, and his thoughts are coherent. The client tells you that he has not completely abstained from alcohol, but his use has significantly decreased. He reports that he went to a virtual AA meeting but did not find it helpful, so he signed off. The client opens up and states, ""I think one of the reasons I am anxious is because I am having an affair. Ever since my wife hurt her back, we have not been intimate."" The client's speech becomes more rapid, and he begins to lose eye contact as he discloses the details of his affair to you. Your client tells you, ""I'm not happy with my wife, either sexually or emotionally. The new woman I'm seeing understands me, and I don't want to drink when I'm around her. She helps me forget everything that causes me stress."" In response to your client focusing on the positives of his affair, you engage the client in a discussion to explore the issue from other perspectives. You ask questions like, ""What do you think would happen if your wife found out about your affair?"" Your client pauses for a moment and looks down, and then says, ""I'm not sure. I care about my wife, but I don't know if she will ever be able to understand me in the way that this other woman does. I feel like I'm trapped."" You listen empathically as your client expresses his feelings of anxiety, despair and confusion. You provide clarification when necessary and strive to help your client gain insight into his thoughts and behaviors.    In the session, you explore the client's anxiety and how it has been related to his affair. You address underlying issues that may be contributing to the anxiety such as unresolved feelings of guilt or fear of being discovered. You emphasize that anxiety is often a sign of trying to avoid uncomfortable emotions and situations, but acknowledging them can help him understand anxiety in a different way. You also talk about the role alcohol has played in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to incorporating strategies to address these issues in his treatment plan, such as scheduling regular self-care activities and exploring the relationship between his thoughts and behaviors. Toward the end of this session, the client appears calmer and confident in his ability to make positive changes. As you are wrapping up the session, the client confides to you that ever since he started having an affair, he has found himself sexually attracted to his daughter. He says, ""It's just kind of exciting to peek in the bathroom and watch her in the bathtub. But I would never touch her! It's just a passing thought. I know that I need to stop. The thrill of my affair is satisfying enough.""","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",Which theoretical approach would work most effectively with this client given his disclosures about his affair?,Gestalt therapy,Cognitive-behavioral therapy,Interpersonal psychotherapy,Jungian analysis,"(A): Gestalt therapy
(B): Cognitive-behavioral therapy
(C): Interpersonal psychotherapy
(D): Jungian analysis",Cognitive-behavioral therapy,B,"This theory base addresses behavioral components and cognitive structure. The client has anxiety that he needs to gain control of and has confessed to intimacy issues which led him to have an affair. The client has stated that he feels that his wife is not supportive of him. This could be a faulty thought process that led him to have an extramarital affair. Exploring the link between the client's thoughts and behaviors would be most beneficial for this client. Therefore, the correct answer is (A)",professional practice and ethics
825,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","You meet with the client’s mother today to update the client’s treatment plan. Since the beginning of the school year, the client has been suspended for a combined total of 8 days. He has responded poorly to many of the behavioral classroom interventions. The mother has reluctantly granted the school permission to begin testing to determine if the client qualifies for an Individualized Education Program. You inform the mother of her parental rights pertaining to this process, particularly as they apply to protections against disability-related discrimination and the maximum number of disability-related suspensions. She is encouraged by the possibility of the client receiving additional supports that consider the client’s strengths and challenges.  Behavior management for ADHD is grounded in contingency theory and social learning theory",Behavior management for ADHD is grounded in contingency theory and social learning theory. Which of the following is a component of social learning theory?,Discrete trial training,Differential reinforcement,Modeling,Counterconditioning,"(A): Discrete trial training
(B): Differential reinforcement
(C): Modeling
(D): Counterconditioning",Modeling,C,"One component of social learning theory is modeling. The theoretical underpinnings of behavior management include contingency theory, social learning theory, and cognitive components. Social learning takes place when behaviors are observed, modeled, and imitated. Discrete trial training teaches a skill step by step and behaviorally reinforces successful approximations to an overall goal. Counterconditioning is the reversal of earlier learning. Finally, differential reinforcement is a behavioral modification principle used to stop undesirable behaviors by positively reinforcing desirable behaviors. Therefore, the correct answer is (C)",counseling skills and interventions
826, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.",Which objective does not need to be prioritized in Raul's counseling treatment plan?,Family functional interventions,Learn prosocial behaviors and implement changes,Processing trauma and learning coping skills,Referral for psychiatric testing and evaluation,"(A): Family functional interventions
(B): Learn prosocial behaviors and implement changes
(C): Processing trauma and learning coping skills
(D): Referral for psychiatric testing and evaluation",Family functional interventions,A,"Referring Raul for psychiatric testing of ADHD and evaluation for medication would be a significant step to work on with Raul's mother to help Raul get closer to being treated adequately. Teaching Raul appropriate behaviors and discussing how to make behavioral changes considering his values, motivations and needs is paramount at this stage of Raul's critical development prior to advancing in school. If Raul is willing to engage in some trauma work once safety and trust have been established, perhaps root issues can be resolved early in his life rather than later once his antisocial behaviors have increased. Engaging in Family Functional therapy is not needed at this time, although individual and joint sessions with his mother would be advantageous in supporting Raul's improvement. Therefore, the correct answer is (A)",treatment planning
827,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex.  During this session, you identify that the client’s girlfriend does not send any signals that sex is not pleasurable","During this session, you identify that the client’s girlfriend does not send any signals that sex is not pleasurable. Which of the following terms defines the use of focusing on the information available to manage thoughts and feelings?",Mindfulness,Relaxation skills,Cognitive challenging,Cognitive reframing,"(A): Mindfulness
(B): Relaxation skills
(C): Cognitive challenging
(D): Cognitive reframing",Mindfulness,A,"Mindfulness is focusing on the present situation, which would be helpful in conjunction with using evidence to counteract cognitive distortions. Cognitive reframing and challenging are helpful techniques in managing cognitive distortions, but they do not directly focus on present evidence for beliefs. Relaxation skills are helpful, but they do not focus on cognitive functions. Therefore, the correct answer is (A)",counseling skills and interventions
828,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.",,How does the client's mental health history affect your treatment plan?,The client's mental health history will dictate what topics and goals are discussed in therapy.,The client's mental health history will determine the length of therapy needed to reach desired outcomes.,The client's mental health history will likely present a barrier to treatment because she is at a higher risk for future issues.,The client's mental health history provides insight into how past experiences may be affecting the client's current emotional state.,"(A): The client's mental health history will dictate what topics and goals are discussed in therapy.
(B): The client's mental health history will determine the length of therapy needed to reach desired outcomes.
(C): The client's mental health history will likely present a barrier to treatment because she is at a higher risk for future issues.
(D): The client's mental health history provides insight into how past experiences may be affecting the client's current emotional state.",The client's mental health history provides insight into how past experiences may be affecting the client's current emotional state.,D,"The client's mental health history can provide important information about what kind of interventions may be most helpful in treating their current situation. By understanding past issues, we are better able to tailor our treatment plan to specifically address the current needs of this individual. Additionally, taking into account any mental health conditions (such as anxiety or depression) that the client may have can help determine what interventions will be most effective in helping them cope and manage their emotions. Ultimately, this information can be used to create an individualized treatment plan that is tailored to the unique needs of the client. Therefore, the correct answer is (B)",treatment planning
829,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","During this session, you decided to use role-playing with the client. Why did you choose to use role-playing instead of psychodrama?",Role-playing allowed the client to act out his personal issues in a safe environment,Role-playing allowed the client to gain insight into his own behavior,Role-playing and Psychodrama are terms both describe the same process,Role-playing explored different perspectives on the client's situation,"(A): Role-playing allowed the client to act out his personal issues in a safe environment
(B): Role-playing allowed the client to gain insight into his own behavior
(C): Role-playing and Psychodrama are terms both describe the same process
(D): Role-playing explored different perspectives on the client's situation",Role-playing explored different perspectives on the client's situation,D,"Role-playing is used to explore different perspectives and practice communication and problem-solving skills, allowing the counselor and their client to stay in control of the experiences they are creating. In role-playing, therapists act out different situations while their clients practice responding. This practice can help them become more confident interacting with other people in real-life situations. Role-play activities also provide a safe way to explore difficult topics without having to experience unpleasant emotions or situations. Therefore, the correct answer is (D)",counseling skills and interventions
830,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","   ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years.  You would like to use the Beck Depression Inventory-II (BDI-II) but are concerned about the possibility of racial bias. You find a study stating, “The recommended cutoff score of 14 for screening for depression appears to be appropriate for African American patients in the primary care setting” (Dutton et al., 2004). This cutoff yielded a specificity of 84%","You would like to use the Beck Depression Inventory-II (BDI-II) but are concerned about the possibility of racial bias. You find a study stating, “The recommended cutoff score of 14 for screening for depression appears to be appropriate for African American patients in the primary care setting” (Dutton et al., 2004). This cutoff yielded a specificity of 84%. How do you interpret these findings?",84% of respondents with depression scored above 14.,84% of respondents have a high probability of scoring above 14.,84% of respondents without depression scored below 14.,84% of respondents have a low probability of scoring above 14.,"(A): 84% of respondents with depression scored above 14.
(B): 84% of respondents have a high probability of scoring above 14.
(C): 84% of respondents without depression scored below 14.
(D): 84% of respondents have a low probability of scoring above 14.",84% of respondents without depression scored below 14.,C,"The study shows a high proportion of people without depression with low scores. BDI-II scoring is as follows: A score of 0–13 is considered in the minimal range, 14–19 is mild, 20–28 is moderate, and 29–63 is severe. Specificity measures (ie, the true negative rate) are the proportion of people without depression with a low score on the BDI-II. In other words, a specificity of 84% indicates that 84% of individuals without depression did not score above a cutoff score of 14. This also means that the study yielded few false negatives. The same study yielded a sensitivity score of 88%. A sensitivity score is a true positive rate because 88% of those with depression scored above the cutoff score of 14 on the BDI-II. Probability is unrelated to specificity and sensitivity and is used to determine the likelihood or chance of an event occurring. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
831,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",Why might you choose the Gestalt technique of the empty chair as an effective way to help the client resolve his interpersonal conflicts?,This Gestalt technique can help clients integrate the many different parts of themselves into one to gain further insight into themselves.,This Gestalt technique can help clients by enhancing client-therapist rapport through activity.,This Gestalt technique can help to allow projection of the client's relationship with his father on you.,"This Gestalt technique can help younger clients engage in physical activities, which helps maintain engagement.","(A): This Gestalt technique can help clients integrate the many different parts of themselves into one to gain further insight into themselves.
(B): This Gestalt technique can help clients by enhancing client-therapist rapport through activity.
(C): This Gestalt technique can help to allow projection of the client's relationship with his father on you.
(D): This Gestalt technique can help younger clients engage in physical activities, which helps maintain engagement.",This Gestalt technique can help clients integrate the many different parts of themselves into one to gain further insight into themselves.,A,"It is beneficial for a client experiencing Gender Dysphoria as it allows the individual to accept who he or she is and who he or she is becoming. Therefore, the correct answer is (C)",counseling skills and interventions
832,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.",,"Based on the client's initial presentation, what assessment instrument would yield additional data regarding a possible comorbid disorder?",Addiction Severity Index - ASI,Ages and Stages Questionnaire,Barratt Impulsiveness Scale - BIS-11,State-Trait Anxiety Inventory - STAI,"(A): Addiction Severity Index - ASI
(B): Ages and Stages Questionnaire
(C): Barratt Impulsiveness Scale - BIS-11
(D): State-Trait Anxiety Inventory - STAI",State-Trait Anxiety Inventory - STAI,D,"The State-Trait Anxiety Inventory is designed to assess anxiety as well as distinguish it from depression. The test differentiates between ""state anxiety"" (temporary) and ""trait anxiety"" (more general and long-term). The STAI can be completed in 10-20 minutes. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
833,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.  Fifth session As today's session starts, the client's mother says she is at her ""wit's end"" because her son is getting worse. As a result, the school may not let the client come back next year. In addition, there has been a major incident at home. The mother, stepfather, and younger sister went for a drive without the client. When they returned, the client was upset and claimed that no one in the family loved him; he wanted to live with his grandmother. The mother responded that his behavior was unacceptable and that he would not live with his grandmother.  Jackson went into his bedroom and began throwing objects around the room in anger after his family left without him. He broke a lamp and overturned his dresser. Jackson's destructive outburst caused damage to his possessions and his room. After his mother told Jackson a second time that he could not live with his grandmother, he started shouting insults at her and his stepfather. Jackson then told them they were not fit parents and only cared about themselves.  In response, his mother told him he was not getting his laptop back until his behavior improved. The client grabbed a dish, threw it against the wall, and threatened to break more items in the home. He said he would continue his destructive behavior until his family realized how much they hurt him on a daily basis and then ran out the door. The stepfather found him wandering the neighborhood and drove him home. Jackson told his stepfather he wished he was dead and not part of their family. You note that the client is pulling his hair as he tells you this. You also notice that he is decompensating. You spend the remainder of the session practicing self-calming skills with him.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",What is the most appropriate intervention for this client in this situation?,Create a token economy,Cognitive restructuring,Mindfulness-focused therapy,Practice self-calming skills,"(A): Create a token economy
(B): Cognitive restructuring
(C): Mindfulness-focused therapy
(D): Practice self-calming skills",Practice self-calming skills,D,"Self-calming skills, such as deep breathing and mindfulness, can help the client to regulate their emotions and reduce their distress. This intervention will allow the client to better manage their emotions and better cope with the feeling that their family does not love them. Therefore, the correct answer is (D)",counseling skills and interventions
834,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","   atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together",Which of the following would be appropriate homework following the intake session?,Complete a daily food log.,Ask the client to create a hierarchy of internal and external triggers for bingeing and purging.,Encourage the client to try foods that she thinks are off limits and to write down thoughts and feelings that she is experiencing when doing so.,Recommend that the client read a book regarding anorexia.,"(A): Complete a daily food log.
(B): Ask the client to create a hierarchy of internal and external triggers for bingeing and purging.
(C): Encourage the client to try foods that she thinks are off limits and to write down thoughts and feelings that she is experiencing when doing so.
(D): Recommend that the client read a book regarding anorexia.",Complete a daily food log.,A,"Appropriate homework for this client after her first session would be to encourage her to complete a daily food log so you can have baseline data on her current eating habits. Providing psychoeducation is helpful, but a book might be too much for a client just starting therapy, and you are also still in the information-gathering phase. Behavioral experiments such as trying triggering foods and creating a hierarchy are both activities that the therapist needs to guide to ensure that no harm is caused; therefore, these interventions are not appropriate for homework. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
835,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",What element of an active treatment plan would involve Shania attending recovery groups regularly?,long-term goal,objective within a long-term goal,intervention to support an objective,discharge recommendation,"(A): long-term goal
(B): objective within a long-term goal
(C): intervention to support an objective
(D): discharge recommendation",objective within a long-term goal,B,"Peer-led recovery support groups have been proven effective for individuals in substance use and dependency recovery as part of an evidence-based treatment plan goal to maintain sobriety, therefore ""sobriety maintenance"" can be considered the long-term goal. An objective within this goal might read ""Shania will maintain weekly attendance at her local Alcoholics Anonymous meetings throughout duration of counseling episode,"" which is why the answer is c). Based on the way the question is phrased, a discharge recommendation is not an element of an ""active treatment plan"" but of a ""discharge plan"", making answer c) the better choice. An intervention to support this objective like answer d) suggests might read ""Therapist will monitor weekly attendance to recovery groups and engage Shania in discussion over what she has reflected upon within each group meeting,"" as interventions are the therapist-led component. Therefore, the correct answer is (C)",treatment planning
836,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",What is the most appropriate course of action to take regarding the client's concern about paying for therapy sessions?,Tell the client that you do not believe this arrangement will be a problem but that you will follow up with him after speaking with your supervisor.,Consult with your supervisor and seek appropriate guidelines.,Accept the client's offer and set up an equitable exchange for therapy and massage sessions.,Decline the client's offer but agree to offer pro bono therapy services.,"(A): Tell the client that you do not believe this arrangement will be a problem but that you will follow up with him after speaking with your supervisor.
(B): Consult with your supervisor and seek appropriate guidelines.
(C): Accept the client's offer and set up an equitable exchange for therapy and massage sessions.
(D): Decline the client's offer but agree to offer pro bono therapy services.",Consult with your supervisor and seek appropriate guidelines.,B,"Consulting with your supervisor is the correct answer because you are a counseling intern. Your supervisor is there to discuss cases with you. The client's suggestion could be viewed as bartering, or it could be a boundary issue. Your supervisor can discuss your feelings about the request and offer options for handling the situation. Therefore, the correct answer is (A)",professional practice and ethics
837,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.","In working with the client on bereavement, which of the following will be most effective in helping him understand and engage in ""good grief""?","Help the client survey friends about how they view grieving and what is ""normal""",Help the client identify the helpful grief traditions in his own and extended family,Help the client recognize that grief is individual so whatever he feels is appropriate,Help the client use a grief workbook so that he can align his emotions with what he reads,"(A): Help the client survey friends about how they view grieving and what is ""normal""
(B): Help the client identify the helpful grief traditions in his own and extended family
(C): Help the client recognize that grief is individual so whatever he feels is appropriate
(D): Help the client use a grief workbook so that he can align his emotions with what he reads",Help the client identify the helpful grief traditions in his own and extended family,B,"Families have different traditions for grieving, which the client will be familiar with, even if these have not been available to him due to his PTSD-related anger. Identifying what traditions have been helpful for past family losses and might be helpful for him now as he grieves his father, will provide him with action steps and a family support system that is likely to help him engage in those traditions. Helping the client embrace the individuality of the grief process is both positive and negative. The client has spent 15 years in a grief process that has been ineffective and emotionally harmful due to the trauma involved in his loss. While grief is experienced differently by individuals, there are emotions and actions that are not helpful in resolving grief, which has been exemplified in this case study. Surveying friends provides information on the different ways families, individuals, and cultures grieve, but will not take into account the client's unique situation, the nature of his grief, or the ways that the client may have seen others in his family grieve well. Traditions for grieving are helpful for clients as they share those traditions with others in their culture and allow people to grieve together rather than in isolation. Many individuals may find a workbook or other structured guide helpful for grieving and learning about grief. While helpful, workbooks or guides are generic in structure and are not able to capture each individuals' specific grief story and needs. It would be inappropriate then for the client to plan to align his own emotions with a workbook. Therefore, the correct answer is (C)",counseling skills and interventions
838,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client",What are you trying to accomplish by discussing the implications of early childhood attachment with the client?,Demonstrate the connection between biopsychosocial factors and symptom severity.,Illustrate the relationship between temperament and unrelenting standards.,Show the association between unmet childhood needs and maladaptive schemas.,Establish the connection between adverse childhood experiences and risk level for perpetration.,"(A): Demonstrate the connection between biopsychosocial factors and symptom severity.
(B): Illustrate the relationship between temperament and unrelenting standards.
(C): Show the association between unmet childhood needs and maladaptive schemas.
(D): Establish the connection between adverse childhood experiences and risk level for perpetration.",Show the association between unmet childhood needs and maladaptive schemas.,C,"The goal of discussing attachment with the client is to determine the association between unmet childhood needs and maladaptive schemas. Schema therapy is an integrative approach used to treat individuals with personality disorders. The theory integrates elements of attachment theory, cognitive-behavioral therapy, and object relations to address maladaptive schemas. A schema is an influential belief system acquired about oneself, others, and society at large. Maladaptive schemas originate from early childhood experiences and create emotional, cognitive, and behavioral impairments. Since there are no indications that the client’s child is at risk for victimization, determining the client’s risk level for perpetration is unnecessary. Temperament is inborn rather than environmental. While determining the role temperament plays in social and relational interactions is essential, the client’s upbringing in foster care provides more insight into attachment and object relations. A biopsychosocial assessment uses a holistic approach to determine biological, social, and psychological influences on a client’s presenting problem. The connection would need to be made between biopsychosocial factors and attachment rather than symptom severity. Therefore, the correct answer is (A)",counseling skills and interventions
839,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students.  Seventh session Almost two months have passed since you first met with the client. She has been meeting you for weekly therapy sessions. During previous sessions, you continued to work on developing a sense of trust with the client which has allowed her to open up to you about the myriad of feelings that she has regarding her injury. You explored and processed feelings of grief and sadness, as well as feelings of anger and resentment. Several sessions have been dedicated to identifying automatic thoughts that have been contributing to the client's negative attitude and replacing negative self-talk like ""I'm broken"" with more positive and realistic statements. You have also been using solution-focused techniques to help her to focus on what is within her power to change and take active steps toward making those changes.    During today's session, the client agrees with you when you state that you believe she has achieved many of her goals in therapy. The client has worked through her ambivalence towards teaching the younger ballet classes and is now actively pursuing this opportunity. She reports that she finds a sense of purpose in helping the students learn and appreciate dance, as well as feel accomplished for their achievements. She says, ""It's still strange not being the student anymore, but I'm glad that I decided to try it. The kids had a performance last week, and one of the girls gave me this really sweet clay ballet shoe that she made in her art class. She told me that I'm the reason she felt 'brave enough' to keep dancing even though she was scared. That meant a lot to me.""    You then ask her about her relationship with her parents. She reports that it has improved since they had the discussion about trust. They are now more willing to listen to her opinions and have loosened some of the restrictions, though there are still some limits in place. Although they still have expectations of her and restrict certain activities, they now talk to her more openly and engage with her in a positive manner. She tells you that she would like to get all A's this semester to make her parents proud. She is getting better grades in history but states that her other classes are ""boring."" She also mentions wanting to put some limits on the amount of time she spends with her friends and ""get away from smoking as much."" She says that she is trying to be a better role model for her ballet students. You acknowledge how hard she has worked to reach this point and congratulate her on taking initiative in improving her academic performance and setting new boundaries with her friends."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",What would you consider the best way to begin the termination process with the client?,Review the progress that she has made on her stated treatment goals,Email the client before the session notifying her that you are starting the termination process,Outline how you will structure future sessions,Discuss unresolved treatment goals,"(A): Review the progress that she has made on her stated treatment goals
(B): Email the client before the session notifying her that you are starting the termination process
(C): Outline how you will structure future sessions
(D): Discuss unresolved treatment goals",Review the progress that she has made on her stated treatment goals,A,"This is probably the best way to start a conversation about termination. Discussion of the client's progress toward the completion of stated goals in therapy is important. Therefore, the correct answer is (C)",treatment planning
840,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,The best approach for the counselor to take considering Molly's disposition is?,Tell Molly she knows how she feels because she lost her dad around the same age,Remind Molly that if she doesn't participate the car will be forfeited,Address questions only to Molly's mother,Ask more open-ended questions to allow Molly to expand on her answers,"(A): Tell Molly she knows how she feels because she lost her dad around the same age
(B): Remind Molly that if she doesn't participate the car will be forfeited
(C): Address questions only to Molly's mother
(D): Ask more open-ended questions to allow Molly to expand on her answers",Ask more open-ended questions to allow Molly to expand on her answers,D,"Asking open ended questions allows Molly to expand on her responses and leads to deeper conversations. Rapport building is key in an initial session. Although the car is what persuaded Molly to come in the first place, it would not wise for the counselor to bring this up as a way to force her to participate. It is best for the client to participate on their own terms especially as Molly seemed hesitant and possible distrustful of her counselor. If the counselor were to stop speaking to Molly altogether and only to her mother, this would hinder the engagement process as Molly was initially showing resistance. The counselor should acknowledge Molly and allow her opportunities to participate at her own pace. Finally, though self-disclosure can be beneficial, it is usually a purposeful intervention. This type of self-disclosure can be interpreted as minimizing the other person's feelings. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
841,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",Which theoretical base would provide the most direct approach in helping the client identify underlying emotions and faulty thoughts contributing to her eating behavior?,Reality therapy,Emotion-Focused Therapy,Gestalt therapy,Solution-focused therapy,"(A): Reality therapy
(B): Emotion-Focused Therapy
(C): Gestalt therapy
(D): Solution-focused therapy",Emotion-Focused Therapy,B,"Emotion-focused therapy (EFT) emphasizes identifying, experiencing, and processing emotions. An EFT therapist would help the client connect with feelings like anxiety, sadness, etc, that may drive disordered eating patterns. Techniques like two-chair dialogues could be used to uncover the emotional roots of the eating behavior. erstanding. Therefore, the correct answer is (C)",treatment planning
842,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","To address your client's attachment style, which of the following steps should be taken as you work together?",All of the above,"Develop social skills, including reading body language and responding to social cues",Build support networks for communication and trust,Address childhood trauma,"(A): All of the above
(B): Develop social skills, including reading body language and responding to social cues
(C): Build support networks for communication and trust
(D): Address childhood trauma",All of the above,A,"Each of these are important factors in building self-esteem, which is critical for resolving ambivalent attachment. Working through childhood trauma allows the individual to see how the parental figures' behavior influenced the client's insecurity. The counselor often acts as a model parental figure during this time to help the client form secure attachments. Individuals with ambivalent attachment are anxious and insecure so building supportive relationships that offer security and trust is helpful for building self-esteem and secure attachments. Finally, children with attachment issues may have poorly developed social skills as they did not feel safe forming attachments early on. In this case, helping the client learn to respond to social cues and read body language may assist him in choosing healthy individuals with whom to form relationships. Therefore, the correct answer is (D)",counseling skills and interventions
843,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.  Ninth session You have seen the client weekly, and she is progressing. She arrives at today's session on time. She appears calm, alert and focused. She states that she has been actively journaling her thoughts and feelings. This has been helpful for her in identifying themes in her faulty cognitions. She tells you that she is surprised by how much she is learning about herself, including how much her past has influenced her current beliefs.    She showed some psychomotor agitation by pulling on the strings of her blouse. The client expressed that she and her husband have been trying to implement a date night which has helped their relationship and for him to better understand what Panic Disorder is. She said that having meaningful conversations with him and having his support in times of panic has helped reduce the attack's length. However, the client did express that she cannot shake the fear of dying and leaving her children. You discuss with her the potential triggers of these panic attacks and discuss ways to manage them.    As she leaves, you see that she has bruises on her arms as she is getting ready to leave and says she was ""roughhousing"" with her husband. You are unsure if she is telling the truth, making you wonder about everything she has been saying about her husband. You discuss with her the option of attending couples therapy to help them work through any issues they may face. She says she is open to it but worried about bringing up deeper issues surrounding their relationship. You reassure her that she and her husband will have a safe space to discuss any topics and remind her about the counseling.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Given the client's admission of her husband causing her bruises and your suspicions, what action should you take?",Acquaint the client about assistance and social services available.,Notify authorities only if you have the client's authorization.,Take the client at her word concerning her bruises.,Report to the authorities without the client's permission.,"(A): Acquaint the client about assistance and social services available.
(B): Notify authorities only if you have the client's authorization.
(C): Take the client at her word concerning her bruises.
(D): Report to the authorities without the client's permission.",Acquaint the client about assistance and social services available.,A,"In this situation, the client does not fall within the vulnerable population that requires mandated reporting. You should, however, help the client identify sources to help address abuse. It is important to assess the client's immediate needs and provide any necessary resources or referrals. You may also want to work with the client on developing strategies for safety and healing from the trauma of being in an abusive relationship. Additionally, if the client expresses a desire to reach out for help, you should provide information about local organizations that specialize in domestic violence. It is important to ensure that the client has a support system in place and knows how to access resources if needed. Therefore, the correct answer is (B)",professional practice and ethics
844,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","You are meeting with the client individually and providing parenting training with the client’s PGM. The client’s teacher has implemented a behavioral chart for the classroom, and you ensure the client is receiving appropriate reinforcement for targeted behaviors. The teacher believes the client’s behavior indicates ADHD, and you have agreed to conduct classroom observations. During the observation, you note that the client gets out of her seat multiple times to sharpen her pencil. While doing so, she glares at other students and is observed balling up her fists and threatening others. The teacher yells at the client to sit down and stop disrupting the classroom, which has little effect on the client’s behavior",Which one of the following accurately describes criterion-referenced measurements?,Measurements determine how a person’s knowledge or skills compare to someone with similar traits.,Measurements compare a person’s knowledge or skills against a predetermined standard.,Measurements compare a person’s knowledge or skills against a normed group.,Measurements are ranked on a bell curve.,"(A): Measurements determine how a person’s knowledge or skills compare to someone with similar traits.
(B): Measurements compare a person’s knowledge or skills against a predetermined standard.
(C): Measurements compare a person’s knowledge or skills against a normed group.
(D): Measurements are ranked on a bell curve.",Measurements compare a person’s knowledge or skills against a predetermined standard.,B,"Criterion-referenced measurements compare a person’s knowledge of skills against a predetermined standard. For example, goal attainment scaling is a criterion-referenced measure because it measures the client’s targeted behaviors, which is the predetermined standard or criterion. The client’s progress is compared with previous scores. Criterion-referenced tests often use cut scores to categorize predetermined standards. For example, the goal attainment scaling scores can be used to determine minimum, moderate, and significant improvement. Norm-referenced measurements compare a person’s knowledge or skills against a normed group, which can be ranked on a bell curve and compared with another person with similar traits. Examples of norm-referenced measures include pediatric growth charts or the SATs. Therefore, the correct answer is (C)",professional practice and ethics
845,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",Which actions would be most ethical for the therapist to take regarding Dawn's feelings of isolation and lack of belonging?,Indicate to the client that she needs to reduce isolating herself and put herself out more socially.,Encourage the client to join campus groups aligned with her interests.,Refer the client to group therapy.,Contact the campus social life director to ask the client's roommates to include her in their plans.,"(A): Indicate to the client that she needs to reduce isolating herself and put herself out more socially.
(B): Encourage the client to join campus groups aligned with her interests.
(C): Refer the client to group therapy.
(D): Contact the campus social life director to ask the client's roommates to include her in their plans.",Encourage the client to join campus groups aligned with her interests.,B,"The therapist is ethically responsible for respecting Dawn's autonomy and empowering her to make connections. Joining campus groups would allow Dawn to take steps to build her social network in a way that aligns with her personal interests. This upholds Principle E of the APA Ethics Code. Therefore, the correct answer is (C)",treatment planning
846,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ","The client claims that there are no issues at school, but the father's statements contradict the client's statement. How can you most effectively address this conflicting information?",Recognize that the client is using denial as a means of helping him cope with his anxiety and make a note for further exploration.,Ask the father to respond about the client's experience at school to reframe the client's experience.,Gently rephrase the question as a means to allow the client to provide a more factual answer.,Ask more detailed questions about the client's experience without directly contradicting the client.,"(A): Recognize that the client is using denial as a means of helping him cope with his anxiety and make a note for further exploration.
(B): Ask the father to respond about the client's experience at school to reframe the client's experience.
(C): Gently rephrase the question as a means to allow the client to provide a more factual answer.
(D): Ask more detailed questions about the client's experience without directly contradicting the client.",Ask more detailed questions about the client's experience without directly contradicting the client.,D,"Exploring the client's experiences while building rapport will help establish a viable therapeutic relationship. This is especially important when working with a child. Directly contradicting and ""calling him out"" risks harming the therapeutic relationship. Therefore, the correct answer is (D)",counseling skills and interventions
847,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.",Which of the following counseling characteristics will be most effective when working with this or any client with a hoarding disorder?,Congruence,Empathic Responding,Sensitivity to multicultural issues,Positive Regard,"(A): Congruence
(B): Empathic Responding
(C): Sensitivity to multicultural issues
(D): Positive Regard",Empathic Responding,B,"Empathic responding will be the most important counseling characteristic when working with this or any client with a hoarding disorder. Even those with hoarding disorders have the autonomy to choose what they will keep and what they will discard. While the client's possessions may have no value to the counselor or others, they hold significant value for the client and the counselor's empathic response, as the client works through modifying thought, experiencing extreme emotions, and making choices, is critical. Congruence and positive regard are important counseling characteristics with all clients and facilitate the trust needed for the therapeutic relationship. While these are important for that relationship, without empathic responding during the hoarding client's exploration of possessions, change will not occur. Sensitivity to multicultural issues is also an important counseling characteristic with all clients and will help the counselor better understand the client's perceptions of the world and themselves; however, it is not as helpful in supporting the client's work on changes as is empathic responding. Therefore, the correct answer is (C)",counseling skills and interventions
848, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,How should the counselor respond to Li's description of her situation?,"""That sounds like a tough job.""","""You should not be treated this way.""","""How was it like in your homeland?""","""This happens all the time.""","(A): ""That sounds like a tough job.""
(B): ""You should not be treated this way.""
(C): ""How was it like in your homeland?""
(D): ""This happens all the time.""","""You should not be treated this way.""",B,"Li is in an exploitive situation, and it must be addressed that this is not safe or appropriate. Choices a and b minimize what Li is experiencing and disregards her safety and well-being. Choice c is assuming that Li had a worse experience where she came from and also minimizes what she is currently going through. Therefore, the correct answer is (D)",professional practice and ethics
849,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","   n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family",How might you use motivational interviewing to elicit change talk from the client?,Evoke the client’s optimism for change by asking about a previous change she successfully made in her life.,Confront the client on how maintaining the status quo is detrimental to progress.,Persuade the client to attend a psychiatric evaluation for medication.,Help the client to reevaluate the nature of the relationship with her husband.,"(A): Evoke the client’s optimism for change by asking about a previous change she successfully made in her life.
(B): Confront the client on how maintaining the status quo is detrimental to progress.
(C): Persuade the client to attend a psychiatric evaluation for medication.
(D): Help the client to reevaluate the nature of the relationship with her husband.",Evoke the client’s optimism for change by asking about a previous change she successfully made in her life.,A,"Using motivational interviewing, you would elicit change talk by evoking the client’s optimism for change by asking about a previous change that she successfully made in her life. Motivational interviewing uses various techniques to reduce ambivalence and enhance motivation to change. The spirit of motivational interviewing focuses on collaborating with the client, evoking reasons for change, and honoring the client’s autonomy. Helping the client reevaluate her relationship with her husband would not be aligned with the spirit of motivational interviewing because the client did not establish this as an area in need of change. Using persuasion and confrontation is not in alignment with the spirit of motivational interviewing. Exploring disadvantages of the status quo is a component of motivational interviewing; however, the counselor must guide the client in this process rather than confront the client to take action. Therefore, the correct answer is (D)",counseling skills and interventions
850,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following treatments would be least helpful for treating this client?,Trauma-focused Cognitive Behavioral Therapy (TF-CBT),Prolonged Exposure Therapy (PE),Brain Spotting,Eye Movement Desensitization Reprocessing (EMDR),"(A): Trauma-focused Cognitive Behavioral Therapy (TF-CBT)
(B): Prolonged Exposure Therapy (PE)
(C): Brain Spotting
(D): Eye Movement Desensitization Reprocessing (EMDR)",Trauma-focused Cognitive Behavioral Therapy (TF-CBT),A,"TF-CBT is not appropriate treatment for this client because TF-CBT is engineered and modeled to be used with children and adolescents who have experienced trauma. EMDR, brain spotting, and PE are all appropriate treatments for adults with PTSD. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
851,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy","As you near the termination phase with your client, you recommend which of the following to help assess progress, maintain learned skills, and prevent relapse?",Booster sessions,Psychoeducation,Value-based living,Mentorship,"(A): Booster sessions
(B): Psychoeducation
(C): Value-based living
(D): Mentorship",Booster sessions,A,"Booster sessions occur after treatment has ended and provide a way for clients to assess progress, maintain learned skills, and prevent relapse. Relapse prevention (RP) is an evidence-based practice for BDD. RP is a process in which skills are reviewed, potential challenges are addressed, and the idea of self-therapy is discussed. RP takes place prior to termination and during future pre-planned booster sessions. Value-based living is a component of acceptance and commitment therapy (ACT). Value-based living is an intervention that can help individuals with BDD de-emphasize the importance of attraction by focusing on other values in one’s life. Psychoeducation is generally used at the beginning of treatment for individuals with BDD to help improve insight. Mentorship is not a component of relapse prevention. Therefore, the correct answer is (C)",treatment planning
852,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.",,How would you explain your primary role as a humanistic-oriented therapist to this client?,"""I'm here to provide a supportive and nonjudgmental space for you to explore your feelings and experiences to help you gain insight into your unique situation.""","""My job is to help you focus on what you want to achieve in the future and use small steps to move towards those goals.""","""During therapy, I will help you identify and challenge any unhelpful thoughts and biases that may be contributing to your current problems.""","""My main objective as your therapist is to help you take ownership of your choices and develop the necessary skills to effectively handle your life circumstances.""","(A): ""I'm here to provide a supportive and nonjudgmental space for you to explore your feelings and experiences to help you gain insight into your unique situation.""
(B): ""My job is to help you focus on what you want to achieve in the future and use small steps to move towards those goals.""
(C): ""During therapy, I will help you identify and challenge any unhelpful thoughts and biases that may be contributing to your current problems.""
(D): ""My main objective as your therapist is to help you take ownership of your choices and develop the necessary skills to effectively handle your life circumstances.""","""I'm here to provide a supportive and nonjudgmental space for you to explore your feelings and experiences to help you gain insight into your unique situation.""",A,"As a humanistic-oriented therapist, your primary role is to provide a safe and supportive environment in which the client can freely explore their feelings and experiences. This allows the client to gain insight and understanding into their unique situation. Your role is not to judge or make decisions for the client, but rather to provide guidance and support in order for them to come to their own conclusions about the best steps for moving forward. Therefore, the correct answer is (B)",professional practice and ethics
853,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.",You have been working with the client weekly and are meeting with the mother today to discuss interventions that she can use at home. She relays that her husband does not support the diagnosis of ADHD and has reached out to their faith community instead. The mother is conflicted about counseling and explains that it is viewed as a sign of weakness in her community. She continues to voice concern over the school’s lack of diversity and her belief that the client is being treated differently because of his race,"In a research study, which methodological feature considers ethnocultural variables when determining external validity?",Choice of outcome measures,Design of the study,Length of follow-up,Criteria for inclusion-exclusion,"(A): Choice of outcome measures
(B): Design of the study
(C): Length of follow-up
(D): Criteria for inclusion-exclusion",Criteria for inclusion-exclusion,D,"A research study’s inclusion-exclusion criteria are a methodological feature that considers ethnocultural variables (eg, race, ethnicity, gender, and age). Inclusion criteria are characteristics of the subjects participating in the study, whereas exclusion criteria disqualify individuals from being included. External validity, or how well the results can be generalized to other settings, is contingent upon the characteristics of the study’s participants. For example, a study concludes that certain foods and additives may impact symptoms of ADHD. However, if the study was only conducted with white adolescent females, it has limited value and thus cannot be generalized to the client, an African American 7-year-old male. The design of the study (whether it is quantitative or qualitative), outcome measures (ie, symptom reduction), and the length of follow-up (ie, the intervention effects over time) are crucial elements of a research study; however, only inclusion-exclusion criteria affect the study’s generalization to ethnocultural groups. Therefore, the correct answer is (D)",professional practice and ethics
854,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","You meet with the client, and she reports that she started dating someone. You and the client spend some time talking about the man who she is dating and agree that he sounds like a nice person that is not taking advantage of her personality. You and the client discuss her having an increased awareness of the behaviors that she has engaged in in the past that she did not like. The client identifies that she has engaged in behavior that worries her with this boyfriend. She went out for lunch and felt compelled to buy him lunch also, even though he was not there. After exploring why the client feels an obligation to buy her boyfriend lunch when he is not present with her, it becomes clear that it is motivated by the fear that he will be offended that she bought herself lunch without thinking of him. You support the client in identifying more helpful thoughts related to this and ask her to complete a behavioral experiment regarding this situation. The client becomes frustrated that she is still struggling with relationships and says, “I think I’ll just date who I want and how I want from here on out. It’s definitely the easiest choice instead of doing all of this.” You remind the client that therapy takes some time but can be really beneficial and you praise her for engaging fully so far",Which of the following statements demonstrates the use of paradox in response to the client’s statement that she should just date who she wants?,"“Maybe you should date who you want and how you want, even though it can be frustrating for you. This process does seem like a really hard step for you.”",“You can continue to date who and how you want to; that is your own choice.”,“What if you decided to try things differently this time because you haven’t been happy in the past with dating.”,“Only you can decide if you want to continue counseling; you can always take a break or wait until you’re ready to work on your relationships.”,"(A): “Maybe you should date who you want and how you want, even though it can be frustrating for you. This process does seem like a really hard step for you.”
(B): “You can continue to date who and how you want to; that is your own choice.”
(C): “What if you decided to try things differently this time because you haven’t been happy in the past with dating.”
(D): “Only you can decide if you want to continue counseling; you can always take a break or wait until you’re ready to work on your relationships.”","“Maybe you should date who you want and how you want, even though it can be frustrating for you. This process does seem like a really hard step for you.”",A,"Paradox is a counseling technique in which the counselor goes along with the client’s statement even if they do not agree with it to demonstrate a deeper empathy for the client’s underlying feelings. It must be used with care in the counseling relationship. The purpose of using paradox is to investigate the roots of the client’s motivation to continue a negative behavior. For instance, this client is frustrated that counseling is taking time and rather than focusing on the client’s statement of continuing negative behavior, you are empathizing with this feeling of frustration by agreeing with her statement as an expression of frustration. This statement can also support the client in identifying reasons to change her behavior. The client has the right to start or stop therapy if she wants, but you would want to support her in finding the motivation to participate. Encouraging the client to try new behavior that may have more positive results is a helpful technique, but it does not demonstrate the use of paradox. Therefore, the correct answer is (C)",counseling skills and interventions
855,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.","You assess that EMDR (eye movement desensitization and reprocessing) therapy will be beneficial for Melanie's treatment of past trauma. However, this service is not covered by her Medicaid insurance provider. How do you bring this up with Melanie?",Provide EMDR services without payment as this is the ethical treatment option,Tell her she needs EMDR to heal regardless of how she pays for it,Explain the constraints on her resources will not afford her the opportunity to have EMDR,None of these approaches are appropriate in handling this situation,"(A): Provide EMDR services without payment as this is the ethical treatment option
(B): Tell her she needs EMDR to heal regardless of how she pays for it
(C): Explain the constraints on her resources will not afford her the opportunity to have EMDR
(D): None of these approaches are appropriate in handling this situation",None of these approaches are appropriate in handling this situation,D,"Your assessment of Melanie's need for EMDR to have effective counseling results is your initial clinical opinion to begin with and does not account for a ""necessity"" in her care despite how supportive it might be for her healing process. You may discuss the option of EMDR therapy with her throughout the course of counseling and educate her on the process while allowing her to make the final decision about receiving the services. Assuming she will not be able to afford EMDR because her specific Medicaid provider does not cover it, is not giving the client the chance to decide what is in her best interest. Providing any services without proper rendering of payment is not necessarily an ethical transaction, however, the transaction may be seen as a charitable one. It is best practice to present your assessment findings to Melanie while explaining how EMDR treatment could be beneficial, then inform her that her insurance does not cover it and collaborate with her on alternative options. Therefore, the correct answer is (D)",professional practice and ethics
856,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.  Ninth session Alexei appeared anxious during his weekly session today. He tells you that he constantly thinks about how good his life was in Germany and is afraid he will never feel comfortable in America. On a positive note, Alexei shares that he and his wife talked about their relationship and want to take steps to repair their marriage. He now admits to you that his drinking is a problem, but he struggles with the physical aspects of trying to quit. Whenever he tries to stop drinking, he gets sweaty and fears that he will have a seizure, so he begins drinking again. He explains that he cannot get past these symptoms. You discuss with Alexei the option of entering a rehabilitation center to assist him medically with the detox process. Alexei admits that he is unsure about the idea of going into treatment. He acknowledges that it might be beneficial but worries about leaving his family for a prolonged period. He expresses concern that his wife will not be able to handle everything on her own and wonders what will happen with their marriage while he is in treatment. You explore his concerns using motivational interviewing techniques and ask him to discuss this information with his wife.    During the session, you commend Alexei for recognizing the impact of his drinking on his life and his willingness to discuss these concerns openly. You acknowledge the challenges he faces in trying to quit and the physical symptoms he experiences. You explain that seeking professional help at a rehabilitation center could provide the medical support he needs to manage withdrawal symptoms safely and effectively. You emphasize that by addressing his alcohol dependence, he will likely find it easier to adapt to his new life in America and repair his marriage.    Regarding his concerns about his wife managing things while he is in treatment, you explore potential solutions and support systems that could be implemented during his absence. You encourage Alexei to discuss these concerns with his wife and involve her in decision-making. Together, they can identify family members, friends, or community resources that could offer assistance. Finally, you reassure Alexei that taking the time for treatment is an investment in his long-term well-being and that of his family. By addressing his alcohol dependence, he will be better equipped to support his wife and family emotionally and practically in the long run.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",What secondary factor may be contributing to the client's substance use?,Codependency issues with his mother,Problems with his marriage,Difficulty in integrating culturally,Loneliness and lack of social interactions,"(A): Codependency issues with his mother
(B): Problems with his marriage
(C): Difficulty in integrating culturally
(D): Loneliness and lack of social interactions",Difficulty in integrating culturally,C,"The client is having difficulty with enculturation, as demonstrated by his missing home and his fear of not being able to adapt to being in America. Therefore, the correct answer is (C)",counseling skills and interventions
857,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Which of the following factors should be considered in an assessment in addition to a client's record?,Biases,All of the above,Influence of professional orientation,Trust and rapport,"(A): Biases
(B): All of the above
(C): Influence of professional orientation
(D): Trust and rapport",All of the above,B,"Although the client's record can provide a wealth of information, it should be reviewed in conjunction with interviews of client, family and collateral sources, as well as recent tests, evaluations or assessments. A counselor should also consider his/her professional orientation and how it may influence case conceptualization. It is also important to evaluate the trust and rapport in the relationship to understand whether there is possibly information that has been withheld. A counselor should also be aware of his/her biases in order to reflect upon those and how they may influence the assessment process. Therefore, the correct answer is (D)",treatment planning
858,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","The client comes to the session, sits down, and is quiet. The parents report that prior to the session he was playing an online game and became so upset that he threw his video game console. The parents express frustration that they do not know what to do when this happens. You provide psychoeducation to the client regarding coping skills to manage frustration. You find out that the parents respond by removing access to video games, and this usually results in yelling back and forth with the parents and the client. The parents do typically encourage the client to listen to music because this appears to be very effective in calming him down. The client expresses frustration with the people that he was playing with by saying that they “cheated and are lying about it.” You support the client with cognitive reframing.  When the client becomes angry, the parents are unsure of what to do","When the client becomes angry, the parents are unsure of what to do. Which of the following would be considered positive reinforcement of the client’s behavior?","When the client resists becoming angry despite circumstances that usually generate his anger, the parents withhold a negative consequence (such as scolding) to encourage him to continue the appropriate behavior.","The client does not become angry when he loses, and the parents provide praise.",The parents remove the video game console and restrict his access to it over the next week.,The parents ignore the client when he throws his video game console.,"(A): When the client resists becoming angry despite circumstances that usually generate his anger, the parents withhold a negative consequence (such as scolding) to encourage him to continue the appropriate behavior.
(B): The client does not become angry when he loses, and the parents provide praise.
(C): The parents remove the video game console and restrict his access to it over the next week.
(D): The parents ignore the client when he throws his video game console.","The client does not become angry when he loses, and the parents provide praise.",B,"The parents are providing positive reinforcement when they provide praise when the client exhibits appropriate behavior. The parents removing a consequence (scolding) to increase appropriate behavior is negative reinforcement. The parents ignoring a behavior is considered extinction. The parents removing the console would be considered punishment for his behavior. Therefore, the correct answer is (A)",counseling skills and interventions
859,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling  Marital Discord Diagnoses:  You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago.  The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of  The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce","What assessment tool should you use to better determine the couple’s relationship distress, cohesiveness, and affectional expression?",Maudsley Marital Questionnaire (MMQ),Dyadic Adjustment Scale (DAS),Measure of Attachment Qualities (MAQ),Personal Assessment of Intimacy in Relationships (PAIR),"(A): Maudsley Marital Questionnaire (MMQ)
(B): Dyadic Adjustment Scale (DAS)
(C): Measure of Attachment Qualities (MAQ)
(D): Personal Assessment of Intimacy in Relationships (PAIR)",Dyadic Adjustment Scale (DAS),B,"The DAS measures a couple’s levels of relationship distress and includes the following four subscales: (1) dyadic consensus (ie, how well the couple agrees with one another), (2) dyadic satisfaction (ie, how content the couple is with the relationship), (3) dyadic cohesion (ie, how well the couple engages in activities with one another), and (4) affectual expression (ie, agreed-upon emotional and affectional expression). The DAS, which consists of a 32-item self-rated assessment instrument, is used to measure levels of perceived distress for couples in committed relationships. The MMQ is also a self-assessment. The MMQ uses two subscales to measure relational and sexual connectedness. The PAIR inventory identifies five forms of intimacy for a couple: emotional, recreational, sexual, social, and intellectual. The MAQ measures secure, avoidant, and anxious-ambivalent attachment styles. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
860, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.","Considering her family history and reported symptoms, which disorder can be ruled out before further assessing for an additional provisional diagnosis?",ADHD,panic disorder,Bipolar II,Bipolar I,"(A): ADHD
(B): panic disorder
(C): Bipolar II
(D): Bipolar I",Bipolar I,D,"The client demonstrates history, behavior and reported symptoms that are reasonable enough to screen and further assess for Panic Disorder, Bipolar II or ADHD. Since the client has not experienced a manic episode for a period of at least one week, she does not meet criteria for Bipolar I Disorder. Her panic symptoms, however, may be better explained by her existing diagnoses of either anxiety or post-traumatic stress. Family history of conditions (such as Bipolar or ADHD) may increase the likelihood but does not automatically implicate next of kin with a diagnosis. The sum of her specific symptoms could very well be side effects of her medication and may not necessarily indicate a co-occurring disorder. Answers a, c and d however, are conditions that have plausible reason to be considered upon further analysis. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
861,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","You are meeting with the client individually and providing parenting training with the client’s PGM. The client’s teacher has implemented a behavioral chart for the classroom, and you ensure the client is receiving appropriate reinforcement for targeted behaviors. The teacher believes the client’s behavior indicates ADHD, and you have agreed to conduct classroom observations. During the observation, you note that the client gets out of her seat multiple times to sharpen her pencil. While doing so, she glares at other students and is observed balling up her fists and threatening others. The teacher yells at the client to sit down and stop disrupting the classroom, which has little effect on the client’s behavior.  The client receives a sticker from her teacher to positively reinforce predetermined operant behaviors",The client receives a sticker from her teacher to positively reinforce predetermined operant behaviors. Which of the following is NOT a key principle of operant conditioning?,Stimulus control,Extinction,Reproduction,Punishment,"(A): Stimulus control
(B): Extinction
(C): Reproduction
(D): Punishment",Reproduction,C,"Reproduction is a social learning concept rather than a key principle of operant conditioning. There are four phases of social learning: (1) attention (ie, noticing a particular behavior; (2) retention (ie, remembering the information); (3) reproduction (ie, imitating the behavior); and (4) motivation (ie, the desire to imitate the behavior). Principles of operant conditioning include extinction, punishment, reinforcement, and stimulus control. For extinction to occur, there must first be a reinforced response. Extinction happens when the reinforcer for that response is stopped, which lessens the possibility of the behavior’s recurrence. In operant conditioning, punishment is the presentation or removal of a circumstance or stimulus, resulting in the decreased probability of that response occurring. Finally, stimulus control is the process in which behavioral responses differentially happen in the presence or absence of particular stimuli. Therefore, the correct answer is (D)",professional practice and ethics
862,Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.","Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.",,Molly requested that the counselor not tell her mother about the consideration of cutting. The counselor should?,Call 911 to have Molly assessed for suicide risk,Immediately call mom in the room because it is a safety risk,"Tell Molly not to worry, she will not tell her mom what is disclosed in session",Provide psychoeducation to Molly regarding self-harm,"(A): Call 911 to have Molly assessed for suicide risk
(B): Immediately call mom in the room because it is a safety risk
(C): Tell Molly not to worry, she will not tell her mom what is disclosed in session
(D): Provide psychoeducation to Molly regarding self-harm",Provide psychoeducation to Molly regarding self-harm,D,"Currently Molly is not at immediate risk of suicide. Self-harm is not necessarily an indication of suicide risk. Typically, cutting provides a release of built-up emotions and is not an indication of suicidal ideation. The best route is to provide Molly with facts about cutting. Telling her mom would also cause mistrust in the therapeutic relationship and Molly may not be honest in future sessions. During the informed consent process, confidentiality should be discussed. Although the therapist maintains confidentiality, there are exceptions to this. During the intake, the counselor must review confidentiality, the limits to confidentiality and the fact that they are a mandated reporter. Therefore, the correct answer is (C)",professional practice and ethics
863,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","   ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation","Given the client’s background, all of the following factors may place him at higher risk for suicide EXCEPT:",Previous suicide attempt,Social isolation,Sexual orientation,Job loss,"(A): Previous suicide attempt
(B): Social isolation
(C): Sexual orientation
(D): Job loss",Previous suicide attempt,A,"Job loss, social isolation, sexual orientation, and previous suicide attempts all place individuals at higher risk for suicide. The client has experienced job loss and social isolation. His depressive symptoms were further complicated by his family’s response to his sexual orientation. However, the client denied suicidal ideation as well as previous suicide attempts in his mental status exam, so this factor would not place him at higher risk for suicide. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
864,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","The client comes to the session, sits down, and is quiet. The parents report that prior to the session he was playing an online game and became so upset that he threw his video game console. The parents express frustration that they do not know what to do when this happens. You provide psychoeducation to the client regarding coping skills to manage frustration. You find out that the parents respond by removing access to video games, and this usually results in yelling back and forth with the parents and the client. The parents do typically encourage the client to listen to music because this appears to be very effective in calming him down. The client expresses frustration with the people that he was playing with by saying that they “cheated and are lying about it.” You support the client with cognitive reframing.  You do not believe that the kids the client was playing video games with were cheating, and you do believe that it is more likely that the client was losing and was upset for that reason","You do not believe that the kids the client was playing video games with were cheating, and you do believe that it is more likely that the client was losing and was upset for that reason. Which one of the following actions would likely be the most helpful response to the client?",Process the situation with the client to help him understand his feelings.,Support the client in developing empathy skills to better understand the kids who he was playing games with.,Process the situation with the client to help him take responsibility for his feelings and actions.,Validate the client’s frustrations and support him in coping with his strong feelings.,"(A): Process the situation with the client to help him understand his feelings.
(B): Support the client in developing empathy skills to better understand the kids who he was playing games with.
(C): Process the situation with the client to help him take responsibility for his feelings and actions.
(D): Validate the client’s frustrations and support him in coping with his strong feelings.",Validate the client’s frustrations and support him in coping with his strong feelings.,D,"Focusing on helping him cope with his strong feelings would be most helpful to the client at this stage of the therapeutic relationship. Supporting the client in taking responsibility might make the client think that you are accusing him of being wrong about his interpretation of the situation. Supporting the client in understanding his feelings might be helpful; however, it does not encourage the client to manage his strong emotions, which are often the root of his negative behavior. Empathy can be a difficult skill for someone diagnosed with ASD to conquer and therefore may not best support the client in managing his strong emotions regarding the situation. Therefore, the correct answer is (D)",counseling skills and interventions
865,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.  Ninth session Alexei appeared anxious during his weekly session today. He tells you that he constantly thinks about how good his life was in Germany and is afraid he will never feel comfortable in America. On a positive note, Alexei shares that he and his wife talked about their relationship and want to take steps to repair their marriage. He now admits to you that his drinking is a problem, but he struggles with the physical aspects of trying to quit. Whenever he tries to stop drinking, he gets sweaty and fears that he will have a seizure, so he begins drinking again. He explains that he cannot get past these symptoms. You discuss with Alexei the option of entering a rehabilitation center to assist him medically with the detox process. Alexei admits that he is unsure about the idea of going into treatment. He acknowledges that it might be beneficial but worries about leaving his family for a prolonged period. He expresses concern that his wife will not be able to handle everything on her own and wonders what will happen with their marriage while he is in treatment. You explore his concerns using motivational interviewing techniques and ask him to discuss this information with his wife.    During the session, you commend Alexei for recognizing the impact of his drinking on his life and his willingness to discuss these concerns openly. You acknowledge the challenges he faces in trying to quit and the physical symptoms he experiences. You explain that seeking professional help at a rehabilitation center could provide the medical support he needs to manage withdrawal symptoms safely and effectively. You emphasize that by addressing his alcohol dependence, he will likely find it easier to adapt to his new life in America and repair his marriage.    Regarding his concerns about his wife managing things while he is in treatment, you explore potential solutions and support systems that could be implemented during his absence. You encourage Alexei to discuss these concerns with his wife and involve her in decision-making. Together, they can identify family members, friends, or community resources that could offer assistance. Finally, you reassure Alexei that taking the time for treatment is an investment in his long-term well-being and that of his family. By addressing his alcohol dependence, he will be better equipped to support his wife and family emotionally and practically in the long run.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","Using motivational interviewing, how would you evoke change talk with Alexei?","""I think you should recognize that your negative ideations are manifestations of catastrophizing, and your recognition of that will help you make progress.""","""The fear and physical symptoms you are experiencing when trying to stop drinking are completely normal. With the help of a rehabilitation center, you can learn how to manage this fear without resorting to drinking.""","""I understand your concerns, but I think your wife will understand if you go into treatment. I believe that making a commitment to become sober is a positive step in achieving your goal of repairing your marriage.""","""You have identified a variety of potential solutions to this problem and I'm wondering what potential advantages or disadvantages you may see from each option.""","(A): ""I think you should recognize that your negative ideations are manifestations of catastrophizing, and your recognition of that will help you make progress.""
(B): ""The fear and physical symptoms you are experiencing when trying to stop drinking are completely normal. With the help of a rehabilitation center, you can learn how to manage this fear without resorting to drinking.""
(C): ""I understand your concerns, but I think your wife will understand if you go into treatment. I believe that making a commitment to become sober is a positive step in achieving your goal of repairing your marriage.""
(D): ""You have identified a variety of potential solutions to this problem and I'm wondering what potential advantages or disadvantages you may see from each option.""","""You have identified a variety of potential solutions to this problem and I'm wondering what potential advantages or disadvantages you may see from each option.""",D,"This question allows the client to explore their thoughts and feelings about the situation, which is an important part of motivational interviewing. It encourages open dialogue and helps Alexei to better identify potential pros and cons to each option. This type of questioning can help Alexei gain insight into his own behavior, preferences, and decisions, which is a key component of motivational enhancement therapy. Additionally, this question does not push him to choose a particular option; rather it encourages him to reflect on his own circumstances and make an informed decision about how he wants to move forward. This can help Alexei feel more empowered in the process and ultimately increase motivation for change. Therefore, the correct answer is (B)",counseling skills and interventions
866,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","   bile. Family History: The client has two younger brothers who are 6 and 7 years old. The client often engages in physical fights and arguments with his younger siblings and often will break or steal their toys. The client takes advantage of his 6-year-old sibling by conning him out of items and activities by convincing him that a certain trade or decision is better for him, when it is usually better for the client. The client’s parents report that these behaviors occur at school and that the client does not have any friends as far as they are aware. The client’s parents state that the client is adopted and that he was in foster care from when he was 2 until he was 4 years old. The client’s parents state that his basic needs were neglected because his birth mother was heavily using drugs","All of the following treatment modalities and services would be appropriate based on the client’s presentation, EXCEPT:",Medication management,DBT,Family therapy,CBT,"(A): Medication management
(B): DBT
(C): Family therapy
(D): CBT",DBT,B,"DBT is not considered effective for treatment of conduct disorder. DBT is a modified version of CBT that was created for treatment of personality disorders, and it has also been proven effective with depression and bipolar disorder. CBT would be helpful in supporting the client in processing his thoughts more effectively in order to improve his behavior; it also has a focus on emotional regulation, which the client would benefit from. Family therapy would be appropriate to consider because the client and his family system are not functioning well as a whole and could use support in reestablishing relationships to become a more effective family system. The client could benefit from medication management for support in managing strong emotions. Therefore, the correct answer is (A)",treatment planning
867,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","   ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression",Which alternative behavior best targets the PGM’s needs based on her current parenting approach?,"Give directives in a calm, matter-of-fact manner.",Ignore negative behavior.,Provide clear expectations.,Use consistent follow through.,"(A): Give directives in a calm, matter-of-fact manner.
(B): Ignore negative behavior.
(C): Provide clear expectations.
(D): Use consistent follow through.",Provide clear expectations.,C,"Providing clear expectations is reflective of the PGM’s current learning needs. We gather from the intake session that the PGM has restricted the client from every single privilege indefinitely. The PGM has told the client that she can regain privileges once she learns to act her age. The best response targets the vague expectation for the client to act her age. You can provide effective parenting training by helping the PGM operationally define what it means for the client to act her age and how to state expectations in the affirmative (ie, instruct the client on what she should do rather than what she shouldn’t do). An example of a clear and positive directive is, “It’s time for you to brush your teeth” rather than, “Stop playing. You know it’s your bedtime” Further, by taking away privileges indefinitely, the PGM has no additional recourse for correcting subsequent misbehavior. While all other answer options are invaluable parenting strategies, insufficient information matches the alternative behaviors to the PGMs’ needs. For example, we do not know if she is ignoring negative behavior, which appropriate behaviors she chooses to ignore, and when. We also do not know if there is consistent follow through, nor do we know the manner in which she provides directives. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
868,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",What cognitive distortion is the client exhibiting during his initial session?,Personalization,Catastrophizing,All-or-nothing thinking,Overgeneralization,"(A): Personalization
(B): Catastrophizing
(C): All-or-nothing thinking
(D): Overgeneralization",All-or-nothing thinking,C,"All-or-nothing thinking is a cognitive distortion wherein a person views a situation in extremes, such as seeing themselves as an utter failure or believing that their thoughts are permanent. In this case, the client believes he is a ""total failure"", no one can help him, and no one cares about him. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
869,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","The client seems to be forthcoming in relation to the frequency and severity of her use of alcohol, but she maintains a reticence in coming to terms with the overall effect of her alcohol use on her life. As part of the initial intake process, which question will help you further evaluate the client’s level of functioning?","""Has your drinking caused you to overlook any obligations at work?""","""What support do you have now that you and your boyfriend are separated?""","""What is your current living situation?""","""Did your episode of driving intoxicated cause harm to anyone?""","(A): ""Has your drinking caused you to overlook any obligations at work?""
(B): ""What support do you have now that you and your boyfriend are separated?""
(C): ""What is your current living situation?""
(D): ""Did your episode of driving intoxicated cause harm to anyone?""","""Has your drinking caused you to overlook any obligations at work?""",A,"Asking whether the client's drinking has affected her ability to fulfill responsibilities at her job will help you assess her level of functioning. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
870,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.  10th session You have been seeing Gregory for therapy every week for the past three months. You have worked to improve the parent-child relationship and incorporated parent-management training into his treatment plan. You have taught Gregory's mother techniques to improve his behavior and support his emotional functioning. Also included in Gregory's treatment plan is improving impulse control, learning problem-solving skills, and improving social skills. You have used CBT interventions, structured activities, games, and role-playing exercises with Gregory to achieve these goals.    Today, Gregory begins the session by taking a paper from his backpack and handing it to you. You see that he received a high grade on his mid-term in Global Studies. You praise him for his hard work. Then, you ask him how it felt to get his grades back up. There is a long silence. Gregory is fidgeting with the string on his backpack. He turns, looks out the window, and whispers, ""Good, I guess."" You notice the client has tears in his eyes. You draw his attention to his behavior and affect and ask, ""Why are you upset after being successful with your exam?"" He shrugs his shoulders, looks at you, says, ""Would you stop asking me so many questions?"" and walks out of the office. You follow him into the waiting room and hear him tell his mom, ""I'll be in the car."" His mom looks confused. You say to her, ""Is something going on or did something happen with Gregory that I should know about? He seemed upset after showing me his good exam grades."" She thinks for a moment and tells you that he found a box of old family pictures and has been going through them. She wonders if this is related to his reaction today.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",What happened during this session that leads you to consider adjusting the client's treatment plan?,The client's sarcastic attitude,The client's shift in emotional response,The client leaving the session early,The client's reported improvement in academic functioning,"(A): The client's sarcastic attitude
(B): The client's shift in emotional response
(C): The client leaving the session early
(D): The client's reported improvement in academic functioning",The client's shift in emotional response,B,"The client's emotional response in this session is very different than what you have seen before. Crying, along with a subdued and almost respectful response is a new behavior he has not demonstrated. This indicates the need for further assessment and/or another diagnosis. Therefore, the correct answer is (C)",treatment planning
871, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",You determine Bob has poor emotional coping skills. Which objective most effectively addresses this?,Bob will identify ineffective coping methods and learn 3 new coping skills within 3 weeks.,Bob will effectively use new coping strategies to deal with his emotions.,Bob will identify 3 ways his emotional coping is ineffective and verbalize them.,Bob will learn and apply 5 new coping skills within 3 weeks.,"(A): Bob will identify ineffective coping methods and learn 3 new coping skills within 3 weeks.
(B): Bob will effectively use new coping strategies to deal with his emotions.
(C): Bob will identify 3 ways his emotional coping is ineffective and verbalize them.
(D): Bob will learn and apply 5 new coping skills within 3 weeks.",Bob will identify ineffective coping methods and learn 3 new coping skills within 3 weeks.,A,"With this objective, Bob is challenged to both recognize what he has been doing that has not been working and learn new ways of coping in their place. This objective satisfies the timeliness factor of a SMART goal by giving an adequate deadline and it is realistic to learn a new coping skill each week he is in rehab. Answer a) does not challenge Bob to learn new skills, only identify ineffective ones, which can be a great start to the learning process but in a short-term program it would be more advantageous to spend his time improving on what he already knows. Answer b) is unrealistic as it mandates that he applies all his learning within just three weeks, and it realistically takes six months for any adult to effectively apply just one coping skill routinely. Answer c) encourages Bob to apply new coping strategies, but it is not specific or timely. Therefore, the correct answer is (D)",counseling skills and interventions
872,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.",aged. Family History: The client reports that she is close with her parents but that they often have high expectations of her and that she worries about disappointing them. The client has an older brother who is 25 and is a lawyer. The client says some of the pressure is wanting to be as successful as her brother because she thinks her parents are really proud of him.  Your client is worried about how panic attacks are affecting her academic life,"Your client is worried about how panic attacks are affecting her academic life. With appropriate releases of information signed by the client, which of the following would be the most effective way to advocate on behalf of the client with the college based on her presenting needs?",Meet with her teachers to discuss what the client is going through.,Meet with teachers of the classes that the client has in the morning to discuss extending deadlines for her assignments.,Meet with the college’s department of disabilities to discuss extending deadlines for her assignments.,Meet with the college’s department of disabilities to discuss leniency with attendance.,"(A): Meet with her teachers to discuss what the client is going through.
(B): Meet with teachers of the classes that the client has in the morning to discuss extending deadlines for her assignments.
(C): Meet with the college’s department of disabilities to discuss extending deadlines for her assignments.
(D): Meet with the college’s department of disabilities to discuss leniency with attendance.",Meet with the college’s department of disabilities to discuss leniency with attendance.,D,"Each university has a department that advocates and provides accommodations for individuals who have disabilities, including mental health conditions. Because the client is experiencing panic attacks that are affecting her academic performance, this might be an appropriate opportunity to advocate for the client’s needs. The client is having trouble with attendance and attending class on time, and this would be the most important area to advocate for leniency. The client does not need to have deadlines extended because as far as you know, she is meeting the deadlines for her assignments. The department of disabilities will coordinate with her teachers; therefore, you do not need to meet with each one. Therefore, the correct answer is (B)",professional practice and ethics
873,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.",What is the best explanation for how the counselor distinguishes between clients with suicidal ideations related to depression and clients who have thoughts of death and dying due to grief?,Clients with depression and suicidal ideations will often have history of suicide attempts in their past; whereas clients who have thoughts of death or dying have no history of previous suicidal attempts.,Clients with depression and suicidal ideations very rarely tell anyone about their thoughts of suicide; whereas clients who think about death due to bereavement very often feel comfortable talking to others about wishing that their life was over.,Clients with depression and suicidal ideations isolate themselves from others; whereas clients who have thoughts of death and dying due to grief seek the company of others even though they are sad.,"Clients with depression and suicidal ideation focus on their own feelings of worthlessness, guilt, or inability to cope; whereas clients with thoughts of death and dying due to grief usually focus on the deceased person.","(A): Clients with depression and suicidal ideations will often have history of suicide attempts in their past; whereas clients who have thoughts of death or dying have no history of previous suicidal attempts.
(B): Clients with depression and suicidal ideations very rarely tell anyone about their thoughts of suicide; whereas clients who think about death due to bereavement very often feel comfortable talking to others about wishing that their life was over.
(C): Clients with depression and suicidal ideations isolate themselves from others; whereas clients who have thoughts of death and dying due to grief seek the company of others even though they are sad.
(D): Clients with depression and suicidal ideation focus on their own feelings of worthlessness, guilt, or inability to cope; whereas clients with thoughts of death and dying due to grief usually focus on the deceased person.","Clients with depression and suicidal ideation focus on their own feelings of worthlessness, guilt, or inability to cope; whereas clients with thoughts of death and dying due to grief usually focus on the deceased person.",D,"Focusing on one's thoughts of death or dying is the best indicator of depression versus bereavement or grief. Alternatively, both clients with depression and clients who are grieving may talk to others about their active or passive suicidal thoughts, may or may not have a history of suicide attempt, or may or may not isolate themselves from others. Therefore, the correct answer is (A)",counseling skills and interventions
874,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.  11th session The group as a whole has made progress, and members have found healthy outlets for expressing their thoughts and feelings. Rick has become more open with the women in the group and seems more receptive to what they have to say. Rick says that his grades have improved, his mother is proud, and he is encouraged by other group members who nod their heads and smile. The group has met its goals. The members have learned strategies to take with them as they prepare for termination. You remind the group that there are only a few more weeks left to meet. You begin to discuss the group members' feelings regarding the end of therapy. Rick starts to cry and says, ""Why does every woman in my life cause problems for me?""    The other group members offer Rick reassurance and empathy, but he continues expressing his frustration and sadness. You encourage the group to reflect on each person's progress and to be mindful of the emotions that this ending brings out. You explain to the group that endings can be difficult and that giving them permission to feel the emotions that arise during this transition is important.    Rick is still struggling with the idea of ending the therapy and expresses his fear of being left alone. He continues to express his feeling that every woman in his life has caused him pain and suffering, and this group's ending has triggered his worst fears. You recognize his fear and attempt to validate his experience by emphasizing his progress in the group and the positive changes he has seen in himself. You explain that the group can support him through the transition and the other members offer encouraging words of encouragement.    Rick is still anxious and overwhelmed. He talks about the difficulty of coping with the loss of the group and how he worries that he won't be able to manage his feelings without the support of the group. You explain to the group that it is natural to feel sadness and loss as well as gratefulness and pride in the progress they have all made. You encourage the group to identify the strategies they have learned in the group that they can use to manage their emotions. Finally, you assure Rick that he can use the skills he has learned in the group to cope with the emotions associated with the end of therapy.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ",A group therapist has been recording group therapy sessions for teaching purposes but has not told the members. What should be done when this is discovered?,"The recorded material must be destroyed, and the therapist's license should be suspended.",The group therapist should get a signed release from group members and continue.,"As long as the faces are blurred and identities disguised, there is no breach of protocol.","The recorded material must be destroyed, and it is the group members' responsibility to file a complaint.","(A): The recorded material must be destroyed, and the therapist's license should be suspended.
(B): The group therapist should get a signed release from group members and continue.
(C): As long as the faces are blurred and identities disguised, there is no breach of protocol.
(D): The recorded material must be destroyed, and it is the group members' responsibility to file a complaint.","The recorded material must be destroyed, and it is the group members' responsibility to file a complaint.",D,"Recording sessions should have been discussed during informed consent where the therapist would discuss with members that sessions would be taped, and the members could choose to partake or withdraw from the group. Taping sessions without group members' consent involves multiple breaches of confidentiality, ethics, and the law. As such, the recorded material should be destroyed and a complaint should be filed by group members. The results of an investigation will determine the penalties. Therefore, the correct answer is (A)",professional practice and ethics
875,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","Prior to ending the intake, which would be the most helpful intervention for this client based on the information gathered?",Provide contact information so client can reach counselor anytime stressors occur,Teach grounding techniques to help client deal with stressors,Identify ways the client has successfully dealt with stressors in the past,Complete a family genogram to determine familial patterns related to stressors,"(A): Provide contact information so client can reach counselor anytime stressors occur
(B): Teach grounding techniques to help client deal with stressors
(C): Identify ways the client has successfully dealt with stressors in the past
(D): Complete a family genogram to determine familial patterns related to stressors",Identify ways the client has successfully dealt with stressors in the past,C,"The best answer is to help the client identify ways he has successfully dealt with stressors in the past. These are techniques that he is familiar with, can be activated as needed, and which he already knows work for him. Completing a genogram will provide insight into why the client responds to stressors in certain ways, but will not provide him with a tool to deal with stressors. Grounding techniques are helpful during times of anxiety but this will be a new skill that the client will need to learn, practice, and become habitual in using, whereas it will be easier to rely on a known skill that has proven to work. Counselors provide emergency contact information but generally do not guarantee that the client can reach their counselor at any time of the day or night. Therefore, the correct answer is (B)",counseling skills and interventions
876,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.  11th session The group as a whole has made progress, and members have found healthy outlets for expressing their thoughts and feelings. Rick has become more open with the women in the group and seems more receptive to what they have to say. Rick says that his grades have improved, his mother is proud, and he is encouraged by other group members who nod their heads and smile. The group has met its goals. The members have learned strategies to take with them as they prepare for termination. You remind the group that there are only a few more weeks left to meet. You begin to discuss the group members' feelings regarding the end of therapy. Rick starts to cry and says, ""Why does every woman in my life cause problems for me?""    The other group members offer Rick reassurance and empathy, but he continues expressing his frustration and sadness. You encourage the group to reflect on each person's progress and to be mindful of the emotions that this ending brings out. You explain to the group that endings can be difficult and that giving them permission to feel the emotions that arise during this transition is important.    Rick is still struggling with the idea of ending the therapy and expresses his fear of being left alone. He continues to express his feeling that every woman in his life has caused him pain and suffering, and this group's ending has triggered his worst fears. You recognize his fear and attempt to validate his experience by emphasizing his progress in the group and the positive changes he has seen in himself. You explain that the group can support him through the transition and the other members offer encouraging words of encouragement.    Rick is still anxious and overwhelmed. He talks about the difficulty of coping with the loss of the group and how he worries that he won't be able to manage his feelings without the support of the group. You explain to the group that it is natural to feel sadness and loss as well as gratefulness and pride in the progress they have all made. You encourage the group to identify the strategies they have learned in the group that they can use to manage their emotions. Finally, you assure Rick that he can use the skills he has learned in the group to cope with the emotions associated with the end of therapy.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","Rick appears distressed about the group ending soon, and you realize that there may be some unfinished business that he needs to work on. What would be the most appropriate way to handle this situation as the group leader?",Ask the client to explicitly share his feelings with the group.,Use active listening and reflection of the meaning,Promote positive interactions by allowing another member to share,Self-disclose by stating that you have difficulty when groups end,"(A): Ask the client to explicitly share his feelings with the group.
(B): Use active listening and reflection of the meaning
(C): Promote positive interactions by allowing another member to share
(D): Self-disclose by stating that you have difficulty when groups end",Use active listening and reflection of the meaning,B,"Active listening and reflection on the meaning would benefit the client. Listening to the client and reflecting on meaning, such as, ""You said every woman in your life causes issues. Does this include any of the group members?. Please tell me, what does that mean to you?"". Therefore, the correct answer is (A)",counseling skills and interventions
877,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.  Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a ""new chance at living."" She further discloses that she recently met a ""wonderful man."" They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that ""he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me."" She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different.    From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. ""He's always around when I need him,"" she explains, ""And he listens to me and takes what I say seriously."" The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, ""If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared.""    You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",The client wants to add her boyfriend to the list of people who can have access to her therapy records. What is the best way to proceed?,Provide the client with a release of information to sign,Share the ethical pitfalls of sharing her records with her new partner,Encourage the client to avoid discussing any of her therapy sessions with her boyfriend,Discuss the client's request with her to gain an understanding of why she feels sharing her records is necessary,"(A): Provide the client with a release of information to sign
(B): Share the ethical pitfalls of sharing her records with her new partner
(C): Encourage the client to avoid discussing any of her therapy sessions with her boyfriend
(D): Discuss the client's request with her to gain an understanding of why she feels sharing her records is necessary",Discuss the client's request with her to gain an understanding of why she feels sharing her records is necessary,D,"It is important to discuss the client's request with her in order to gain an understanding of why she feels sharing her records with her boyfriend is necessary. This will help ensure that the decision is made in line with the client's wishes and that it is respectful of her privacy and autonomy. This can help protect against any potential risks associated with sharing sensitive information. Therefore, the correct answer is (D)",counseling skills and interventions
878,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",What adjunct service might you recommend for this client?,Case manager,Group therapy,Nutritionist,Psychiatrist,"(A): Case manager
(B): Group therapy
(C): Nutritionist
(D): Psychiatrist",Psychiatrist,D,"A medication review is essential in this case to ensure proper mood stabilization as soon as possible. The proper course of treatment for anyone exhibiting mood dysregulation patterns is to ensure that they are able to stabilize their mood first and foremost while at the same time ensuring their personal safety. Therefore, the correct answer is (B)",treatment planning
879,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",Which defense mechanism best describes the husband's behavior at home as described by his wife?,Regression,Denial,Displacement,Reaction formation,"(A): Regression
(B): Denial
(C): Displacement
(D): Reaction formation",Regression,A,"The husband's behavior at home as described by his wife is an example of regression. Regression is a defense mechanism in which an individual reverts to behavior from an earlier stage of development in order to cope with stressful situations. In this case, the husband is engaging in behaviors that are more typical of someone younger (eg, watching cartoons instead of helping around the house) as a way to avoid dealing with the stress and pressure he feels due to his family's situation. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
880,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.","Toward the end of the session, you reflect back the main points that you and the client have discussed. Which statement provides the more accurate summarization of today's session?","""We talked about your ballet injury and how it's affecting your mental health. From what you've told me, it doesn't seem like you're interested in teaching younger ballet students right now.""","""We talked about your suicidal ideation and how your parents reacted to it, which seems to have made things worse. I can understand why you're upset about me telling your parents, but it was necessary for your safety.""","""We talked about your recent experiences with your parents, your thoughts about helping teach ballet classes, and your overall mental health. While we explored some difficult feelings and situations, we also talked about potential opportunities for you to find purpose and enjoyment.""","""We talked about how your parents have been restricting you and making you feel watched, which has made things worse for you.""","(A): ""We talked about your ballet injury and how it's affecting your mental health. From what you've told me, it doesn't seem like you're interested in teaching younger ballet students right now.""
(B): ""We talked about your suicidal ideation and how your parents reacted to it, which seems to have made things worse. I can understand why you're upset about me telling your parents, but it was necessary for your safety.""
(C): ""We talked about your recent experiences with your parents, your thoughts about helping teach ballet classes, and your overall mental health. While we explored some difficult feelings and situations, we also talked about potential opportunities for you to find purpose and enjoyment.""
(D): ""We talked about how your parents have been restricting you and making you feel watched, which has made things worse for you.""","""We talked about your recent experiences with your parents, your thoughts about helping teach ballet classes, and your overall mental health. While we explored some difficult feelings and situations, we also talked about potential opportunities for you to find purpose and enjoyment.""",C,"This is a good summarization statement because it accurately reflects the key points that were discussed during the session. It demonstrates that the therapist was listening and engaged with the client and is able to understand and reflect back the important issues that were raised. The statement acknowledges the client's feelings and ambivalence about teaching ballet, while also recognizing the importance of safety and the concerns the client has about her parents' restrictions. By summarizing these points, the therapist can help the client to gain a clearer understanding of what was discussed, and provide a foundation for further exploration and progress in future sessions. Therefore, the correct answer is (D)",counseling skills and interventions
881,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ","Which would you include in the treatment plan for this client, based on her disclosures during today's session?","Taking an art class, meal planning, and increasing activity level.","Hypnosis, reading articles on anxiety, and recommended homework to reduce anxiety symptoms.","Sleep hygiene, meal planning, increase in activity level, and deep breathing.","Psychoeducation about anxiety, relaxation methods, deep breathing, and visualization.","(A): Taking an art class, meal planning, and increasing activity level.
(B): Hypnosis, reading articles on anxiety, and recommended homework to reduce anxiety symptoms.
(C): Sleep hygiene, meal planning, increase in activity level, and deep breathing.
(D): Psychoeducation about anxiety, relaxation methods, deep breathing, and visualization.","Psychoeducation about anxiety, relaxation methods, deep breathing, and visualization.",D,"These methods are evidence-based to reduce anxiety symptoms. You could use articles or reading for your client, but these methods are a good starting point to lower anxiety symptoms. Therefore, the correct answer is (D)",treatment planning
882,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.","Using the information you have learned, which of the following should be addressed first in this session?",How can the client know when she feels better,Process progress with children and setting boundaries with her friend,Review circumstances around her arrival to the party and why she was angry,Discuss plans for helping the client work on not being angry at herself,"(A): How can the client know when she feels better
(B): Process progress with children and setting boundaries with her friend
(C): Review circumstances around her arrival to the party and why she was angry
(D): Discuss plans for helping the client work on not being angry at herself",Process progress with children and setting boundaries with her friend,B,"The client has made progress in two areas and while these are first steps, the counselor and client should process the client's emotions about having made these choices and acknowledge her hard work and success. Celebrating her success will increase the client's motivation to continue making positive changes. Following this, the counselor and client can address the other responses. Helping the client know when she feels better will be made easier by first processing her emotions about the positive steps she has already taken. Reviewing the circumstances around that party and instilling new skills to help her not become so angry at herself are important parts of the session, but new tasks should not be embarked upon without acknowledging and processing what she has already accomplished. Therefore, the correct answer is (B)",counseling skills and interventions
883,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","   fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend",Which of the following would be the most appropriate short-term goal to focus on first in therapy for this client?,Identify the current ADHD behaviors that cause the most difficulty for the client.,Encourage the client to invite his girlfriend to a session so they can work through how ADHD affects their relationship.,Learn and implement planning and organization skills.,"Identify, challenge, and reframe self-talk that reinforces behaviors associated with ADHD.","(A): Identify the current ADHD behaviors that cause the most difficulty for the client.
(B): Encourage the client to invite his girlfriend to a session so they can work through how ADHD affects their relationship.
(C): Learn and implement planning and organization skills.
(D): Identify, challenge, and reframe self-talk that reinforces behaviors associated with ADHD.",Identify the current ADHD behaviors that cause the most difficulty for the client.,A,"Identifying the current ADHD behaviors that cause the most difficulty for the client is the most important first step in this client’s therapy, followed by determining the impact of symptoms on functioning. Encouraging the participation of the client’s girlfriend may provide insight into the client’s functioning and may also provide a social support for the client; however, relationship issues were not indicated in the first sessionOrganization skills and cognitive reframing are important parts of therapy for treatment of ADHD; however, they are not the first step. Psychoeducation on reframing and organization must be prioritized as well, but you need to identify the behaviors that cause the most difficulty to begin working on these skills. Therefore, the correct answer is (B)",treatment planning
884,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",Which assessment tools would you select to better understand the client's problem?,Adlerian Family Constellation Assessment,Family Map Inventory (FMI) and Beck Anxiety Inventory (BAI),Parenting Stress Index,Family Environment Scale (FES) and the Beck Depression Inventory (BDI),"(A): Adlerian Family Constellation Assessment
(B): Family Map Inventory (FMI) and Beck Anxiety Inventory (BAI)
(C): Parenting Stress Index
(D): Family Environment Scale (FES) and the Beck Depression Inventory (BDI)",Family Environment Scale (FES) and the Beck Depression Inventory (BDI),D,"This covers both the family system issues and the possible depressive symptoms appearing in the case. The FES gives you an overview of how the client perceives the family and how each member's behavior affects the family. The BDI assists in determining a baseline for possible clinical depression. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
885,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.",use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends,Which of the following would be an appropriate short-term goal for this client that could be completed in the next month?,Decrease the client’s urges to masturbate.,Learn and implement coping skills for anxiety.,Explore what the client has liked and disliked about his current and past jobs.,Identify and implement assertiveness skills in the workplace.,"(A): Decrease the client’s urges to masturbate.
(B): Learn and implement coping skills for anxiety.
(C): Explore what the client has liked and disliked about his current and past jobs.
(D): Identify and implement assertiveness skills in the workplace.",Explore what the client has liked and disliked about his current and past jobs.,C,"The client wants to focus initially on cessation of pornography use and his unhappiness in the workplace. Exploring what the client has liked and disliked about his current and past employment is an appropriate short-term goal that can open up conversations about possibly changing the employment and identifying what matters to the client when at work. Although decreasing the frequency of masturbation may happen in the first month, you likely will only have a few sessions in this time period, and the skills necessary to manage urges to masturbate will not likely be developed at this point. Assertiveness skills training can be helpful in improving work situations; however, the client has already had several conversations with his supervisors and it does not appear that they have been open to his input thus far. The client does have a generalized anxiety diagnosis; however, he has more immediately pressing issues that he wants to work on, so you likely will not master coping skills for anxiety within the first month. Therefore, the correct answer is (B)",counseling skills and interventions
886,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.  Ninth session The client's one-on-one aide presents to this session with the client. The client is crying and having difficulties following the aid's directives in the hallway. You walk into the hall and show the client a picture with ""a quiet sign."" You open your door, and he reluctantly walks in and begins to kick the toy bins. You show him the ""no"" visual sign and shake your head no. You sit on the floor quietly until he joins you on the floor. You pull out a deck of visual cue cards and place them in front of him. He points to a picture of a boy being mean to another classmate, then starts to cry harder.    You allow some extra time for the client to process his emotions. You then explain to him that it is not okay to kick the toy bin, and that he can use his words or draw pictures of what he feels instead. You provide reassurance that you are there to help him learn how to control his feelings in a better way. You then select some calming activities such as squeezing the stress ball and playing a matching game. As he begins to gain control of his emotions, you reinforce positive behaviors with verbal praise and approval. Throughout the session, you actively listen and provide opportunities for him to express himself in whatever manner is comfortable to him. You end the session by drawing a picture of yourself and your client, with both of you smiling together. You explain that this is what happens when you work together to find positive ways to cope with emotions.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ","Using a filial therapy approach, what might you employ with the parents to increase interactional dynamics?","Assist the parents as a combination of trainer, supervisor, and coach in learning how to conduct ""special playtime"" sessions with the child.","Employ empathy, unconditional positive regard, and congruence as well as provide a nonjudgmental, understanding venue for the client's parents to explore what they need to explore.",Employ brief therapeutic procedures often in the form of paradox designed to change undesired patterns.,"Educate the parents about a combination of biological, psychological, and social factors which drive how humans come to feel and act as they do.","(A): Assist the parents as a combination of trainer, supervisor, and coach in learning how to conduct ""special playtime"" sessions with the child.
(B): Employ empathy, unconditional positive regard, and congruence as well as provide a nonjudgmental, understanding venue for the client's parents to explore what they need to explore.
(C): Employ brief therapeutic procedures often in the form of paradox designed to change undesired patterns.
(D): Educate the parents about a combination of biological, psychological, and social factors which drive how humans come to feel and act as they do.","Assist the parents as a combination of trainer, supervisor, and coach in learning how to conduct ""special playtime"" sessions with the child.",A,"This describes the primary concepts behind filial therapy. Therefore, the correct answer is (C)",counseling skills and interventions
887,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.  Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered.  Sixth session You and your intern, who has never facilitated a group, meet five weeks after intake with the group members. One of the members shows up late to the group despite knowing the norms and rules. This member is from a Hispanic background. One of the other members, an African-American woman, says angrily, ""You're wasting our time when you arrive late to every session. We have to pause for you. I have anxiety and need help. If you do not need help from the group, why don't you leave!"" The Hispanic woman starts to cry and says, ""Mind your business. I'm taking care of my dying mother and also have anxiety, so shut up!"" You have to intervene as other members are getting frazzled and upset. You ask the intern to carry on with the group as you ask the two members to step outside.",,"Once the two members have calmed down and returned, you have the other group members tell how the altercation made them feel. You, as the therapist, listen without interrupting and avoid giving advice. Which technique are you demonstrating?",Free association,Congruence,Positive regard,Storytelling,"(A): Free association
(B): Congruence
(C): Positive regard
(D): Storytelling",Positive regard,C,"When using positive regard, the therapist listens without interrupting and avoids giving advice. There is no judgment, and the therapist listens actively. Therefore, the correct answer is (A)",counseling skills and interventions
888,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks.  You had an argument with your roommate prior to the session and are distracted",You had an argument with your roommate prior to the session and are distracted. Which of the following would be the most appropriate decision with regard to your client’s well-being as it is impacted by your distraction?,Start the session a little late so you can resolve the argument in order to be more focused.,Reschedule the session with the client.,Talk with the client about how you might impact the session and get refocused.,Be aware of how your personal life is impacting the session and refocus as needed.,"(A): Start the session a little late so you can resolve the argument in order to be more focused.
(B): Reschedule the session with the client.
(C): Talk with the client about how you might impact the session and get refocused.
(D): Be aware of how your personal life is impacting the session and refocus as needed.",Be aware of how your personal life is impacting the session and refocus as needed.,D,"It is most ethical and appropriate to continue your session as scheduled, while maintaining awareness of how your personal life is affecting the counseling session because you want to support the client and prevent as much personal impact as possible. Rescheduling may be appropriate if the impact of your personal life is unavoidable; however, it is your responsibility as a therapist to ensure that you are minimizing your own personal life’s impact on the client. Occasionally, you may need to directly address emotions or thoughts that you are having during sessions; however, this topic may distract from the client and reduce their confidence in your focus this session. You want to be consistent and be on time to respect your client’s time and to show your investment in the client. Therefore, the correct answer is (B)",professional practice and ethics
889,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","You meet with the client 2 weeks after the initial intake because she refused to come for the session scheduled the past week. Because of the cancellation, you decide to change the focus of your session to meet the client’s needs for comfort and security over the foster parents’ need for guidance and skills. The client engages a little more in interacting with you, and you praise her for her involvement. At one point in the session, the client hits you and goes and sits down to continue playing. At the end of the session, you provide the foster parents with ways that they can increase attachment and positive interactions with your client. You empathize with the foster parents regarding their desire to help the client feel loved and cared for.  The foster parents state, “we know that we are going to mess up, and she will be worse off","The foster parents state, “we know that we are going to mess up, and she will be worse off.” What kind of cognitive distortion is this?",Blaming,“Should” statements,Overgeneralization,All-or-nothing thinking,"(A): Blaming
(B): “Should” statements
(C): Overgeneralization
(D): All-or-nothing thinking",Blaming,A,"This kind of thinking places blame on the couple, and it may be helpful to focus on what the couple is doing well for the client in order to increase their confidence. “Should” statements focus on what the individual should do. The parents aren’t focusing on what they should do; rather, they feel guilty for the client’s potential future situation. This is not all-or-nothing thinking because the parents are not focusing on their actions as either extremely good or bad. Instead, they are blaming themselves for the client’s situation. Overgeneralization focuses on creating an expectation based on an experience. The client’s foster parents are not creating an expectation based on an experience because she is rather blaming them for the future outcome. Therefore, the correct answer is (A)",counseling skills and interventions
890,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues.  Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand.    When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have ""one drink."" He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",What is most important to consider when developing this client's treatment plan?,The client's level of motivation to change,The client's support network,The client's ability to maintain employment,The client's genetic predisposition to addiction,"(A): The client's level of motivation to change
(B): The client's support network
(C): The client's ability to maintain employment
(D): The client's genetic predisposition to addiction",The client's level of motivation to change,A,"Assessing the stage of change which he is currently in will help guide your treatment plan. If the client is not motivated to make any changes, therapy will not be effective. Therefore, the correct answer is (B)",treatment planning
891,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","   mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic.  Due to your observation of anxious behavior, you prompt the client to identify and rate his feelings at the start and end of the session","Due to your observation of anxious behavior, you prompt the client to identify and rate his feelings at the start and end of the session. What would be the main purpose of this therapeutic intervention in the first session?",To facilitate the client’s awareness of his anxious behavior,To determine the client’s level of comfort,To determine if the counselor can meet the needs of the client,To facilitate discussion regarding goals for anxiety management,"(A): To facilitate the client’s awareness of his anxious behavior
(B): To determine the client’s level of comfort
(C): To determine if the counselor can meet the needs of the client
(D): To facilitate discussion regarding goals for anxiety management",To determine the client’s level of comfort,B,"The client’s level of comfort is assessed using this therapeutic intervention. This intervention involves the use of the counseling skill called “immediacy” Immediacy addresses emotional responses that are present in the counseling session and can facilitate deeper processing of emotions and building therapeutic rapport. Although the client’s hesitation before speaking and him wringing his hands may indicate anxiety, it is common for clients to be nervous during their first therapy session. Creating awareness of anxious behavior alone may make the client feel judgment, which may make him more uncomfortable. This intervention will not, on its own, determine if the counselor is a good fit for the client. Therefore, the correct answer is (B)",professional practice and ethics
892,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.  10th session As you have been working with the client over the past two and a half months, he has made significant progress with treatment goals, including mood stabilization and behavioral control. In the last session, as you reviewed the progress that the client had made over the course of treatment, you both agreed that the client was ready for termination as he felt he had gotten what he needed from therapy. The client was especially pleased when considering his progress in mood regulation and mindfulness, as well as addressing his thrill-seeking behaviors during his manic phases.    For this final session, the client arrived ten minutes late. He appears out of breath as he runs into the room. The client states that he got a call from the hospital where his sister was just admitted. As he describes the phone call, he pauses and looks out the window with tears in his eyes. You ask him how he feels. The client responds quietly, ""I don't know, my sister has been in a serious accident, and I don't know how I'll continue without her support,"" prompting you to recognize that unresolved issues may require additional therapy. You state, ""It sounds like your sister's accident has brought up a lot of emotions for you. You are feeling overwhelmed and unsure about how to cope without her support. It must be difficult to process all of this at once."" The client nods his head. You continue by telling him that it is natural to feel overwhelmed and uncertain in a situation like this. You engage him in a discussion about coping strategies or support systems that have helped him in the past when facing difficult challenges. You also ask him if it would be helpful to have additional therapy sessions during this time to which he replies, ""Yes, I don't want to undo all the progress I've made.""","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",What cognitive-behavioral technique might best facilitate mood stabilization for this client?,Mood charting,Cognitive restructuring,Mindfulness meditation,Progressive muscle relaxation,"(A): Mood charting
(B): Cognitive restructuring
(C): Mindfulness meditation
(D): Progressive muscle relaxation",Cognitive restructuring,B,"Cognitive restructuring is a CBT technique that instructs clients to examine their thoughts by looking for distortions to achieve more balanced thinking. Individuals' thoughts influence their emotions which then affect their mood and behavior. Therefore, the correct answer is (B)",treatment planning
893, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",What focus area(s) would be most helpful for Bob throughout the remainder of his treatment?,relationship skill building,family systems and codependency,stages of addiction,communication and forgiveness,"(A): relationship skill building
(B): family systems and codependency
(C): stages of addiction
(D): communication and forgiveness",communication and forgiveness,D,"Teaching communication skills such as assertiveness can help Bob learn how to share his feelings, attempt getting his needs met, and set boundaries for himself and within his marriage. Addressing forgiveness using evidence-based approaches has been clinically proven to reduce anger, anxiety and helplessness while raising self-esteem and independence. Answer a) is not going to be possible without his wife engaged in the process, and Bob is not yet in a willing place. Answer b) would also be a useful area to engage both parties of the marriage together, with specific focus of codependency for his wife. Answer c) is crucial to his education in recovery and would likely have been covered in his first week of treatment but does not prepare Bob to face the challenges of his triggers ahead when he arrives home. Therefore, the correct answer is (D)",counseling skills and interventions
894,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors.  Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor.    You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ","You are currently dealing with some difficult unresolved childhood issues, and your client's explosive outburst in session has made you feel uncomfortable and threatened. Given the client's intense reaction, how should you proceed?",Contact a supervisor to discuss your issues and provide insight on possible next steps,Contact a supervisor to help you compartmentalize your personal and professional issues,Contact a supervisor to refer the client to another therapist,Contact a supervisor to help manage transference issues related to your childhood trauma,"(A): Contact a supervisor to discuss your issues and provide insight on possible next steps
(B): Contact a supervisor to help you compartmentalize your personal and professional issues
(C): Contact a supervisor to refer the client to another therapist
(D): Contact a supervisor to help manage transference issues related to your childhood trauma",Contact a supervisor to discuss your issues and provide insight on possible next steps,A,"Therapists should always be aware of their own issues and how they affect the therapeutic process. If personal issues are affecting the therapeutic relationship, the therapist should seek supervision. Therefore, the correct answer is (D)",professional practice and ethics
895,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.","Based on the information provided, which of the following is not a cultural factor to explore with this client?",Client growing up in a family with a verbally abusive parent,Client becoming a widow and single parent before age 30,Client growing up in a family with a parent diagnosed with schizophrenia,Client marrying her former boyfriend's best friend,"(A): Client growing up in a family with a verbally abusive parent
(B): Client becoming a widow and single parent before age 30
(C): Client growing up in a family with a parent diagnosed with schizophrenia
(D): Client marrying her former boyfriend's best friend",Client marrying her former boyfriend's best friend,D,"Culture includes a client's race, ethnicity, socioeconomic style, family structure, and any group membership that the client is or becomes a part of that influences her identity and personality formation. Marrying her husband, who was the best friend of her former boyfriend, is not a cultural factor and may be explored in relation to the client's history, but not as part of the section of the intake that explores the client's cultural formation. Living with a parent who has schizophrenia and another parent who is verbally abusive will shape how the client perceives herself and the world around her. It is unexpected to lose a spouse prior to age 30 and places the client in a cultural category with other young women who have been widowed early in life and will shape the way the client views herself and the world around her. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
896,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","You and the client review his safety plan. The client believes the antidepressant has helped decrease his feelings of hopelessness and suicidality. Despite the hot and humid conditions, the client arrives at his counseling session in a hoodie. He explains that he has been getting out of the house “some” but continues to avoid social situations because of overwhelming thoughts of others staring at him and mocking his appearance. The client was a no-show for his appointment last week and has requested distance counseling to avoid anxiety experienced when leaving the house. You and the client work together to set appropriate treatment plan goals; however, this is difficult due to poor insight into his presenting problem. You provide psychoeducation about BDD and ask about his goals for the future",Which is of the following is an ethical expectation for certified counselors providing distance counseling and maintaining a social media presence?,"Refrain from viewing a client’s personal or public social media profile without permission; however, counselors must discuss professional limitations with maintaining confidential electronic communication.",Ensure that professional social media accounts are merged with personal accounts to avoid ambiguity and confusion.,Refrain from entering personal virtual relationships with clients for a period of 5 years following the last professional contact.,"Develop informed consent procedures covering issues such as the possibility of technology failure, emergencies, and the increased risk for harmful boundary violations.","(A): Refrain from viewing a client’s personal or public social media profile without permission; however, counselors must discuss professional limitations with maintaining confidential electronic communication.
(B): Ensure that professional social media accounts are merged with personal accounts to avoid ambiguity and confusion.
(C): Refrain from entering personal virtual relationships with clients for a period of 5 years following the last professional contact.
(D): Develop informed consent procedures covering issues such as the possibility of technology failure, emergencies, and the increased risk for harmful boundary violations.","Refrain from viewing a client’s personal or public social media profile without permission; however, counselors must discuss professional limitations with maintaining confidential electronic communication.",A,"Distance counseling, technology, and social media use is covered in section H of the ACA Code of Ethics (2014). Concerning social media, counselors must refrain from viewing a client’s personal or public social media profile without permission. Confidentiality and its limitations must be addressed in terms of potential unauthorized and authorized electronic records and their transmissions. Answer B is incorrect because counselors are encouraged to keep their personal and professional accounts separate. For answer C, developing informed consent procedures covering issues such as the possibility of technology failure and emergency policies is correct, but addressing the increased risk for harmful boundary violations (eg, sexual relationships, exploitation) is incorrect because counselors are solely responsible for protecting clients from harm and eliminating risks. Boundary violations are not only unethical but may also have legal implications. Lastly, according to the ACA Code of Ethics, “counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (eg, through social and other media) (ACA, 2014)” The 5-year timeframe refers to sexual relationships. Specifically, “client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact (ACA, 2014)”. Therefore, the correct answer is (A)",professional practice and ethics
897,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.  Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered.  Sixth session You and your intern, who has never facilitated a group, meet five weeks after intake with the group members. One of the members shows up late to the group despite knowing the norms and rules. This member is from a Hispanic background. One of the other members, an African-American woman, says angrily, ""You're wasting our time when you arrive late to every session. We have to pause for you. I have anxiety and need help. If you do not need help from the group, why don't you leave!"" The Hispanic woman starts to cry and says, ""Mind your business. I'm taking care of my dying mother and also have anxiety, so shut up!"" You have to intervene as other members are getting frazzled and upset. You ask the intern to carry on with the group as you ask the two members to step outside.",,Two group members are talking over each other and getting louder to prove their points. What method would be effective in handling this situation?,Blocking,Prompt the intern to intervene under your supervision,Providing self-disclosure,Linking,"(A): Blocking
(B): Prompt the intern to intervene under your supervision
(C): Providing self-disclosure
(D): Linking",Blocking,A,"Blocking is a term which is used to cut off members from talking too much or, in certain cases, to cut off members who may be getting out of control. As the leader, you need to intervene in such cases. Therefore, the correct answer is (B)",counseling skills and interventions
898,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client is responding well to your therapeutic interventions. School has ended, and her summertime athletic and academic commitments have lessened. The client reports that she is happy to be out of school and spoke again about not fitting in with her peers. She states that there are limited opportunities for sustaining friendships and worries that she will never find a romantic interest. She reports that her mother has suspended her social media account because the client was overly consumed by the number of “likes” that she received for her online posts. You explain that you will be starting a 12-week group of diverse teens who also experience anxiety and would like her to join. She agrees and is eager to participate.  You are concerned about the client’s online activity. You search and find her social media account, view the content, and find evidence of cyberbullying","You are concerned about the client’s online activity. You search and find her social media account, view the content, and find evidence of cyberbullying. You and your supervisor use an ethical decision-making model to appropriately determine which of the following?",You must respect the client’s privacy unless she permits you to view her social media account.,You must breach confidentiality and inform the client’s parents.,You must respect the client’s privacy but report the cyberbullying peers.,You must disclose the findings to the client and assess for safety.,"(A): You must respect the client’s privacy unless she permits you to view her social media account.
(B): You must breach confidentiality and inform the client’s parents.
(C): You must respect the client’s privacy but report the cyberbullying peers.
(D): You must disclose the findings to the client and assess for safety.",You must respect the client’s privacy unless she permits you to view her social media account.,A,"You and your supervisor appropriately determine that you must respect the client’s privacy unless she permits you to view her social media account. The ACA Code of Ethics addresses this issue in Section H6c, entitled “Client Virtual Presence” In this scenario, you searched for the client’s social media account without prior permission. You appropriately discuss the ethical dilemma with your supervisor. Per the ACA Code of Ethics, counselors “are expected to engage in a carefully considered ethical decision-making process” This process generally involves determining the scope of the problem, applying the code of ethics, consulting supervisors and other appropriate professionals, and determining the best course of action. You not only viewed a private account without permission but did not have grounds for suspicion. The client stated that she felt like she didn’t fit in with her peers and equated her number of likes with her worth as a person; this did not include allegations of cyberbullying or other safety-related concerns. Therefore, the correct answer is (C)",professional practice and ethics
899,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.","In addition to a potential substance use disorder, which of the following mental health disorders should be viewed as potential diagnoses based on the information provided?",Narcissistic Personality Disorder (NPD),Borderline Personality Disorder (BPD),Post Traumatic Stress Disorder (PTSD),General Anxiety Disorder (GAD),"(A): Narcissistic Personality Disorder (NPD)
(B): Borderline Personality Disorder (BPD)
(C): Post Traumatic Stress Disorder (PTSD)
(D): General Anxiety Disorder (GAD)",Borderline Personality Disorder (BPD),B,"While BPD is diagnosed primarily in females, males can also meet criteria for this disorder. The client admits to being manipulative in his words to keep women from leaving him (Criterion 1); his relationship patterns are unstable and often intense (C2. ); he demonstrates impulsivity in spending and substance use, which are self-damaging as he has trouble meeting financial obligations and has increased his substance use in the past eighteen months (C4); he has made recurrent suicidal threats (C5); he exhibits transient, stress-related paranoid ideation (C9). The client does not demonstrate excessive or irrational worry about the future as seen in GAD, and does not present with a history of trauma as needed for a PTSD diagnosis. The client's lack of insight, ambivalence, and feeling that he should not have to make changes can indicate some traits of NPD, but he does not demonstrate the grandiose sense of self-importance or preoccupation with himself as special, and powerful that would be expected with that diagnosis. It is very possible for the client to possess traits of NPD without meeting the full diagnosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
900,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","You work with the client and their parents to help the parents understand how the client conceptualizes their gender identity. You use the client’s self-identified, gender-affirming pronouns and praise the client for taking a brave first step. The client’s mother is fearful and anxious, particularly when thinking about the client’s safety. The client’s father expresses an overall lack of understanding and thinks it could be a phase. You recognize the father’s efforts to understand and help the client explain the distressing emotions associated with coming to terms with their gender identity, including an increase in severity since the onset of adolescence. The father states that he is unsure if he can accept the client’s transgender identity but says that he is committed to the counseling process.  Your goal is to deliberately disrupt the family’s homeostasis through unbalancing, blocking transactional patterns, and shifting boundaries","Your goal is to deliberately disrupt the family’s homeostasis through unbalancing, blocking transactional patterns, and shifting boundaries. These techniques are associated with which one of the following?",Contextual family therapy,Structural family therapy,Strategic family therapy,Multigenerational family therapy,"(A): Contextual family therapy
(B): Structural family therapy
(C): Strategic family therapy
(D): Multigenerational family therapy",Structural family therapy,B,"Structural family therapy’s primary purpose is to strengthen the boundaries within family systems. Counselors accomplish this by deliberately disrupting the family’s homeostasis through techniques that include unbalancing, blocking transactional patterns, and shifting boundaries. Additional structural family therapy techniques include assigning tasks, reframing, escalating stress, psychoeducation, and developing implicit conflict. Contextual family therapy emphasizes the ethical elements of each family, including loyalty, trust, and relational principles. Murray Bowen developed multigenerational (extended) family systems theory, which focuses on families with high levels of emotional fusion and low levels of differentiation. Bowenian therapists use multigenerational transmission process to assess how a family’s dysfunctional interactions can be handed down from generation to generation. Strategic family therapy places much less emphasis on boundaries; instead, it focuses on patterns of communication and interactions. Some techniques of strategic family therapy include paradoxical intervention, pretend techniques, and hypothesizing. Therefore, the correct answer is (B)",counseling skills and interventions
901, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
 
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,The technique the counselor is demonstrating during the session is?,Capping,Focusing,Proxemics,Structuring,"(A): Capping
(B): Focusing
(C): Proxemics
(D): Structuring",Structuring,D,"Structuring is letting the client know what to expect from the counseling session. It is an important aspect of the counseling process as it helps to organize the session and keep things on track. It can also help establish a rhythm for future sessions. Capping occurs when the counselor de-escalates the emotions of the client when the client is starting to lose control. Proxemics is the study of the client's body language and movements to determine emotions, thoughts, and feelings. Focusing is non-verbal attention to the client's words which can help the counselor to see things from the client's perspective and to help determine next steps. Therefore, the correct answer is (C)",treatment planning
902,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.  Eighth session It has been seven weeks since the client presented for the initial interview. Today, the client returns to your office for his weekly session. He admits that he has not been following through with any of the activities you have assigned as part of his systematic desensitization plan, and he continues to feels overwhelmed by anxiety. His facial expressions reveal a sense of defeat and disappointment as he shares his struggles with making progress. He says, ""I just want to be a normal guy. What's wrong with me?"" The client expresses feeling overwhelmed with fear and shame at being unable to make any changes. He asks if you know of anyone else who has experienced social anxiety before and if there is any hope for him to get better. You normalize his experience and briefly share a story about being afraid to wear glasses in high school out of fear that your classmates would make fun of you. You then explain to him that even though it may feel like he is alone in his experience and feels discouraged, recovery is possible. You emphasize the importance of being patient with himself and expressing self-compassion as he works through the process.    During the session, the client also mentions that his parents are having a difficult time in their relationship which has been causing additional distress for him. You explain that this could cause extra feelings of worry and insecurity, even when he is away from them. He acknowledges the connection between his parents’ relationship dynamics and his own struggles with anxiety. In order to address the additional stressors created by the distress in the client's parents' relationship, you explore ways he can work on managing his own emotions and reactions. You explain that building self-awareness of his feelings and responses may help empower him to have greater control over his anxiety symptoms. You discuss mindful breathing and visualization techniques. Afterwards, you provide examples of cognitive reappraisal strategies that can be used to challenge any irrational beliefs related to fear of failure or embarrassment that might be driving his avoidance behaviors. You explain the importance of consistently doing the practice in order for it to be effective and positive changes can be expected with consistent effort. You also give the client a homework assignment to read about social anxiety.    Toward the end of the session, you summarize what you have discussed during today's session, and you address his feelings of disappointment in his perceived lack of progress by saying, ""I understand your frustration. It can seem like things are not changing but in reality, even small changes are a sign of progress. The most important thing for you to remember is that it takes time and effort to learn how to manage your anxiety and make meaningful change in your life. As you continue working on the strategies we have discussed, I want you to recognize any successes or moments of improvement as they occur; no matter how small they may be. This will help keep you motivated and encourage further growth.""","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ","Your statement, ""When I was in high school, I was afraid to wear glasses in fear that others would make fun of me,"" is an example of which of the following?",Empathy,Focusing on oneself,Constructive confrontation,Self-disclosure,"(A): Empathy
(B): Focusing on oneself
(C): Constructive confrontation
(D): Self-disclosure",Self-disclosure,D,"You used a form of self-disclosure to show relatability to the client that his fears and feelings about others making fun of him or scrutinizing him are somewhat normal. Therefore, the correct answer is (B)",counseling skills and interventions
903,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.","In addition to coordinating adjunct services, which interventions should be considered a top priority due to this client's presenting complaints?","Family consultation, education, and intervention.",Structured problem-solving.,Substance use intervention.,Behavioral reinforcement.,"(A): Family consultation, education, and intervention.
(B): Structured problem-solving.
(C): Substance use intervention.
(D): Behavioral reinforcement.","Family consultation, education, and intervention.",A,"The client complains of familial problems, and including the family in treatment may help improve outcomes and patterns of interaction. Therefore, the correct answer is (C)",treatment planning
904,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",Which of the following would be considered the best empathic response to the client's statement about never being able to dance again?,"It must be very difficult for you to come to terms with the possibility of not being able to pursue your dream of becoming a ballet dancer.""","""I would challenge the idea that all of your dreams are crushed. What other dreams do you have in your life besides dancing?""","""I understand how difficult this whole process must be for you. I'm so sorry that you're going through this.""","""There's another way that we could look at this. Instead of thinking about this as the end of ballet in your life, are there other ways that you could still be involved in dance?""","(A): It must be very difficult for you to come to terms with the possibility of not being able to pursue your dream of becoming a ballet dancer.""
(B): ""I would challenge the idea that all of your dreams are crushed. What other dreams do you have in your life besides dancing?""
(C): ""I understand how difficult this whole process must be for you. I'm so sorry that you're going through this.""
(D): ""There's another way that we could look at this. Instead of thinking about this as the end of ballet in your life, are there other ways that you could still be involved in dance?""","It must be very difficult for you to come to terms with the possibility of not being able to pursue your dream of becoming a ballet dancer.""",A,"This accurately reflects her two emotions while also summating the objective content the client reported. Therefore, the correct answer is (B)",counseling skills and interventions
905,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",What is the most important step to take during this session with the client?,Encourage the client to open a second savings account in his name only because of the continued threats of his wife to leave him,Review the treatment plan and revise as needed to meet the client's current needs,Work on techniques to decrease depressive symptoms,Suggest the client start an exercise routine,"(A): Encourage the client to open a second savings account in his name only because of the continued threats of his wife to leave him
(B): Review the treatment plan and revise as needed to meet the client's current needs
(C): Work on techniques to decrease depressive symptoms
(D): Suggest the client start an exercise routine",Review the treatment plan and revise as needed to meet the client's current needs,B,"Reviewing and revising the treatment plan is the correct answer. The client has stated that he is not improving, and, in fact, he is feeling worse this week. Therefore, the correct answer is (B)",professional practice and ethics
906,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","Since the fourth session, child protective services investigated the client’s abuse allegations and determined that they were unfounded. You discuss this with the client and he says he was lying because he was mad at his parents that day. You praise the client for being forthright today regarding the allegations and discuss how false allegations can be incredibly harmful to others and can strain his relationship with his parents further. You and the client process several situations similar to this in which he avoided responsibility. You empathize with the client and support his reflection on his behavior.  The client is resistant to making changes to his behavior",The client is resistant to making changes to his behavior. Which of the following conversations might you have with the client to encourage more appropriate behavior?,"Continue the current course of treatment because you have developed a good rapport and he continues to participate; therefore, he will be ready to make changes when the time is right for him.","Assist him in identifying how he often receives negative consequences. Reiterate that the consequences of his actions do not make him happy, so it is worth trying something different.",Discuss the reward system to see if it can be made more motivating.,Empathize with the client regarding his desires and help him identify that more appropriate behavior can help him get what he wants more so than what he is doing now.,"(A): Continue the current course of treatment because you have developed a good rapport and he continues to participate; therefore, he will be ready to make changes when the time is right for him.
(B): Assist him in identifying how he often receives negative consequences. Reiterate that the consequences of his actions do not make him happy, so it is worth trying something different.
(C): Discuss the reward system to see if it can be made more motivating.
(D): Empathize with the client regarding his desires and help him identify that more appropriate behavior can help him get what he wants more so than what he is doing now.",Empathize with the client regarding his desires and help him identify that more appropriate behavior can help him get what he wants more so than what he is doing now.,D,"Empathizing with the client and showing him that you are on his side and want him to live a happy life is likely going to be the most encouraging approach for this client. This also empowers the client to understand that he can play by the rules and get what he wants instead of breaking the rules, not getting what he wants, and suffering consequences. Focusing on the consequences alone does not address that you acknowledge his wants and needs and that you want to support him in meeting these needs. It may be helpful to reexamine the reward system, but the reward system is not a long-term tool and is not focused on the client’s internal motivation. Although the client may continue to improve and eventually agree to make changes with different rewards, this is not a proactive strategy because it does not foster internal motivation. Therefore, the correct answer is (C)",counseling skills and interventions
907,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.",rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family.  The client signs a release of protected health information (PHI) for his primary care physician (PCP),The client signs a release of protected health information (PHI) for his primary care physician (PCP). Which of the following would be the most ethical level of disclosure of PHI to provide to the PCP?,Provide minimal information regarding the client’s mental health’s effects on his physical health.,Provide the client’s progress notes and treatment plan.,Provide a biopsychosocial assessment so that the PCP has a well-rounded view of the client.,Provide information on treatment participation and progress.,"(A): Provide minimal information regarding the client’s mental health’s effects on his physical health.
(B): Provide the client’s progress notes and treatment plan.
(C): Provide a biopsychosocial assessment so that the PCP has a well-rounded view of the client.
(D): Provide information on treatment participation and progress.",Provide minimal information regarding the client’s mental health’s effects on his physical health.,A,"According to the ACA Code of Ethics,minimal provision of information is an important ethical consideration because you only want to disclose what is absolutely necessary (ACA, 2014). The PCP would only need to know what pertains to their specialty and their service provision, which would be the client’s mental health and its impact on his physical health. Provision of progress notes, biopsychosocial assessment, treatment plan, and client treatment participation could be providing more than is necessary for coordination between services, exceeding the counselor’s ethical obligations. If the provider were a psychiatrist prescribing mental health medication, the other areas would be more relevant for them to know. Therefore, the correct answer is (A)",professional practice and ethics
908,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,The counselor code of ethics states that?,Bartering is not allowed.,Bartering is acceptable.,Counselors should discontinue therapy for those who offer bartering.,Counselors may barter under certain circumstances.,"(A): Bartering is not allowed.
(B): Bartering is acceptable.
(C): Counselors should discontinue therapy for those who offer bartering.
(D): Counselors may barter under certain circumstances.",Counselors may barter under certain circumstances.,D,"ACA code of ethics A10e. bartering states that counselors may only barter if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. There is no hard and fast rule that bartering is or isn't allowed, there must be careful consideration for each scenario. Additionally, a counselor should not dismiss the client solely due to the client asking this question. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
909,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","You meet with the client’s mother today to update the client’s treatment plan. Since the beginning of the school year, the client has been suspended for a combined total of 8 days. He has responded poorly to many of the behavioral classroom interventions. The mother has reluctantly granted the school permission to begin testing to determine if the client qualifies for an Individualized Education Program. You inform the mother of her parental rights pertaining to this process, particularly as they apply to protections against disability-related discrimination and the maximum number of disability-related suspensions. She is encouraged by the possibility of the client receiving additional supports that consider the client’s strengths and challenges.  Federal law requires that an evaluation for an Individualized Education Program be conducted in a nondiscriminatory fashion, and, if qualifications are met, students are entitled to a free and appropriate public education","Federal law requires that an evaluation for an Individualized Education Program be conducted in a nondiscriminatory fashion, and, if qualifications are met, students are entitled to a free and appropriate public education. Which federal law grants this protection?",The Family Educational Rights and Privacy Act of 1974 (FERPA),The United States Civil Rights Law,The Special Education and Rehabilitative Services Act,The Individuals with Disabilities Education Act,"(A): The Family Educational Rights and Privacy Act of 1974 (FERPA)
(B): The United States Civil Rights Law
(C): The Special Education and Rehabilitative Services Act
(D): The Individuals with Disabilities Education Act",The Individuals with Disabilities Education Act,D,"The Individuals with Disabilities Education Act ensures that students attending public schools are identified and assessed in a nondiscriminatory fashion. If students meet qualifications, they are entitled to a free and appropriate public education. This federal law also grants parents the right to due process, which would allow the mother the right to challenge the client’s placement or treatment. The US Department of Education Office for Civil Rights ensures equal access to public school education; it enforces federal laws prohibiting racial discrimination, including Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act. The Special Education and Rehabilitative Services Act ensures that individuals with disabilities are integrated into society and that parents, teachers, and students receive special education support. Lastly, FERPA, also known as the Buckley Amendment, protects the privacy of educational records by giving parents the right to access and, if necessary, amend their child’s academic records. Therefore, the correct answer is (B)",professional practice and ethics
910,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.",Melanie's boyfriend contacts you saying Melanie gave him permission and wants to discuss Melanie's treatment. What response is in your best interest?,Ask to see a Release of Information consent form signed by Melanie.,"Speak to him, but only about general recovery information and resources.","Let him know you will return his call, then speak with Melanie to obtain consent.",Provide him with whatever information he needs to help support Melanie's recovery.,"(A): Ask to see a Release of Information consent form signed by Melanie.
(B): Speak to him, but only about general recovery information and resources.
(C): Let him know you will return his call, then speak with Melanie to obtain consent.
(D): Provide him with whatever information he needs to help support Melanie's recovery.","Let him know you will return his call, then speak with Melanie to obtain consent.",C,"It is in violation of HIPAA to speak to anyone asking about Melanie without Melanie's express consent. It might be legally acceptable to move forward with a signed release of information as answer c) suggests, however using best ethical practices knowing Melanie has been through treatment outside of her home for quite some time it is always possible a signed release of information can be forged without her knowledge. Furthermore, Melanie has also never mentioned including her boyfriend in any information about her care. Directly connecting with Melanie first, followed by retrieving a signed consent form and prior to speaking with her boyfriend, would be in your best interest as a professional counselor. Providing general resources and information might be considered harmless, but even confirming you are the counselor of an individual in question could be a violation of a client's HIPAA protections and rights. Therefore, the correct answer is (B)",professional practice and ethics
911,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","You meet with the client and review a log that he brings in that documents how often he masturbated over the past week. The client’s log showed that he masturbates about three to four times per day. The client appears to masturbate more when his roommates are not in the apartment and late at night when his time is less structured. The client reports that he has a job interview in a few days at a nonprofit agency that works with children to ensure that they have clothing. He feels that this will be meaningful work and is encouraged because he knows the supervisor there from a previous job, and he thinks that the supervisor is a respectful person. The client expresses worry that he will not be competent at the job based on how he is doing at his current place of employment. You support the client with reframing his anxious thoughts about the interview","Based on the data gathered regarding the factors that lead to masturbation, all of the following would be possible interventions to manage these urges, EXCEPT:",Read the Bible or pray.,"If possible, leave the bedroom to be with his roommates or go for a drive.",Call a friend from his Bible study if he feels the urge to masturbate.,Use the aversion therapy technique in which the client snaps a rubber band on his wrist when he feels the urge to masturbate.,"(A): Read the Bible or pray.
(B): If possible, leave the bedroom to be with his roommates or go for a drive.
(C): Call a friend from his Bible study if he feels the urge to masturbate.
(D): Use the aversion therapy technique in which the client snaps a rubber band on his wrist when he feels the urge to masturbate.",Use the aversion therapy technique in which the client snaps a rubber band on his wrist when he feels the urge to masturbate.,D,"Snapping a rubber band on the wrist can be helpful in stopping some bad habits (cursing, negative thinking, etc. ); however, this often leads to avoiding dealing emotionally with what is happening and would not likely stop the client from masturbating. Conversely, reading the Bible, praying, or calling a friend are ways for this client to emotionally deal with these urges and will remind the client of his motivation to refrain from masturbating. Leaving his bedroom or going for a drive would be incompatible with masturbation and may also act as a healthy distraction. Therefore, the correct answer is (D)",counseling skills and interventions
912,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,Conduct disorder is often a pre-cursor to?,Histrionic personality disorder,Schizotypal personality disorder,Borderline personality disorder,Antisocial personality disorder,"(A): Histrionic personality disorder
(B): Schizotypal personality disorder
(C): Borderline personality disorder
(D): Antisocial personality disorder",Antisocial personality disorder,D,"Antisocial personality disorder is diagnosed at the minimum age of 18. The individual must have a history which is congruent with the criteria for conduct disorder. Borderline personality disorder is characterized by, ""instability in interpersonal relationships, self-image and affects, and marked impulsivity"". This commonly co-occurs with depressive or bipolar disorders. The essential feature of schizotypal personality disorder is a pattern of interpersonal/social deficits which results in the inability to have close relationships. Histrionic personality disorder is characterized by excessive attention-seeking behavior. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
913,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client attends a process-oriented CBT group that is nearing the middle stage of group development. The client presents today with a bright affect and arrives early to converse with two other women in the group. During group activities, she is reticent to share and is sensitive to a conflict between two members that has started to emerge. One member becomes openly critical of the group tasks and their usefulness. Other members start to weigh in and take sides. The conflict quickly escalates between two members, with one shouting at another, “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you.” Other members nod in agreement","As the leader of this process-oriented group, what is your best response to the emerging conflict?",“How might removing a member deprive you of learning from one another?”,“What core beliefs might underlie the strong opinions expressed today?”,“I’d like to pause for a moment and remind everyone of the group rules.”,“Let’s explore ways that we have all responded to difficult people in our lives.”,"(A): “How might removing a member deprive you of learning from one another?”
(B): “What core beliefs might underlie the strong opinions expressed today?”
(C): “I’d like to pause for a moment and remind everyone of the group rules.”
(D): “Let’s explore ways that we have all responded to difficult people in our lives.”",“How might removing a member deprive you of learning from one another?”,A,"The best response to the group’s conflict is the statement, “How might removing a member deprive you of learning from one another?” This question tests your knowledge of the stages of group development, the need to provide a here-and-now focus, and the leadership skills used to promote group cohesion. The middle stage of group development, also appropriately known as the storming stage (Tuckman, 1984), is characterized by conflict among members, challenges toward group leaders, and the formation of alliances or subgroups. Group leaders are tasked with normalizing conflict and redirecting members to here-and-now interpersonal exchanges rather than labeling certain members as “problematic” or “scapegoats” Core beliefs are schemas rooted in childhood. Although counselors can address core beliefs in process-oriented groups, caution must be used when group leaders interpret conflict as core beliefs, partly because it takes away from the group’s here-and-now focus. Exploring how members respond to difficult people in their lives is incorrect because it refers to other members as “difficult” rather than ascribing the conflict as member’s behaviors. Therefore, the correct answer is (C)",counseling skills and interventions
914,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","   ully. Family History: Several clients report coming from a single-parent home, whereas others are from a two-parent home. All clients report that they have siblings. Several clients reported having parents that were or are involved in the justice system",All of the following are helpful in drawing out a group member EXCEPT:,Dyads,Written activities,Cognitive reframing,Rounds,"(A): Dyads
(B): Written activities
(C): Cognitive reframing
(D): Rounds",Cognitive reframing,C,"Cognitive reframing might help manage anxiety in a group setting, but it does not specifically focus on encouraging participation and drawing out members. Written activities can be used to prompt responses and may be used in the context of rounds to promote the expectation that each member has a voice and is expected to provide a response. Dyads separate the members up into groups of two to discuss various topics and can ease some of the discomfort associated with larger group formats while promoting discussion in a smaller setting prior to returning to a group setting to report on what was discussed. Therefore, the correct answer is (B)",counseling skills and interventions
915,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.",How will showing Millie unconditional positive regard help her clinically?,Being genuinely nice to Millie will guarantee she will continue to see you.,Millie will experience paradoxical intention and develop insight into her behaviors.,Millie will more likely engage therapeutically over time if she feels accepted.,Approval of Millie's behavior will make her feel better about her decisions.,"(A): Being genuinely nice to Millie will guarantee she will continue to see you.
(B): Millie will experience paradoxical intention and develop insight into her behaviors.
(C): Millie will more likely engage therapeutically over time if she feels accepted.
(D): Approval of Millie's behavior will make her feel better about her decisions.",Millie will more likely engage therapeutically over time if she feels accepted.,C,"Unconditional positive regard (UPR), credited by the humanist psychologist Carl Rogers, is demonstrating unconditional love, acceptance and affection for your client while not necessarily approving of their behaviors, as in answer b. Through UPR, a therapist offers compassion and puts their value in the person over their choices. Use of this core counseling attribute will not guarantee a client will continue in therapy as in answer c but will increase the chances they will feel willing to engage and participate. Paradoxical intention as in answer d is the cognitive technique of persuading a patient to engage in their most feared or conflicted behavior and is therefore not applicable. Therefore, the correct answer is (A)",core counseling attributes
916,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.","The referring attorney offers to pay your counseling fees once the case is litigated, which may be up to a year from now. Which of the following is the best choice for responding to the attorney's offer for payment?",Offer to work with the client regarding payments and suggest the client and attorney make their own financial arrangements.,"Offer to work with the client and have the attorney's office make regular, monthly payments for counseling services.",Suggest that the attorney find a different therapist for this client so that you will not need to wait for payment.,Offer to bill the attorney's office after each appointment with the expectation of payment within 30 days.,"(A): Offer to work with the client regarding payments and suggest the client and attorney make their own financial arrangements.
(B): Offer to work with the client and have the attorney's office make regular, monthly payments for counseling services.
(C): Suggest that the attorney find a different therapist for this client so that you will not need to wait for payment.
(D): Offer to bill the attorney's office after each appointment with the expectation of payment within 30 days.",Offer to work with the client regarding payments and suggest the client and attorney make their own financial arrangements.,A,"Arranging payments between the counselor and the client provides greater autonomy for the client in choosing how often they will participate in therapy and minimizes ethical concerns related to who the counselor is working for - the client or the attorney. Counselors may receive payment from attorneys; however, this situation can impact the therapeutic relationship between client and counselor. Therefore, the correct answer is (B)",professional practice and ethics
917,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","   e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family","During the initial stages of therapy, which of the following would best enhance the family’s motivation and adherence to treatment?",Providing written information explaining the components of informed consent,"Integrating contextualized factors (e.g., cultural, spiritual) into treatment interventions","Offering a selection from a variety of treatment modalities (e.g., individual, group, family)","Coordinating treatment with youth-serving systems (e.g., educational, medical)","(A): Providing written information explaining the components of informed consent
(B): Integrating contextualized factors (e.g., cultural, spiritual) into treatment interventions
(C): Offering a selection from a variety of treatment modalities (e.g., individual, group, family)
(D): Coordinating treatment with youth-serving systems (e.g., educational, medical)","Integrating contextualized factors (e.g., cultural, spiritual) into treatment interventions",B,"Integrating contextualized factors in treatment interventions is the best way to enhance the family’s motivation and adherence to treatment. Integrating contextual factors is one method that counselors use to help establish a therapeutic alliance, enhance motivation, and increase treatment adherence. Examples of contextualized elements include race, ethnicity, gender, spirituality, and culture. The client is an African American female with concerns about fitting in with her predominantly white peers. When delivering contextualized treatment interventions, the client’s and counselor’s racial and ethnic identity and positionality (ie, privileged versus marginalized) must also be considered. Offering a selection of treatment modalities during the initial stages of therapy may not be appropriate or desired. Coordinating treatment with youth-serving systems is vital to the client’s care but is not the best way to influence motivation and treatment adherence. Counselors provide written verbal explanations of informed consent and transparent back-and-forth discussions to help foster a clear understanding of all components of informed consent before obtaining an agreement. Therefore, the correct answer is (B)",core counseling attributes
918,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","   ence. Family History: The client is married and has a 10-year-old daughter from a previous marriage. The client explains that her father was “distant and quiet unless he was drinking.” She remembers hearing that her paternal grandfather declared bankruptcy “at least once” due to gambling losses. The client’s mother has been diagnosed with bipolar disorder, with acute episodes requiring hospitalization. The client indicates that a former therapist also diagnosed her with bipolar disorder, but she rejects the diagnosis stating her symptoms are “nothing like my mother’s","Based on the client’s diagnosis, which assessment instrument would you use to obtain baseline data on the client’s current level of functioning?",Brief Psychiatric Rating Scale (BPRS),Level of Care Utilization System (LOCUS),DSM-5-TR Level 1 Cross-Cutting Symptom Measures,Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES),"(A): Brief Psychiatric Rating Scale (BPRS)
(B): Level of Care Utilization System (LOCUS)
(C): DSM-5-TR Level 1 Cross-Cutting Symptom Measures
(D): Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES)",DSM-5-TR Level 1 Cross-Cutting Symptom Measures,C,"The DSM-5-TR Level 1 Cross-Cutting Symptom Measures is “intended to help clinicians identify additional areas of inquiry that may have significant impact on the individual’s treatment and prognosis. In addition, the measure may be used to track changes in the individual’s symptom presentation over time” There are 13 domains for adults, including depression and mania, making DSM-5-TR Level 1 Cross-Cutting Symptom Measures a solid choice for obtaining baseline data. The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is a self-administered instrument used to help determine an individual’s motivation to change alcohol-related behaviors. Level of Care Utilization System (LOCUS) is an assessment instrument specifically designed to determine an appropriate level of care for individuals with addiction and psychiatric comorbidity. Finally, the Psychiatric Rating Scale (BPRS) measures psychosis and psychosis-related symptoms of schizophrenia or major psychotic disorders. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
919,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.",Melanie agrees to move forward with addiction treatment. What should be her first level of care?,Partial Hospitalization program,Residential detox facility,Outpatient because she has a child and cannot leave her home,Intensive Outpatient because she has already been in psychotherapy for so long,"(A): Partial Hospitalization program
(B): Residential detox facility
(C): Outpatient because she has a child and cannot leave her home
(D): Intensive Outpatient because she has already been in psychotherapy for so long",Residential detox facility,B,"All substance use treatment begins with residential detox which is the highest level of care, regardless of prior experience in any type of therapy. Clients must be monitored by medical professionals for safety while detoxing from the addictive substance before engaging in lower levels of care. Concurrent levels of care are partial hospitalization, intensive outpatient program, and eventually the return to outpatient counseling. Therefore, the correct answer is (C)",treatment planning
920,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,A treatment intervention that would not be beneficial is?,"Strengthening Carlos' positive support system, including his family",Determining what Carlos gets out of being in a gang,Collaborate with school to come up with an intervention plan,Ending treatment if Carlos continues to be resistant,"(A): Strengthening Carlos' positive support system, including his family
(B): Determining what Carlos gets out of being in a gang
(C): Collaborate with school to come up with an intervention plan
(D): Ending treatment if Carlos continues to be resistant",Ending treatment if Carlos continues to be resistant,D,"A counselor will often come across resistant clients. Carlos has a history of abuse and neglect, and he appears to be using anger as a defense mechanism. He may be distrustful of authority but shows signs of wanting to belong or be accepted. Some clients may take longer to engage than others. One beneficial intervention is to pinpoint what Carlos' motivation is to be part of a gang and see if he can get that same result through a more positive outlet. Also, by building up Carlos' positive support system, this may decrease his involvement with negative influences. Carlos seems to be having the most difficulty in school. By collaborating with the school, a plan can be constructed that is more motivating for Carlos than punitive. Therefore, the correct answer is (C)",treatment planning
921,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","   ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times. This is the client’s first marriage. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining",,It originates from future-oriented feelings of hopelessness and pessimism.,It manifests in deceitfulness and impulsivity.,It is marked by an inefficient persistence at tasks.,It is characterized by separation and insecurity.,"(A): It originates from future-oriented feelings of hopelessness and pessimism.
(B): It manifests in deceitfulness and impulsivity.
(C): It is marked by an inefficient persistence at tasks.
(D): It is characterized by separation and insecurity.",It is marked by an inefficient persistence at tasks.,C,"In Section III of the DSM-5-TR, a trait-specific approach to personality disorders is discussed. In the Alternative DSM-5 Model for Personality Disorders, characteristics of pathological personality traits are presented, along with impairments in functioning. Pathological personality traits are grouped into five domains: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. Negative affectivity is defined as “frequent and intense experiences of high levels of a wide range of negative emotions (eg, anxiety, depression, guilt/ shame, worry, and their behavioral (eg, self-harm) and interpersonal (eg, dependency) manifestations” (APA, 2022). The negative affectivity of OCPD is perseveration. The DSM-5-TR defines this as “persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same behavior despite repeated failures” Deceitfulness and impulsivity, an aspect of negative affectivity, is associated with narcissistic personality disorder. Pessimism and hopelessness characterize the negative affectivity of anxiousness, which is associated with avoidant personality disorder. Lastly, separation and insecurity are aspects of the negative affectivity domain for borderline personality disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
922,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","   ully. Family History: Several clients report coming from a single-parent home, whereas others are from a two-parent home. All clients report that they have siblings. Several clients reported having parents that were or are involved in the justice system.  The goal of your group is to prevent reincarceration through addressing the factors that brought these young people into the justice system",The goal of your group is to prevent reincarceration through addressing the factors that brought these young people into the justice system. Which one of the following best defines this approach to group therapy?,Support group therapy,Skill development group therapy,Cognitive-behavioral group therapy,Interpersonal group therapy,"(A): Support group therapy
(B): Skill development group therapy
(C): Cognitive-behavioral group therapy
(D): Interpersonal group therapy",Cognitive-behavioral group therapy,C,"Incarceration in the juvenile population is due to a combination of thoughts and actions that result in illegal activity. Cognitive-behavioral group therapy is the most appropriate approach for this group because it focuses on the group identifying the thoughts and behaviors that affect them negatively and then changing those thoughts and behaviors to have a different outcome. Interpersonal group therapy works on several types of mental health issues by focusing on personal relationships with family, friends, or coworkers. Skill development group therapy focuses on teaching skills in multiple areas to improve functioning. Support groups are not typically led by a therapist and often involve people with similar struggles supporting each other. Although most of these modalities may provide secondary support for this therapy group, cognitive-behavioral therapy more comprehensively addresses the goal of changing thoughts and behaviors for a different outcome. Therefore, the correct answer is (B)",counseling skills and interventions
923,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day.  The client wants to work on the conflict that he and his wife are experiencing",The client wants to work on the conflict that he and his wife are experiencing. Which of the following would be the most ethical and clinical decision based on the client’s needs and current situation?,Offer to have the client’s wife in the session one time to focus on how they can support each other through this transition.,Continue individual counseling with the client and include methods on resolving conflicts with his wife during a single session.,Refer the couple to a couples counselor.,Offer to provide couples counseling in addition to continued individual counseling for your client after explaining the risks involved.,"(A): Offer to have the client’s wife in the session one time to focus on how they can support each other through this transition.
(B): Continue individual counseling with the client and include methods on resolving conflicts with his wife during a single session.
(C): Refer the couple to a couples counselor.
(D): Offer to provide couples counseling in addition to continued individual counseling for your client after explaining the risks involved.",Offer to have the client’s wife in the session one time to focus on how they can support each other through this transition.,A,"The ACA Code of Ethics prohibits providing services to the client’s family members because this affects objectivity in the counseling process (2014, p 5). You can provide a counseling session for the client that involves his spouse if it focuses on supporting your client’s well-being and is not an ongoing process because this would be a dual relationship and biases would affect efficacy. The couple should be referred to couples counseling; however, the client has concerns about paying for sessions and currently does not have health insurance, which would make this an untenable option. Therefore, the correct answer is (C)",professional practice and ethics
924,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","You learn that the client withheld information during the intake interview because of a negative experience with psychiatric treatment. Two years previously, the client presented at the emergency room with symptoms of depression and suicidal ideation. The emergency department clinician recommended hospitalization, and the client complied. During his hospital stay, he was placed on an antipsychotic medication for paranoia and was diagnosed with schizoaffective disorder. Although the client admits to suicidal ideation, he denies ever experiencing paranoia. He reports having side effects from the medication and immediately discontinued it after discharge. The client states that he has been very depressed since the breakup with his girlfriend and was willing to give counseling another try before his depression “hit rock bottom",Which approach emphasizes establishing a therapeutic alliance upon which you can safely examine the client’s cognitive distortions?,Rational-emotive behavior therapy,Cognitive therapy,Person-centered therapy,Psychoanalytic therapy,"(A): Rational-emotive behavior therapy
(B): Cognitive therapy
(C): Person-centered therapy
(D): Psychoanalytic therapy",Cognitive therapy,B,"Cognitive therapy emphasizes the therapeutic alliance as a vital component for addressing cognitive distortions. Aaron Beck is credited with developing cognitive therapy. This treatment assumes that cognitive distortions result from irrational thinking and posits that depression stems from the client’s negative view of themselves, others, and the future (ie, the cognitive triad). Rational-emotive behavior therapy (REBT) is more directive and relies on the therapist challenging and disputing the client’s irrational thoughts. REBT therapists view the importance of unconditional acceptance but believe that emphasizing the therapeutic relationship can impede progress and create dependency. Freud and other psychoanalytic theorists believe that the therapeutic relationship is affected by transference and countertransference. Rather than focus on cognitive distortions, psychanalytic therapists value uncovering unconscious motives and biological drives to increase intellectual and emotional awareness. Person-centered therapy is nondirective and collaborative. Person-centered therapists help clients achieve congruence between their values and their behavior. Cognitive therapists adopt a humanistic approach as a foundation for examining irrational thinking, but person-centered therapists do not explore irrational thinking. Therefore, the correct answer is (B)",counseling skills and interventions
925,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.",ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself,"When considering differential diagnoses, which of the following personality disorders might present similarly to dependent personality disorder?",Histrionic personality disorder,Obsessive-compulsive personality disorder (OCPD),Schizoid personality disorder,Antisocial personality disorder,"(A): Histrionic personality disorder
(B): Obsessive-compulsive personality disorder (OCPD)
(C): Schizoid personality disorder
(D): Antisocial personality disorder",Histrionic personality disorder,A,"Histrionic personality disorder may appear similar in presentation to dependent personality disorder because the individual with histrionic personality disorder would be seeking assurance and validation from others and may demonstrate the same clingy behaviors. The difference is that a client with dependent personality disorder is less likely to actively engage in behavior for attention and is rather more submissive. Schizoid personality disorder involves a lack of desire to have relationships, and individuals with this disorder are often loners. OCPD is characterized by perfectionism and rigidity with certain tasks and thoughts. Antisocial personality disorder involves behavior that goes against social norms such as deceit and breaking laws. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
926,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The couple acknowledge some improvement with communication, but they continue to feel significant levels of relationship distress. The client has been asking for what she needs, mainly when she is in pain and functionally limited, but she reports that the husband continues to do little to support her. The husband reiterates that he has a demanding job that depletes his energy and that he has little to give when he gets home at night. The husband’s child has been verbally abusive to the client, and her husband minimizes her concern. The client feels “stuck in the middle” when determining her stepson’s schedule and activities. The client states that her husband’s bitter ex-wife makes her new role as stepparent “nearly impossible.” To help with the postdivorce adjustment and lessen conflict, you provide information on local support groups, parent education programs through family court, and additional educational resources.  The client expresses negative beliefs about herself, her world, and her future","The client expresses negative beliefs about herself, her world, and her future. Which one of the following theorists described this as the cognitive triad?",William Glasser,Aaron Beck,Frederick Perls,Albert Ellis,"(A): William Glasser
(B): Aaron Beck
(C): Frederick Perls
(D): Albert Ellis",Aaron Beck,B,"Aaron Beck used the term cognitive triad to refer to negative beliefs one has about oneself, one’s world, and one’s future. Beck is known for the cognitive theory of depression. Albert Ellis founded REBT. William Glasser is associated with reality therapy, and Frederick Perls is known for gestalt therapy. Therefore, the correct answer is (C)",counseling skills and interventions
927,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","You meet with the client and review a log that he brings in that documents how often he masturbated over the past week. The client’s log showed that he masturbates about three to four times per day. The client appears to masturbate more when his roommates are not in the apartment and late at night when his time is less structured. The client reports that he has a job interview in a few days at a nonprofit agency that works with children to ensure that they have clothing. He feels that this will be meaningful work and is encouraged because he knows the supervisor there from a previous job, and he thinks that the supervisor is a respectful person. The client expresses worry that he will not be competent at the job based on how he is doing at his current place of employment. You support the client with reframing his anxious thoughts about the interview",Which of the following best describes the client’s worry that he will not perform well at the new job opportunity based on his current employment?,Catastrophizing,Emotional reasoning,Overgeneralization,Fortune telling,"(A): Catastrophizing
(B): Emotional reasoning
(C): Overgeneralization
(D): Fortune telling",Overgeneralization,C,"This exemplifies overgeneralization because the client is taking his experience at the current position and applying it to his future employment opportunities. Overgeneralization does not take into account different factors such as supervising style, skills the client has, etc, and because of this, it is likely not an accurate thought pattern. Although the client’s statement may have a level of fortune telling, it does not account for the use of the past experience to inform future experiences. Catastrophizing is assuming the worst possible outcome, which is not what the client is doing in this situation. Emotional reasoning assumes that “I feel incompetent; therefore, I must be incompetent,” which is not what the client is doing in this case. Rather, he is taking past experiences and projecting them onto future experiences. Therefore, the correct answer is (C)",counseling skills and interventions
928,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",The client's teacher has requested feedback regarding the client's diagnosis. How do you proceed?,You share this information with the teacher.,You do not share any information with the teacher due to HIPAA regulations.,"Before disclosing any information to the teacher, you must ask the parent's and client's permission.",You must request the parents' permission before disclosing any information to the teacher.,"(A): You share this information with the teacher.
(B): You do not share any information with the teacher due to HIPAA regulations.
(C): Before disclosing any information to the teacher, you must ask the parent's and client's permission.
(D): You must request the parents' permission before disclosing any information to the teacher.",You share this information with the teacher.,A,"Since this is a school setting with the teacher participating in developing the IEP for the client, the teacher has access to the therapist's diagnostic impression of the client. Therefore, the correct answer is (C)",professional practice and ethics
929,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.",,"After potential clients are made aware that the group is available, what is the next step?",Establish relationship parameters with group members,Prepare to handle monopolizers in the group,Discuss how to handle clients receiving individual/group with the same therapist,Establish group norms,"(A): Establish relationship parameters with group members
(B): Prepare to handle monopolizers in the group
(C): Discuss how to handle clients receiving individual/group with the same therapist
(D): Establish group norms",Establish group norms,D,"Although the norms may change based on clients' makeup, it is important to create a rough blueprint for group norms so that counselors and clients will understand how the group operates. Therefore, the correct answer is (C)",professional practice and ethics
930, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.",Which of the following tools will best help you understand the needs of this client?,Beck's Depression Inventory-II (BDI-II),Kaufman Test of Educational Achievement (KTEA-3),Eating Inventory (EI),Personality Assessment Inventory (PAI),"(A): Beck's Depression Inventory-II (BDI-II)
(B): Kaufman Test of Educational Achievement (KTEA-3)
(C): Eating Inventory (EI)
(D): Personality Assessment Inventory (PAI)",Personality Assessment Inventory (PAI),D,"The client demonstrates behaviors that may be linked to psychopathology, such as her criminal history, the extreme lengths she has taken to create personas to engage with others, and her affect when describing her family member's criminal history. The PAI assesses personality and psychopathology and shows convergent validity with the MMPI-2. The client is in school currently but no educational issues are mentioned in the intake so the KTEA-3 is not appropriate. The BDI-II will provide information on the client's current emotional health related to possible depression, but as a stand-alone test, it will not provide the counselor with enough information to ascertain this client's overall counseling needs. The EI is used for evaluating current or past eating disorders. This is a good tool to use if the client's eating disorder is the subject of counseling. Because the client has never received a diagnosis, has never been treated for Bulimia Nervosa, and has been able to self-control her urges, this test would not be helpful at this time. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
931,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",Which information in the narrative allows you to rule out a diagnosis of Bipolar I Disorder?,The client has a history of suicide attempts,The client presents with depressive symptoms,The client has not experienced any manic episodes,The client does not have a family history of Bipolar I Disorder,"(A): The client has a history of suicide attempts
(B): The client presents with depressive symptoms
(C): The client has not experienced any manic episodes
(D): The client does not have a family history of Bipolar I Disorder",The client has not experienced any manic episodes,C,"Bipolar I Disorder is characterized by manic episodes of abnormal, elevated moods that persist for at least one week (or less if hospitalization is needed). The presence of impulsive and self-destructive behavior, unstable relationships, intense emotional distress, and suicidal attempts are all more indicative of BPD than of Bipolar I Disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
932,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","The client has arrived 15 minutes late for your scheduled session. When you approach the waiting room, you find her loudly talking on her cell phone. She abruptly ends the call and follows you back to your office. She is visibly shaken and angry. She explains that her soon-to-be ex-husband is a “master manipulator” and is “ruining my life.” She remains confident that she can stop drinking but states she can only do so once her family situation is under control. After all, she states, “You would drink too if you had my problems.” She begins to de-escalate as the session progresses, and she is able to identify and prioritize treatment issues. Her sleep continues to be a concern. Upon further exploration, she indicates she is having nightmares and has been for quite some time. The two of you work together to prioritize treatment plan goals. Her mood and demeanor brighten as the session concludes.  In addition to helping her sleep, the client states that drinking helps her feel more connected to others","In addition to helping her sleep, the client states that drinking helps her feel more connected to others. How would an Adlerian therapist address these thoughts with the client?","Support the client by showing empathy, unconditional positive regard, and nonjudgmental acceptance.",Instruct the client to identify the irrational belief associated with the activating event of drinking with others.,Introduce the concept of social interest and authenticity as replacements for the false sense of security she currently experiences when drinking with others.,Help the client learn new social skills and gain confidence through role play and corrective feedback.,"(A): Support the client by showing empathy, unconditional positive regard, and nonjudgmental acceptance.
(B): Instruct the client to identify the irrational belief associated with the activating event of drinking with others.
(C): Introduce the concept of social interest and authenticity as replacements for the false sense of security she currently experiences when drinking with others.
(D): Help the client learn new social skills and gain confidence through role play and corrective feedback.",Introduce the concept of social interest and authenticity as replacements for the false sense of security she currently experiences when drinking with others.,C,"Adlerian therapists would introduce the concept of social interest and authenticity as replacements for the false sense of security she currently experiences when drinking with others. Social interest emphasizes belonging and connection with others by valuing the “common good” over individual interests and endeavors. Individuals with substance use disorder often struggle with a sense of belonging and authenticity, making Adlerian therapy a best practice for alcohol use disorder. Humanistic, or person-centered, therapists demonstrate empathy, unconditional positive regard, and nonjudgmental acceptance. Social skills training is a behavioral approach that helps clients learn new social skills through instruction, behavioral rehearsal, corrective feedback, and positive reinforcement. Rational-emotive behavioral therapy (REBT) would be used to identify the irrational belief associated with an activating event (ie, drinking with others). Therefore, the correct answer is (A)",counseling skills and interventions
933,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","   vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week.  The client states that he still loves his ex-wife and that she often reaches out for support","The client states that he still loves his ex-wife and that she often reaches out for support. Based on the information provided, which of the following would be an appropriate goal regarding his new relationship with his ex-wife?",The client will continue to engage in supporting his ex-wife because this is a positive interaction.,The client will explore boundaries to establish what his new role is with his ex-wife.,The client will continue to work toward reconciling his relationship with his ex-wife to see if they can make the relationship work.,The client will stop engaging in supporting his ex-wife.,"(A): The client will continue to engage in supporting his ex-wife because this is a positive interaction.
(B): The client will explore boundaries to establish what his new role is with his ex-wife.
(C): The client will continue to work toward reconciling his relationship with his ex-wife to see if they can make the relationship work.
(D): The client will stop engaging in supporting his ex-wife.",The client will explore boundaries to establish what his new role is with his ex-wife.,B,"Exploring boundaries will be beneficial because the client does care about his ex-wife, which is part of who he is, and he also must maintain a relationship with her because they share custody of their children. Further engaging in supporting his ex-wife will continue to make the new roles confusing for the client and would not benefit him in identifying his new role in her life. The client reports that he continues to love his ex-wife, and, although not emotionally supporting her might be beneficial, he likely would not be ready to do this all at once. The client states that he “knows the relationship won’t return to where it was”; therefore, it likely would put the client in a situation in which he could get hurt if you encourage him to try to reconcile. Therefore, the correct answer is (B)",treatment planning
934,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.  10th session During your last session with the client, she discussed the anxiety that she was feeling about going home for winter break in a few weeks. She told you that her mom and stepdad always prepare a large meal for the holidays, and the extended family members get together to eat. She expressed a desire to participate in the family festivities but concern about her mom and stepdad's lack of understanding about her illness. She told you, ""I don't want to make anyone feel bad, but I just can't eat like everyone else. It's not only the food - it's the conversations and comments about my body that really bother me."" You listened as she expressed her fear of disappointing her family and reassured her that is was okay to set boundaries and have conversations about food. Together, you brainstormed coping strategies to manage her anxiety. You also suggested that she bring a dish of food that she would be comfortable eating to the winter break gathering. At the end of the session, she asked if she could bring her parents to the next session in an effort to gain their support and to help them understand what she is going through. You agreed to her request and scheduled an appointment to meet with the client and her parents.    At the start of today's session, you introduce yourself to her parents and explain your role in helping their daughter. The client's mother tearfully shares that she had no idea her daughter was struggling so much and that she wishes she had picked up on the signs sooner. The stepfather appears quiet and reserved. You help guide a conversation between the client and her parents about her eating disorder and symptoms that she is experiencing. The client shares her fears, triggers, and struggles around food. Her stepfather speaks up and says, ""I've heard enough. This is just ridiculous. You should just be able to eat, like everyone else. Your generation has gone 'soft' and started making up problems. There are people out there who don't have any food. When I was growing up, we had nothing. Your behavior is disrespectful."" As he is talking, the client's mother is quiet and visibly uncomfortable. The client interjects, ""Are you kidding? I'm the one who's being disrespectful?"" She looks toward you and says, ""When I'm home, he cooks these extravagant meals and refuses to let me leave the table until I've eaten what he's served me because it's 'wasteful to throw away food.' It's abuse! I feel like a captive when I'm at home."" She looks back at her stepfather and says, ""All I'm asking is that you understand what I'm going through and try to be a little more supportive."" The stepfather's face turns red with anger, and he gets up to leave the room. You intervene and ask him to stay, offering a suggestion that you all take a few moments to reflect on what each person has shared before continuing the conversation. While the stepfather takes a break, you encourage the mother to open up and express her feelings. She reveals that she is scared of not being able to help her daughter and feels helpless in understanding how to come together as a family. You discuss ways that she can be supportive and provide an empathetic environment for her daughter.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","As a mandated reporter, do you need to call in the incident reported by the client in this session?",No. The client's description does not constitute abuse.,Yes. It is abusive anytime someone is being forced to eat.,No. You should educate the client about abuse.,No. You must first consult with a colleague to determine a course of action.,"(A): No. The client's description does not constitute abuse.
(B): Yes. It is abusive anytime someone is being forced to eat.
(C): No. You should educate the client about abuse.
(D): No. You must first consult with a colleague to determine a course of action.",No. The client's description does not constitute abuse.,A,"This is not abuse in the language of mandated reporting; however, the client becomes anxious when she feels forced to eat, which should be addressed in therapy. Therefore, the correct answer is (A)",professional practice and ethics
935,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client continues to be compliant with therapy but is having difficulty discontinuing his drug use. He states he uses because it changes his mood and helps him forget about not fitting in at home or school. He explains that when he speaks English or dresses in non-traditional clothing, his family says they feel like, “I’ll forget where I came from. But when I leave the house, all I hear is, ‘Go back to where you came from.’” The client states he began using at the end of 7th grade and started using daily approximately four months ago. He admits to feeling guilty about how his use affects his family but claims, “It’s not like I’m an addict or anything.” His parents arrive today with an interpreter and attend a concurrent parenting group with a psychoeducational component that addresses adolescent substance abuse.  At the end of today’s session, you respond, “While on the one hand you really enjoy using and don’t want to give it up, on the other hand you feel guilty about how your drug use affects your family","At the end of today’s session, you respond, “While on the one hand you really enjoy using and don’t want to give it up, on the other hand you feel guilty about how your drug use affects your family.” How would you classify this response?",Empathetic reflection,Summarization,Encourager,Reframing,"(A): Empathetic reflection
(B): Summarization
(C): Encourager
(D): Reframing",Empathetic reflection,A,"This response is an example of an empathetic reflection, or more specifically, a double-sided empathetic reflection. A double-sided reflection is a motivational interviewing strategy used to help examine ambivalence and look at both sides of the client’s discrepancies. Counselors use reframing to help clients view situations, feelings, and relationships in a more positive light. Summarization ties together multiple concepts, feelings, or ideas. Counselors can use summarization at the end of the session or throughout the session to narrow the focus or examine a particular theme. An encourager is also called a prompt or a furthering response and involves a word, phrase, or nod used to encourage the client to continue talking. Therefore, the correct answer is (C)",counseling skills and interventions
936,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","   k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress.”  Which theorist would stress the importance of the client’s life roles (e\. g","Which theorist would stress the importance of the client’s life roles (e.g., tennis player, wife, youth mentor), self-concept, and career maturity?",Roe,Schein,Hansen,Super,"(A): Roe
(B): Schein
(C): Hansen
(D): Super",Super,D,"Donald Super’s life-span life-space theory is based on the assumption that career development is an ongoing process. Super integrated the constructs of life roles (eg, tennis player, volunteer, wife), self-concept (ie, self-understanding), and career maturity (ie, one’s ability to master tasks associated with the corresponding stages of career development) into his career development theory. Sunny Hansen is known for her theory of integrative life planning, which focuses on integrating values and cultural influences (eg, socioeconomic status, ethnicity, gender, spirituality) into one’s work. Anne Roe’s theory of personality development and career choice emphasizes the role of early childhood experiences on career development. Finally, Edgar Schein used the concept of career anchors to explain how one’s personal beliefs and values serve as an impetus for career choice. Therefore, the correct answer is (B)",counseling skills and interventions
937,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client comes to the session reporting that he and his girlfriend attempted to have sex the past week, and he wrote down some thoughts he was having on his CBT thought log. The client and the clinician reviewed his thoughts and engaged in cognitive reframing to support him in creating new scripts to use when engaging in sex. The client also wrote down physical responses to anxiety that he was experiencing before and during sex that included muscle tension and increased heart rate",All of the following are effective behavioral techniques used to reduce premature ejaculation EXCEPT:,The use of antidepressants,Pelvic floor exercises,Focus on foreplay,The use of condoms,"(A): The use of antidepressants
(B): Pelvic floor exercises
(C): Focus on foreplay
(D): The use of condoms",The use of antidepressants,A,"The use of antidepressants is not a behavioral approach that would affect premature ejaculation; rather, it is a medical approach that helps delay the time to ejaculation. Pelvic floor exercises affect the client’s ability to refrain from ejaculation and are an effective behavioral technique in delaying it. Foreplay in a sexual encounter can delay ejaculation and reduce anxiety prior to sexual intercourse. Condoms reduce sensitivity and can aid in delaying premature ejaculation. Therefore, the correct answer is (D)",treatment planning
938,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.","Based on your assessment, which of the following diagnoses is the most accurate for the client at this time?",Post Traumatic Stress Disorder,Adjustment Disorder,Major Depressive Disorder,Bereavement,"(A): Post Traumatic Stress Disorder
(B): Adjustment Disorder
(C): Major Depressive Disorder
(D): Bereavement",Major Depressive Disorder,C,"The client meets five or more criteria for a Major Depressive (MDD) diagnosis, including depressed mood most days in at least 2-week period; significant weight loss when not dieting; insomnia nearly every day; psychomotor retardation; loss of energy nearly every day; inappropriate guilt; symptoms cause clinical distress in social and occupational functioning; symptoms are not attributable to other medical condition. While the event was traumatic, the client is not exhibiting symptoms that fulfill criteria for a PTSD diagnosis, such as intrusion symptoms, prolonged distress at exposure to internal or external cues, or dissociative reactions. The client's symptoms do include bereavement symptoms, such as prolonged sadness, mourning behaviors, weight loss, rumination, and insomnia, but the severity and progression of symptoms are better reflected as MDD. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
939,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","   atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together",Which of the following areas would be indicated to assess for in addition to eating disorders?,Anxiety,Depression,Relationship quality,Trauma,"(A): Anxiety
(B): Depression
(C): Relationship quality
(D): Trauma",Trauma,D,"Trauma is most indicated as a focus for assessment because the client’s mother is deceased and the manner of her passing is directly connected to the client’s thought process surrounding her eating patterns. Anxious and depressive symptoms might be present, but they are not the most debilitating symptoms. The client’s relationship quality is also important to consider; however, the client’s trauma regarding her mother appears to be the most likely root to some of her eating disorder symptoms and triggers and should therefore be considered and investigated first. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
940,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",her. Family History: The client says that she has a good relationship with her parents. She says that they are encouraging and supportive of her. The client says that she has a younger brother who is 6 years old and an older brother who is 16 years old. The client states that she has a good group of friends and spends time with them regularly,Which one of the following is an effective use of nonverbal attending?,Minimize the use of hand gestures and head nods.,Maintain an appropriate distance of approximately 4–8 feet.,Lean back in your chair in order to seem less threatening or less dominant.,Maintain eye contact to increase the closeness of the relationship because it demonstrates the desire to help.,"(A): Minimize the use of hand gestures and head nods.
(B): Maintain an appropriate distance of approximately 4–8 feet.
(C): Lean back in your chair in order to seem less threatening or less dominant.
(D): Maintain eye contact to increase the closeness of the relationship because it demonstrates the desire to help.",Maintain eye contact to increase the closeness of the relationship because it demonstrates the desire to help.,D,"Engaging with eye contact is an effective use of nonverbal attending because it demonstrates attention and interest, which supports the client in feeling comfortable. Leaning forward, using hand gestures, and nodding (vs leaning back and minimizing the use of gestures and head nods) all demonstrate warm attending behaviors that will also increase the client’s comfort. The most appropriate distance for personal conversation is 15–4 feet with approximately 3–4 feet being the most comfortable spacing for individuals. Therefore, the correct answer is (A)",counseling skills and interventions
941,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","In planning treatment for this client that is consistent with this diagnosis, which of the following would be the most effective referral?",A therapeutic counseling group,Psychiatry for medication evaluation,A clinician who specializes in addiction,Alcoholics Anonymous,"(A): A therapeutic counseling group
(B): Psychiatry for medication evaluation
(C): A clinician who specializes in addiction
(D): Alcoholics Anonymous",Psychiatry for medication evaluation,B,"The degradation of the client's presentation with increased sleep and alcohol use, along with a history of periods of depression and anxiety would make referral to a psychiatrist or psychiatric nurse practitioner an expected and the most effective referral. Community mental health agencies often have psychiatric services to provide medication management at low or no cost. Given his financial situation, this would be important. Therapeutic group counseling can help the client begin connecting with others but may not be available in community health and financially prohibitive. Referral to Alcoholics Anonymous would be premature as the client's increased drinking appears related to a current crisis. Referral to a clinician who specializes in addictions would be inappropriate at this time. The client's increase in alcohol appears related to his current distressing situation and should not be labeled as an addiction. Therefore, the correct answer is (A)",treatment planning
942, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,A possible treatment which involves repeated contact to the stimuli associated with the negative events is called?,Confrontation,Intermittent reinforcement,Conditioning,Direct therapeutic exposure,"(A): Confrontation
(B): Intermittent reinforcement
(C): Conditioning
(D): Direct therapeutic exposure",Direct therapeutic exposure,D,"Direct therapeutic exposure has been proven effective for those diagnosed with PTSD. By real life or imagined exposure of the feared stimuli, skills like relaxation training are taught to help control client's reactions. Intermittent reinforcement and conditioning are used to reward behavior and would not be warranted here. Confrontation is a therapeutic technique that happens within the client when they are taking a realistic look at their actions or patterns. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
943,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,"All of the below can be used to screen for developmental status, EXCEPT?",ASQ,WISC,SWYC,PEDS,"(A): ASQ
(B): WISC
(C): SWYC
(D): PEDS",WISC,B,"The Wechsler Intelligence Scale for Children (WISC-V) is an intelligence test that measures a child's intellectual ability and five cognitive domains that impact performance. The Parent Evaluation Developmental Screening (PEDS) is a parent report screening tool which helps to identify disabilities in areas of learning, language, mental health and other areas. The Ages and Stages Questionnaire (ASQ) is a developmental and social-emotional screening tool. The Survey for Well Being in Young Children (SWYC) is a screening tool used for children under the age of 55 which helps to identify risk in development/behavioral issues. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
944,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",Which issue presented during the first session needs to be first addressed?,Substance abuse,Ethical considerations,The client's competence to make informed decisions,Mental health needs,"(A): Substance abuse
(B): Ethical considerations
(C): The client's competence to make informed decisions
(D): Mental health needs",Ethical considerations,B,"You have a distant family relationship with the client. You need to consider the ethical implications of continuing to see him for therapy before you deal with other issues presented in the first session. To continue therapy when you may have to transfer the client to another therapist would be inappropriate and harmful to the client. Therefore, the correct answer is (D)",professional practice and ethics
945,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community",Which core professional value calls on counselors to promote equity for all people and groups by actively confronting oppressive systems of power?,Multicultural awareness,Social justice,Professional integrity,Beneficence,"(A): Multicultural awareness
(B): Social justice
(C): Professional integrity
(D): Beneficence",Social justice,B,"The ACA Code of Ethics defines social justice as “the promotion of equity for all people and groups for the purpose of ending oppression and injustice affecting clients, students, counselors, families, communities, schools, workplaces, governments, and other social and institutional systems” As such, promoting social justice is considered a core professional value for all certified counselors. Counselors must be aware of their client’s uniqueness within the client’s culture and within the counselor’s own culture. Counselors must consider multiple ways that the intersectional identities of the client and counselor exist within the surrounding society. Professional integrity involves protecting and honoring the client-counselor relationship. Counselors are also called to honor diversity and embrace a “multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts” (ACA, 2014). Lastly, beneficence is a professional value demonstrated when one is “working for the good of the individual and society by promoting mental health and well-being” (ACA, 2014). Therefore, the correct answer is (C)",professional practice and ethics
946,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.","Based on the information provided, which of the following skills will be most appropriate for the counselor to teach during this session?",Active listening and attending skills,Conflict resolution,Relaxation techniques,Boundaries,"(A): Active listening and attending skills
(B): Conflict resolution
(C): Relaxation techniques
(D): Boundaries",Boundaries,D,"The client has demonstrated that she uses rigid boundaries to control others, yet struggles and becomes angry when others attempt to control her. Explaining the concept of boundaries and how these can provide protection from others' overcontrol, while learning to recognize when the client is trying to control others is a skill which will assist her in each of the relationships she has brought into the counseling sessions thus far. Conflict resolution is an important skill which will be shared under the concept of boundaries. Currently, the client avoids conflict while giving in to her friends and feeling angry. Teaching conflict resolutions skills will help resolve this problem but will not help her learn to deal with controlling and being controlled. Active listening and attending skills will help the client as she communicates more effectively with others, but will not help her address her anger at being controlled or when she controls others and they do not submit. Relaxation techniques will be helpful for this client to reduce her anger and help her interact with more patience when irritated. This symptom-specific skill is important but will not address the root of her anger, which is caused by the feeling of being controlled or controlling others without their agreement. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
947, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,The counselor's targeting of Autumn's distortions about eating and body image is an example of?,Gestalt Therapy,Humanistic Therapy,Cognitive Behavioral Therapy,Feminist Therapy,"(A): Gestalt Therapy
(B): Humanistic Therapy
(C): Cognitive Behavioral Therapy
(D): Feminist Therapy",Cognitive Behavioral Therapy,C,"One of the methods of cognitive behavioral therapy is to detect irrational beliefs and understand how they affect behavior. One of the goals of CBT is to restructure or change the client's self-talk. CBT has been proven to be an effective treatment for individuals diagnosed with an eating disorder. Feminist therapy focuses on gender specific issue derived from power inequities and social systems. Gestalt therapy is a more experiential approach where the counselor can be very directive and sometimes confrontational. Humanistic therapy is nondirective and is not the best modality of treatment for what Autumn is experiencing as she needs more directive, short term interventions. Therefore, the correct answer is (A)",counseling skills and interventions
948,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","   e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services.  You meet with the client’s parents and sibling for family therapy to establish a strong working relationship",You meet with the client’s parents and sibling for family therapy to establish a strong working relationship. How would a structural family therapist best accomplish this task?,Teach problem-free talk.,Demonstrate an enactment.,Engage in the process of joining.,Use triangulation to reduce anxiety.,"(A): Teach problem-free talk.
(B): Demonstrate an enactment.
(C): Engage in the process of joining.
(D): Use triangulation to reduce anxiety.",Engage in the process of joining.,C,"Joining is a foundational component of structural family therapy. Counselors join with families through the processes of tracking (ie, “following the facts” in content and interactions), mimesis (ie, becoming like the family), confirmation (eg, identifying the disconnect between verbal and nonverbal communication), and accommodation (ie, making personal adjustments to the family’s way of being). Each process is designed to strengthen the therapeutic alliance among all family members. SFBT treatment is known for teaching problem-free talk—a technique that is used to help all family members share aspects of their lives that are going well. Enactments are also used in structural family therapy as a way to actively demonstrate interactions and explore changes within the family dynamics. Unlike joining, the counselor requests that family members interact with one another rather than interacting directly with the counselor. The use of triangulation to reduce anxiety among family dyads is a Bowenian family therapy technique. Therefore, the correct answer is (A)",counseling skills and interventions
949,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","    History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork.  You cover administrative and clinical protocols when reviewing paperwork with the client, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule","You cover administrative and clinical protocols when reviewing paperwork with the client, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. Which one of the following statements is true of HIPAA?","HIPAA serves as an authorization (i.e., consent) to counseling services.",HIPAA ensures that confidential information will not be used in legal proceedings.,HIPAA protects and safeguards confidential electronic records from potential security risks.,HIPAA gives clients the right to be informed of privacy and confidentiality policies before providing consent.,"(A): HIPAA serves as an authorization (i.e., consent) to counseling services.
(B): HIPAA ensures that confidential information will not be used in legal proceedings.
(C): HIPAA protects and safeguards confidential electronic records from potential security risks.
(D): HIPAA gives clients the right to be informed of privacy and confidentiality policies before providing consent.",HIPAA protects and safeguards confidential electronic records from potential security risks.,C,"HIPAA protects and safeguards confidential electronic records. Components of the HIPAA Privacy Notice include protecting electronic records from being tampered with, destroyed, or disclosed to unsanctioned persons. The notice further stipulates that protection under HIPAA applies to intentional and unintentional acts. Privilege applies to protecting confidential information in legal proceedings. State and legal mandates dictate information used in court, and mandates vary from state to state. HIPAA is not the same as informed consent. You are not providing consent to treat, nor is the client authorizing information to be released to third parties. HIPAA signatures and initials simply indicate that the client has received or was offered the HIPAA Notice of Privacy Practices. Informed consent (rather than HIPAA) covers the client’s rights and responsibilities, including the right to be informed beforehand of privacy and confidentiality policies before consent for treatment is provided. Therefore, the correct answer is (D)",professional practice and ethics
950,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","When aiming to develop a comprehensive understanding of the client's current psychological and behavioral status, what information would be most instrumental in assessing overall level of functioning and subsequently determining the most appropriate therapeutic intervention and treatment approach?",The client's family relationships and dynamics,A description of the client's typical day-to-day activities,A comprehensive evaluation of the client's social support system,An assessment of the client's coping mechanisms and resilience,"(A): The client's family relationships and dynamics
(B): A description of the client's typical day-to-day activities
(C): A comprehensive evaluation of the client's social support system
(D): An assessment of the client's coping mechanisms and resilience",A description of the client's typical day-to-day activities,B,"This information will help you gain insight into how the client's anxiety, poor body image, and eating behaviors are impacting her daily life. A description of her typical day-to-day activities will provide valuable data to assess their level of functioning and determine how best to approach treatment. For example, if the client is struggling to attend classes due to their anxiety, this would indicate that the issue is causing significant impairment in functioning and require more intensive intervention. On the other hand, if she is able to go to school but have difficulty with other activities such as socializing or studying, this provides additional insight into where treatment should be focused. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
951,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ","A teacher tells you that she has seen the client running around in the hallway, and she is sure that he has ADHD. She mentions that she has seen him go to your office, and asks if you are seeing him for therapy. How do you respond?","Advise the teacher that therapy is confidential, and you cannot confirm or deny that he is in therapy.",Advise the teacher that you must make a report to the administration for a breach of confidentiality regarding your client.,"Advise the teacher that therapy is confidential, so since she saw the client go to your office, ask that she not tell anyone else.","Advise the teacher that therapy is confidential, tell her that the student is not in therapy, and excuse yourself from the conversation","(A): Advise the teacher that therapy is confidential, and you cannot confirm or deny that he is in therapy.
(B): Advise the teacher that you must make a report to the administration for a breach of confidentiality regarding your client.
(C): Advise the teacher that therapy is confidential, so since she saw the client go to your office, ask that she not tell anyone else.
(D): Advise the teacher that therapy is confidential, tell her that the student is not in therapy, and excuse yourself from the conversation","Advise the teacher that therapy is confidential, and you cannot confirm or deny that he is in therapy.",A,"Therapists make every effort to ensure that the privacy and confidentiality of clients are maintained. You do not know if this teacher is included in the IEP team, so you cannot disclose any information to her. Therefore, the correct answer is (C)",professional practice and ethics
952,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,Destiny is not displaying symptoms for the following diagnosis?,Separation anxiety disorder,Intellectual disability (Intellectual developmental disorder),Reactive attachment disorder,Autism spectrum disorder,"(A): Separation anxiety disorder
(B): Intellectual disability (Intellectual developmental disorder)
(C): Reactive attachment disorder
(D): Autism spectrum disorder",Separation anxiety disorder,A,"Destiny is not displaying symptoms of Separation Anxiety Disorder as that is characterized by excessive fear and anxiety concerning separation from whom the individual is attached. From the information given, Destiny may be showing signs of autism spectrum disorder in the lack of interest in playing with other children and mood fluctuations. Cognitive delays and poor social and emotional skills can be symptoms of intellectual disability. These symptoms can also be a sign of reactive attachment disorder. Therefore, the correct answer is (D)",treatment planning
953,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.",You learn Melanie has been a marijuana user since she was 19. You research late-stage marijuana-use conditions and discover Melanie fits all criteria for having developed Cannabinoid Hyperemesis Syndrome (CHS) to explain her vomiting. What treatment intervention should be implemented?,"Educate Melanie on findings, process thoughts and feelings, collaborate on treatment options",Collect self-report inventories from family members to further support research,Inform Melanie she has CHS and redirect her to contact her primary care provider,Use constructive confrontation to explain addiction and send her involuntarily to detox,"(A): Educate Melanie on findings, process thoughts and feelings, collaborate on treatment options
(B): Collect self-report inventories from family members to further support research
(C): Inform Melanie she has CHS and redirect her to contact her primary care provider
(D): Use constructive confrontation to explain addiction and send her involuntarily to detox","Educate Melanie on findings, process thoughts and feelings, collaborate on treatment options",A,"Evaluating a client's reported conditions, exploring and researching all viable options to explain and treat their distress, encompasses the core behaviors of effective counselors. Providing Melanie with education and information on your assessments and helping her process what she should do next is the correct person-centered and empathic intervention to use while still aligning with her empathically and hoping to improve her motivation to change. There is no need to collect inventories as she already meets all criteria and further has not reported positive relationships with family members, which could skew results. Declaring that your findings are medically accurate is also not appropriate considering she has not been screened yet medically; however, recommending she contact her primary care provider is appropriate. The steps you are taking in answer a) make up a significant portion of substance use intervention and are more likely to be effective than the confrontational method used in answer d). If she can come to an understanding of what is happening to her body on her own, she may agree to get help for herself if intervention a) is used, whereas she might become defensive, combative and non-compliant if pressured into treatment. Therefore, the correct answer is (A)",counseling skills and interventions
954,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","The client discusses how his case manager has gotten him into a shelter and is currently working on securing housing for him. The client processes feelings surrounding the shelter and has begun a detox program for his fentanyl addiction. The client verbalizes that he is experiencing anxiety surrounding being at meetings with the case manager, talking with other residents, reintegrating into a “more normal life,” and worrying about whether he can ever have a relationship with his kids or ex-wife if he gets sober. Through processing, you realize that this anxiety was present prior to drug use and that he has experienced anxiety throughout his life","Due to the presence of anxiety symptoms, which would be the most probable second diagnosis to consider?",Agoraphobia,Generalized anxiety disorder,Social anxiety disorder,Substance/medication-induced anxiety disorder,"(A): Agoraphobia
(B): Generalized anxiety disorder
(C): Social anxiety disorder
(D): Substance/medication-induced anxiety disorder",Generalized anxiety disorder,B,"Generalized anxiety disorder appears to be the most probable diagnosis because the anxiety appears to cover many different areas of the client’s life. Although some of the anxiety is related to social situations, social anxiety disorder is specifically about fear of judgment or scrutiny (American Psychiatric Association [APA], 2013). Although the client does use substances, the anxiety predates the substance use and it is possible that the substances helped the client feel a reduction in anxiety. Agoraphobia is the fear of being in public spaces alone, closed in with others, and it generally results in an individual being afraid to leave home (APA, 2013). Although the client does express anxiety about living in a shelter, that anxiety is likely less specific to his living situation than it is a generalized sense of being overwhelmed by all of the issues that he is currently confronting. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
955,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",Which measurement tool would best identify Mary's difficulties with adjustment into widowhood?,Grief Intensity Scale,Grief Resolution Index,Quality of Dying and Death questionnaire,Brief Symptom Inventory,"(A): Grief Intensity Scale
(B): Grief Resolution Index
(C): Quality of Dying and Death questionnaire
(D): Brief Symptom Inventory",Grief Resolution Index,B,"The purpose of the GRI helps give an indication of how well or poorly an individual can navigate the process of grief and can predict both short and long-term adjustment to widowhood. It would help identify factors contributing to Mary's prolonged psychological distress associated with the death of her spouse. The GIS assesses thoughts, feelings and behaviors of people who have lost someone important and can identify risks of prolonged grief disorder and related conditions. It captures the level of intensity a person is experiencing of a loss. It is a useful tool for understanding Mary's reaction to her husband's death but does not specifically relate to how well she is able to process it. The BSI is a self-report inventory covering nine dimensions (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism) and helps clients identify pertinent contributing factors to their distress on a 5-point scale. It is another useful tool for treatment planning purposes but does not relate to adjustment into widowhood. The QODD is an instrument for assessing the quality of a person's experience with death and dying. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
956,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","The client has arrived 15 minutes late for your scheduled session. When you approach the waiting room, you find her loudly talking on her cell phone. She abruptly ends the call and follows you back to your office. She is visibly shaken and angry. She explains that her soon-to-be ex-husband is a “master manipulator” and is “ruining my life.” She remains confident that she can stop drinking but states she can only do so once her family situation is under control. After all, she states, “You would drink too if you had my problems.” She begins to de-escalate as the session progresses, and she is able to identify and prioritize treatment issues. Her sleep continues to be a concern. Upon further exploration, she indicates she is having nightmares and has been for quite some time. The two of you work together to prioritize treatment plan goals. Her mood and demeanor brighten as the session concludes","Given the client’s history of childhood trauma and continued alcohol use, how would you deliver trauma-informed care for this client in the early stages of treatment?",Provide education on the physiological dangers of treating trauma amid alcohol misuse.,"Address the trauma if the client agrees to concurrent, short-term psychopharmacological treatment.",Process the details of the client’s trauma experience or trauma narrative.,Help the client understand symptoms of their trauma and offer appropriate outside supports.,"(A): Provide education on the physiological dangers of treating trauma amid alcohol misuse.
(B): Address the trauma if the client agrees to concurrent, short-term psychopharmacological treatment.
(C): Process the details of the client’s trauma experience or trauma narrative.
(D): Help the client understand symptoms of their trauma and offer appropriate outside supports.",Help the client understand symptoms of their trauma and offer appropriate outside supports.,D,"The principles of trauma-informed care (TIC) are emotional safety, collaboration, choice, empowerment, and transparency. Counselors using a TIC approach help the client understand symptoms of their trauma and offer appropriate outside supports (eg, Seeking Safety groups). When treating AUD and addressing trauma, the goal in the early stages of therapy is to increase emotional safety by minimizing the risk of re-traumatization. Providing the client with an understanding of symptoms rather than exploring their trauma narrative (ie, recalling details of the trauma), helps accomplish this goal. Processing trauma in the early stages of therapy can increase the client’s risk of decompensation before developing adequate coping skills. While there are physiological risks associated with treating both trauma and AUD, the counselor must remain transparent by providing information on the risks, as well as the benefits, of concurrent treatment. Attaining short-term psychopharmacological treatment is not a TIC condition, as it does little to empower clients to make educated choices for their care. Therefore, the correct answer is (B)",treatment planning
957,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following best describes the purpose of teaching the client grounding skills when treating PTSD?,Grounding skills help the client focus on their past experiences instead of the present.,Grounding skills help prevent flashbacks while the client is in therapy.,Grounding skills help prevent intrusive memories from occurring.,Grounding skills help the client keep one foot in the present while they revisit the past.,"(A): Grounding skills help the client focus on their past experiences instead of the present.
(B): Grounding skills help prevent flashbacks while the client is in therapy.
(C): Grounding skills help prevent intrusive memories from occurring.
(D): Grounding skills help the client keep one foot in the present while they revisit the past.",Grounding skills help the client keep one foot in the present while they revisit the past.,D,"Grounding skills are used in PTSD treatment because they help the client keep one foot (ie, part of their mind) in the present while they have one foot in the past. This allows them to revisit past traumatic memories without dissociating. Having the client focus only on their past experiences instead of keeping part of their mind in the present may cause a dissociative break or extreme emotional outburst that can cause the client further emotional injury. Grounding skills will not help prevent intrusive memories or flashbacks from occurring, but these techniques can help the client who experiences either of these to lessen the disturbance through connecting to where they are in the present. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
958,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,"At the initial intake, the counselor should first?",Choose an appropriate treatment intervention,Assess if further testing/assessment is needed,Gather clinical report and school evaluations,Conduct a clinical interview including mental status exam,"(A): Choose an appropriate treatment intervention
(B): Assess if further testing/assessment is needed
(C): Gather clinical report and school evaluations
(D): Conduct a clinical interview including mental status exam",Conduct a clinical interview including mental status exam,D,"The first step would be to conduct a clinical interview including a mental status exam so the counselor can gain relevant background information and assess if Carlos is a safety risk to himself or others. This would help also to determine if further testing and assessments are warranted. Although the counselor is aware of some symptoms, treatment interventions should not be chosen without a better understanding of the client's history, severity of symptoms and any pertinent information from other sources. Any past clinical reports and/or school evaluations should be collected at this time. Therefore, the correct answer is (A)",counseling skills and interventions
959,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","   ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake.  You think you may know the client’s husband. To ensure that there are no boundary violations, you search for your client online and look through her public social media postings","You think you may know the client’s husband. To ensure that there are no boundary violations, you search for your client online and look through her public social media postings. Is your behavior consistent with ethical standards of practice?","Yes, the information is public and you have an ethical responsibility to maintain boundaries.","Yes, your informed consent includes the risks and benefits of engaging in technology and social media.","No, you have an ethical responsibility to respect the client’s privacy of her presence on social media.","No, in doing so, you are violating client confidentiality.","(A): Yes, the information is public and you have an ethical responsibility to maintain boundaries.
(B): Yes, your informed consent includes the risks and benefits of engaging in technology and social media.
(C): No, you have an ethical responsibility to respect the client’s privacy of her presence on social media.
(D): No, in doing so, you are violating client confidentiality.","No, you have an ethical responsibility to respect the client’s privacy of her presence on social media.",C,"According to the ACA Code of Ethics (2014), “Counselors respect the privacy of their clients’ presence on social media unless given consent to view such information” As such, viewing the client’s social media page is not consistent with ethical standards of practice. Because you have an ethical responsibility to maintain boundaries, it is unethical for you to search the client’s social media page without permission. It is standard practice to include social media, technology, and distance counseling benefits and limitations in the process of informed consent. However, the client’s permission to search their social media page must be attained regardless of specifications included in informed consent. Searching the client’s social media page is not a violation of confidentiality because you are not disclosing personal information. Therefore, the correct answer is (B)",professional practice and ethics
960,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.",book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends,"All of the following would be indicated short-term goals for the client based on the information presented, EXCEPT:",The client will improve imaginative play skills in order to improve relationship quality with peers.,The client will learn and implement coping skills for managing frustration when his schedule changes.,The client will improve in his anger management skills.,The client will learn social skills to improve social interactions with peers.,"(A): The client will improve imaginative play skills in order to improve relationship quality with peers.
(B): The client will learn and implement coping skills for managing frustration when his schedule changes.
(C): The client will improve in his anger management skills.
(D): The client will learn social skills to improve social interactions with peers.",The client will improve imaginative play skills in order to improve relationship quality with peers.,A,"The client will have difficulty improving imaginative play due to his diagnosis of autism spectrum disorder. The client would benefit from developing his social skills, coping skills for frustration management, and anger management because he has trouble tolerating change and because of his anger regarding rigidity and changes in his schedule. Therefore, the correct answer is (B)",treatment planning
961,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.  Ninth session Logan arrives at the session a few minutes late and apologizes. He says that he was outside playing kickball with his class. He reports that he has been feeling better about being in school lately. His classmates are friendlier to him, or at the very least, ""they don't bother me so much,"" He is now eating lunch back in the lunchroom. He is learning to play soccer and plans to ask his parents if he can join the summer league. Next, you call Logan's mother and share his progress in counseling with her. Finally, you examine Logan's care plan and assess for any changes needed.    Logan's progress in counseling has been notable as he has demonstrated increased social engagement and involvement in extracurricular activities. It appears that the therapeutic interventions implemented have successfully addressed his initial concerns regarding social anxiety and peer relationships. In addition, Logan's newfound interest in soccer and desire to join a summer league further demonstrates his willingness to engage with peers and develop new skills.    In conversation with Logan's mother, you emphasize the importance of fostering a supportive home environment to encourage Logan's growth and self-confidence. The mother expresses gratitude for the improvements in her son's well-being and commits to facilitating Logan's involvement in the summer soccer league. Additionally, she agrees to maintain open communication with the counselor to address any potential concerns that may arise in the future.    Upon reviewing Logan's care plan, the counselor determines that the current therapeutic goals and interventions remain appropriate and relevant to Logan's ongoing progress. However, it may be beneficial to introduce supplementary strategies to further enhance his self-esteem and resilience and promote effective communication and problem-solving skills. By doing so, Logan will be better equipped to navigate any challenges that may emerge as he develops and maintains positive relationships with his peers.    After the session, you receive a phone call that your wife has passed away. In the midst of the sudden loss of your beloved wife, you find yourself struggling to maintain your usual level of composure, which is understandable, feeling overwhelmed and emotionally drained during this difficult time. Being a therapist, you recognize the weight of your emotional burden and decide to reach out to your supervisor to discuss your struggles. After a heartfelt conversation, you feel a sense of relief and connection with your supervisor, who has provided you with support and understanding.    As the conversation draws to a close, you make an unexpected request of your supervisor: that she attend your wife's memorial and wake so that she can meet your family and share in the memories of your loved ones. This request may seem a lot to ask, but you feel comforted by the thought of having someone close to you share in this challenging time. You also ask if she can take over your caseload as you deal with your wife's passing.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What are some preventative skills to consider in helping this client prepare to continue without the support of weekly counseling sessions with you?,Indicate to the client that he can return to therapy if necessary.,Reinforce the importance of family support.,Explore external supports for the client.,Establish and coordinate an effective aftercare plan.,"(A): Indicate to the client that he can return to therapy if necessary.
(B): Reinforce the importance of family support.
(C): Explore external supports for the client.
(D): Establish and coordinate an effective aftercare plan.",Establish and coordinate an effective aftercare plan.,D,"Participation in Tier 1 preventive interventions include involvement with social-emotional lessons that are used in the classroom, behavioral expectations taught by teachers, counselors coming into the classroom to model strategies for responding to or reporting bullying, and holding classroom meetings among students and teachers to discuss emotionally relevant issues related to bullying or equity. Universal interventions could also include guidelines for the use of digital media, such as youth’s use of social network sites with group support. Therefore, the correct answer is (D)",treatment planning
962,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","   mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic","What area is most important for you to further assess to confirm a diagnosis of major depressive disorder, recurrent, mild?",The timeline of the depressive symptoms,The presence or absence of social supports,The association of symptoms to drug and alcohol use,"Functioning at work, home, and socially","(A): The timeline of the depressive symptoms
(B): The presence or absence of social supports
(C): The association of symptoms to drug and alcohol use
(D): Functioning at work, home, and socially","Functioning at work, home, and socially",D,"All of these elements are important foci for treatment planning purposes. The timeline was already identified in the first session (2 years); therefore, it does not need to be assessed further to confirm this diagnosis. The client already relayed that he does not use drugs or alcohol; therefore, this has also already been addressed. The DSM-5-TR requires at least five depressive symptoms in order to meet the criteria for diagnosis of major depressive disorder, in addition to four additional criteria: the impact of symptoms on functioning in critical areas of the individual’s life, the episodes are not attributed to substance use or other disorders, the episodes are not attributed to psychotic disorders, and the episodes are not also accompanied by alternating manic episodes. Enough symptoms were identified for the diagnosis; however, it is important for you to further assess the impact of these depressive symptoms on functioning across multiple areas of the client’s life in order to confirm this diagnosis. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
963, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”","Considering the information provided, which of the following tasks will you use most often use with this client?",Roll with resistance,Develop discrepancy,Express empathy,Support self-efficacy,"(A): Roll with resistance
(B): Develop discrepancy
(C): Express empathy
(D): Support self-efficacy",Roll with resistance,A,"The counselor will need to develop strong skills in rolling with resistance when using motivational interviewing. The client has stated his resistance to letting others know of his alcohol use, refusal to attend alcohol support groups where he would need to participate, and has twice been prescribed medication for his depressive symptoms and refused to try them. Expressing empathy, developing discrepancy, and supporting self-efficacy are all elements of motivational interviewing that the counselor will need to use during treatment, however, because the resistance of the client is high, it is likely that working with (rolling with) the resistance will continue to be the main focus. Therefore, the correct answer is (C)",counseling skills and interventions
964,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group, and they appear to be starting to become more comfortable with one another. You noticed that throughout the past week, when you saw your clients on their unit, they were spending more time together and that they are all talking when they come in for the session. During the session, you and the clients discuss past experiences that led to them engaging in the crimes that led to their incarceration. During this conversation, client 1 is talking about his father and how he killed a pedestrian while driving. Client 4 then asserts that client 1’s father is going to hell for killing someone. You cut off client 4 and redirect the attention back to client 1.  You want to relate what client 1 is talking about with what client 3 has said earlier in the session",You want to relate what client 1 is talking about with what client 3 has said earlier in the session. Which of the following terms identifies this intervention?,Identifying allies,Reflection,Coleading,Linking,"(A): Identifying allies
(B): Reflection
(C): Coleading
(D): Linking",Linking,D,"This is an example of linking, which is the act of connecting individuals’ experiences for the sake of bonding. Coleading involves two counselors leading a group to use their shared experiences for the benefit of the group. Identifying allies is helpful because it involves identifying group members who are helpful to the group process, but this does not equate to the use of linking. Reflection is restating the content of a message, and, although it is helpful, it is not the intervention you are using when linking a client’s experience with another client’s experience. Therefore, the correct answer is (A)",counseling skills and interventions
965,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","You arrive at the client’s house for the session, and he decides to meet with you in the family office and brings some toys with him. He sits on the floor, and you decide to sit on the floor with him and engage in play to continue building rapport. While playing, you begin to ask the client about what frustrates him about his parents, and, through processing, you identify that he desires some independence. You meet with the parents after the session and encourage them to give him some choices throughout his day so that he can have a sense of control. You state that they can be choices that may not be consequential, such as the order of the bedtime routine, so that the routine still happens but he has some control over the order of the process.  The client expresses frustration that his parents make him do homework when he gets home from school",The client expresses frustration that his parents make him do homework when he gets home from school. Which of the following would be a supportive and empathetic response to the client?,"“When you listen to your parents, things seem to work out better for you.”","“What if you asked your parents for a break before you start your homework, in order to take a break from schoolwork?”",“I can see how it might be frustrating to have to start homework right after school.”,“Maybe it would be good to get the homework over with so you can play.”,"(A): “When you listen to your parents, things seem to work out better for you.”
(B): “What if you asked your parents for a break before you start your homework, in order to take a break from schoolwork?”
(C): “I can see how it might be frustrating to have to start homework right after school.”
(D): “Maybe it would be good to get the homework over with so you can play.”","“What if you asked your parents for a break before you start your homework, in order to take a break from schoolwork?”",B,"It would be supportive to encourage the client to request what he needs, which is a break from schoolwork before starting his homework. It is also empathetic because it identifies and appreciates his unspoken desire for a break and makes the client feel understood and that his desires are valid. The statement identifying that it is frustrating to start schoolwork displays some empathy but does not provide an option for next steps to take and therefore is not the best response in this scenario. Telling the client to get his homework over with or encouraging him to listen to his parents does not provide empathy (because it reinforces the parents’ request over his desire), nor does it assist the client with identifying actions that he can take to improve his situation. Therefore, the correct answer is (D)",counseling skills and interventions
966,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",How would you approach the client's expressed fears concerning drinking?,"""You're right to consider how big changes like that will affect you and your life. Let's explore why you might be having these feelings in the first place.""","""Do you think you won't have friends because drinking is the only thing you have in common?""","""I understand where you're coming from, and I can empathize, but you can't control what other people think or do.""","""Don't worry about your friends right now. What's important is getting you to where you need to be.""","(A): ""You're right to consider how big changes like that will affect you and your life. Let's explore why you might be having these feelings in the first place.""
(B): ""Do you think you won't have friends because drinking is the only thing you have in common?""
(C): ""I understand where you're coming from, and I can empathize, but you can't control what other people think or do.""
(D): ""Don't worry about your friends right now. What's important is getting you to where you need to be.""","""You're right to consider how big changes like that will affect you and your life. Let's explore why you might be having these feelings in the first place.""",A,"This directly validates the client's emotions and encourages him to examine the underlying reasons associated with his fear. Therefore, the correct answer is (D)",counseling skills and interventions
967,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",Which strategy would you consider most effective in assisting the client in developing a healthy support system?,Give the client a homework assignment to join a study group before your next scheduled therapy session,Ask the client to identify important people in her past or present and describe the quality of her relationship with each person,Provide the client with the contact information for a nearby church that emphasizes college-age groups.,Suggest that the client join an exercise group at the university gym,"(A): Give the client a homework assignment to join a study group before your next scheduled therapy session
(B): Ask the client to identify important people in her past or present and describe the quality of her relationship with each person
(C): Provide the client with the contact information for a nearby church that emphasizes college-age groups.
(D): Suggest that the client join an exercise group at the university gym",Ask the client to identify important people in her past or present and describe the quality of her relationship with each person,B,"By identifying important people in the client’s past or present and describing the quality of those relationships, the client will recognize existing sources of support, expand this social support, and make effective use of the network. Therefore, the correct answer is (B)",counseling skills and interventions
968,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,An attribute the counselor is displaying is?,Attentiveness,Observation,Empathy,Genuineness,"(A): Attentiveness
(B): Observation
(C): Empathy
(D): Genuineness",Empathy,C,"Empathy is a counselor attribute in which the counselor puts themselves in the client's shoes to try to understand the issues within the client's world view and cultural values. Attentiveness is being able to focus on the client and what they are saying in the present moment. Genuineness refers to the ability of the counselor to be their authentic self in session and not put on a façade. Observation is the ability for the counselor to pick up on nuances in the counseling session such as non-verbal communication. Therefore, the correct answer is (C)",counseling skills and interventions
969,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",The client is upset about his father's unrealistic expectations and says the pressure to live up to his father's standards is almost impossible to manage. How would you accurately reflect the client's feelings?,"""It's natural for your father to want the best for you, but it sounds like he has taken his concerns about your performance to the extreme.""","""Your feelings of frustration make sense to me, especially given what you have told me about your father.""","""It's completely understandable that you're feeling overwhelmed by your father's high expectations.""","""You're feeling overwhelmed by the pressure you're under trying to meet your father's expectations.""","(A): ""It's natural for your father to want the best for you, but it sounds like he has taken his concerns about your performance to the extreme.""
(B): ""Your feelings of frustration make sense to me, especially given what you have told me about your father.""
(C): ""It's completely understandable that you're feeling overwhelmed by your father's high expectations.""
(D): ""You're feeling overwhelmed by the pressure you're under trying to meet your father's expectations.""","""You're feeling overwhelmed by the pressure you're under trying to meet your father's expectations.""",D,"This response accurately reflects the client's feelings by acknowledging the pressure and frustration he is feeling because of a family member's expectations. Therefore, the correct answer is (B)",counseling skills and interventions
970,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","   age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement",Which one of the following is a technique of person-centered theory?,Showing unconditional positive regard,Using free association,Challenging irrational beliefs,Acting as if there is not a problem,"(A): Showing unconditional positive regard
(B): Using free association
(C): Challenging irrational beliefs
(D): Acting as if there is not a problem",Showing unconditional positive regard,A,"The technique associated with a person-centered therapy is showing unconditional positive regard. Counselors show this through warmth, care, and nonjudgmental acceptance. Acting as if there is not a problem is an Adlerian technique. Adlerians encourage clients to adopt an action-oriented mindset and use various techniques to help clients increase their level of functioning. REBT practitioners focus on challenging a client’s irrational beliefs and replacing these beliefs with more realistic and logical ones. Free association is a Freudian concept used to tap into one’s unconscious and gain insight. The process of free association involves the client verbalizing all of their thoughts without censorship. Therefore, the correct answer is (B)",counseling skills and interventions
971,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","Near the end of the session, the client tells you, “Lately I’ve been missing my brother. We used to talk all the time, but he is overseas in the Middle East undercover in special ops. Unlike my mom, my brother is an excellent listener, and he understands me.” You reply, “So what I hear you saying is that you feel listened to and understood by your brother and that your relationship with your mom is different. Is that correct?” What are you attempting to accomplish with this type of response?",Paraphrase the client’s statements,Reflect the client’s feelings,Explore the client’s thoughts,Summarize the client's statements,"(A): Paraphrase the client’s statements
(B): Reflect the client’s feelings
(C): Explore the client’s thoughts
(D): Summarize the client's statements",Paraphrase the client’s statements,A,"Paraphrasing involves the therapist using his/her own words to repeat his/her understanding of what the client has said. This allows the client to feel heard and understood by the therapist. Therefore, the correct answer is (B)",counseling skills and interventions
972,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","   n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family","Of the following, which DSM-5-TR criteria for MDD can present as delusional?",Subjective reports of depression,Estimation of impending danger,Excessive or inappropriate guilt,Recurrent thoughts of death,"(A): Subjective reports of depression
(B): Estimation of impending danger
(C): Excessive or inappropriate guilt
(D): Recurrent thoughts of death",Excessive or inappropriate guilt,C,"A DSM-5-TR criterion for MDD includes feelings of worthlessness or excessive or inappropriate guilt nearly every day that may be considered delusional. Recurrent thoughts of death and depressed mood also characterize MDD but are not associated with delusional thinking. An overestimation of impending danger occurs in the presence of agoraphobia, specific phobias, and other related conditions. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
973,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client arrives twenty minutes late for his appointment today. He explains that Mondays are the days he does laundry, and he cannot come again on a Monday. You review the required components of informed consent with the client. He expresses an understanding of the counseling process and provides written consent. The client states he has re-considered counseling because he believes you can help him find another girlfriend who will have sex with him. You tell him about a small group you run with other neurodiverse men, most of whom are on the autism spectrum. He expresses an interest in joining after hearing that sexual intimacy would be part of the curriculum. He provides a more solid commitment when you tell him the group is not held on Mondays",What are the advantages of group therapy for individuals with autism spectrum disorder?,Group cohesion can help promote deeper expressions of emotional intimacy.,Emotional bonds can be created when group members share similar goals and interests.,Social skills training can be used to improve social-emotional reciprocity.,Groups members can establish group-specific social norms that are shaped and reinforced in real-time.,"(A): Group cohesion can help promote deeper expressions of emotional intimacy.
(B): Emotional bonds can be created when group members share similar goals and interests.
(C): Social skills training can be used to improve social-emotional reciprocity.
(D): Groups members can establish group-specific social norms that are shaped and reinforced in real-time.",Social skills training can be used to improve social-emotional reciprocity.,C,"Social skills training can be used to help improve social-emotional reciprocity. This question tests your knowledge of ASD and group dynamics. Applied Behavioral Analysis (ABA) is the gold standard for the treatment of ASD. ABA uses behavioral reinforcement to shape behaviors and enhance social skills. Answers A, B, and C describe a product-oriented group, or a behavioral group with pre-established goals and specific target behaviors. Answer D represents process-oriented groups. Process-oriented groups focus on the impact of the group process itself. Group cohesion, one of Yalom’s curative factors, occurs when members create emotional bonds with shared interests and goals. Group cohesion is a process-oriented aspect of group therapy. Social norms can be established in real-time; however, this is best done when group leaders collaborate with group members to shape and reinforce appropriate social norms. Additionally, psychoeducation is a product-oriented group and a standard component for teaching social skills. Social norms primarily occur in process-oriented groups, making answer D incorrect. Therefore, the correct answer is (A)",counseling skills and interventions
974,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated.  The client’s probation officer requests session progress notes from the time with your client due to it being court-ordered therapy",The client’s probation officer requests session progress notes from the time with your client due to it being court-ordered therapy. Which one of the following statements is true regarding court-ordered therapy?,You must request a release of information form from your client prior to releasing documentation.,You must provide the requested documentation because this is court-ordered therapy and you are working under the discretion of the court in this situation.,The client does not retain any rights in court-ordered counseling.,"Although the client does not retain rights, you try to receive informed consent anyway in order to retain the therapeutic relationship with the client.","(A): You must request a release of information form from your client prior to releasing documentation.
(B): You must provide the requested documentation because this is court-ordered therapy and you are working under the discretion of the court in this situation.
(C): The client does not retain any rights in court-ordered counseling.
(D): Although the client does not retain rights, you try to receive informed consent anyway in order to retain the therapeutic relationship with the client.",You must request a release of information form from your client prior to releasing documentation.,A,"The client does retain rights in court-ordered therapy, and you must get a release of information to provide the probation officer with the requested notes if a subpoena is not provided. Even when a client, including a minor, does not retain rights, it is important to get the client’s consent to services in order to preserve trust in the counseling relationship. Therefore, the correct answer is (C)",professional practice and ethics
975,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.",,Which diagnosis would be most plausible if you eliminated the cultural component for this client?,Acute Stress Disorder,Adjustment Disorder,Narcissistic Personality Disorder,Malingering,"(A): Acute Stress Disorder
(B): Adjustment Disorder
(C): Narcissistic Personality Disorder
(D): Malingering",Adjustment Disorder,B,"The client is experiencing distress related to an identifiable stressor (moving to the United States). If you did not have the cultural component, this would be the most likely diagnosis. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
976,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues.  Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand.    When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have ""one drink."" He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed.  Seventh session The client's attendance in weekly therapy sessions has been inconsistent. Today, he presents to his scheduled session, and he hands you a discharge summary from another recent hospitalization. The client states that he was on one of his ""highs,"" went to a bar, and ended up fighting with one of the other customers. He says he has no recollection of how the fight started, but the person he was fighting with told him that ""his life was useless and that he would be better off dead."" The client states that having a few drinks and driving around in his car while listening to music helps him calm down. You validate the client's attempts to identify coping skills.    The client's depression is further evidenced by his lack of motivation and interest in activities he once found enjoyable. He reports feeling overwhelming hopelessness and expresses a pervasive feeling of worthlessness. His low self-esteem is apparent in his statements and is further evidenced by his inability to recall accurately the events leading up to the altercation.    The client's risk for self-harm is elevated, given his recent suicidal ideation. He reports feeling his life has no value and that he would be better off dead. His current safety plan is inadequate to address his risk for self-harm and is further exacerbated by his use of alcohol as a coping mechanism. The client has little insight into his current mental state and cannot accurately identify the signs of his deteriorating mental health. He lacks insight into his coping skills and their potential consequences and is unable to recognize the need for more comprehensive safety planning"," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",What assessment would you initiate considering the information which the client has disclosed during this session?,California Psychological Inventory,Assessment for at-risk behavior,Alcohol Use Disorders Identification Test (AUDIT),Michigan Alcoholism Screening Test (MAST),"(A): California Psychological Inventory
(B): Assessment for at-risk behavior
(C): Alcohol Use Disorders Identification Test (AUDIT)
(D): Michigan Alcoholism Screening Test (MAST)",Assessment for at-risk behavior,B,"The client has recently been discharged from the hospital, is talking about wanting to drink and drive, and appears depressed. It is important to perform a risk assessment at this time. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
977,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","The client has presented with a matrix of issues that all relate to the presenting problem. In this session, she has mentioned several factors that she connects to her present affect. When formulating a treatment plan for the client, what information is most important to consider?",The client's needs and goals for therapy,The client's family background,The client's relationship history,The client's current alcohol consumption habits,"(A): The client's needs and goals for therapy
(B): The client's family background
(C): The client's relationship history
(D): The client's current alcohol consumption habits",The client's needs and goals for therapy,A,"it is important to understand what the client is hoping to gain from therapy in order to develop an effective treatment plan. This can include understanding the underlying causes of her drinking, developing healthy coping skills, or exploring other issues that may be causing stress and leading her to excessive alcohol use. Therefore, the correct answer is (B)",treatment planning
978, Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.","Based on the information provided, which action is most appropriate for you to take with this client?","Report your client, anonymously, as an impaired professional to his licensing board",Assess your client's level of insight into potential impairment and substance abuse,Tell your client that you must report him to the licensing board as an impaired professional,Do not discuss impairment as he does not use substances while working with clients,"(A): Report your client, anonymously, as an impaired professional to his licensing board
(B): Assess your client's level of insight into potential impairment and substance abuse
(C): Tell your client that you must report him to the licensing board as an impaired professional
(D): Do not discuss impairment as he does not use substances while working with clients",Assess your client's level of insight into potential impairment and substance abuse,B,"Impairment in professionals includes actual and potential for harm to clients; your client's insight and ability to assess his potential for impairment is a determining factor in your actions. He has already demonstrated little insight into his personal and professional problems. If he does not recognize the potential for impairment with his increased substance abuse, you may wish to report him to his licensing board - either telling him in advance or reporting anonymously. It is likely that your client will suspect you as the reporting source, which is likely rupture the therapeutic relationship. Sometimes it is helpful to talk with a client before reporting them as an impaired provider so that the report can be made collaboratively and the therapeutic relationship can be maintained. This allows the counselor and client to continue working on these issues, however, it is dependent on the client recognizing and having insight into their issue as a real or potential impairment. It is always appropriate to discuss impairment with other health professionals to determine if one's behaviors, thoughts, or emotions are actually or potentially impairing their work with clients. Therefore, the correct answer is (C)",counseling skills and interventions
979,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,Elaina is showing symptoms indicating a diagnosis of?,Unspecified Bipolar and Related Disorder,Cyclothymic Disorder,Bipolar I,Bipolar II,"(A): Unspecified Bipolar and Related Disorder
(B): Cyclothymic Disorder
(C): Bipolar I
(D): Bipolar II",Bipolar I,C,"Elaina is showing symptoms consistent with Bipolar I Disorder as evidenced by at least one lifetime Manic episode. Although Elaina also shows symptoms of Major Depressive Disorder, this is not required for a diagnosis of bipolar disorder. Bipolar II is characterized by hypomania episodes (lasting only a few days) as opposed to mania episodes which last over a week. From what Elaina has shared, her episodes lasted more than a few days. Since Elaina has met the criteria for a depressive and manic episode, both Cyclothymic and Unspecified bipolar and Related Disorder are ruled out. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
980,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.  Ninth session Alexei appeared anxious during his weekly session today. He tells you that he constantly thinks about how good his life was in Germany and is afraid he will never feel comfortable in America. On a positive note, Alexei shares that he and his wife talked about their relationship and want to take steps to repair their marriage. He now admits to you that his drinking is a problem, but he struggles with the physical aspects of trying to quit. Whenever he tries to stop drinking, he gets sweaty and fears that he will have a seizure, so he begins drinking again. He explains that he cannot get past these symptoms. You discuss with Alexei the option of entering a rehabilitation center to assist him medically with the detox process. Alexei admits that he is unsure about the idea of going into treatment. He acknowledges that it might be beneficial but worries about leaving his family for a prolonged period. He expresses concern that his wife will not be able to handle everything on her own and wonders what will happen with their marriage while he is in treatment. You explore his concerns using motivational interviewing techniques and ask him to discuss this information with his wife.    During the session, you commend Alexei for recognizing the impact of his drinking on his life and his willingness to discuss these concerns openly. You acknowledge the challenges he faces in trying to quit and the physical symptoms he experiences. You explain that seeking professional help at a rehabilitation center could provide the medical support he needs to manage withdrawal symptoms safely and effectively. You emphasize that by addressing his alcohol dependence, he will likely find it easier to adapt to his new life in America and repair his marriage.    Regarding his concerns about his wife managing things while he is in treatment, you explore potential solutions and support systems that could be implemented during his absence. You encourage Alexei to discuss these concerns with his wife and involve her in decision-making. Together, they can identify family members, friends, or community resources that could offer assistance. Finally, you reassure Alexei that taking the time for treatment is an investment in his long-term well-being and that of his family. By addressing his alcohol dependence, he will be better equipped to support his wife and family emotionally and practically in the long run.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",What data is least important to assess when determining the level of care that would most benefit the client?,The client's financial status,The client's perception of rehabilitation in his home country,Alexei's educational background or career history,The client's willingness to engage in treatment,"(A): The client's financial status
(B): The client's perception of rehabilitation in his home country
(C): Alexei's educational background or career history
(D): The client's willingness to engage in treatment",The client's financial status,A,"Financial information is the least important data to assess when determining the level of care that would most benefit the client. Although a client's financial status may have some bearing on their choice and ability to access certain levels of care, financial considerations should only come into play once the most appropriate level of care has been determined. All clients should be treated equally regardless of their financial situation. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
981, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.",Which of the following strategies is derived from a strengths-based approach?,"""Tell me about the last time you successfully got through a similar situation.""","""Explain what makes you think you will not get through this.""","""List the qualities you believe you will need to get through this.""","""Share with me how can I help you can get through this.""","(A): ""Tell me about the last time you successfully got through a similar situation.""
(B): ""Explain what makes you think you will not get through this.""
(C): ""List the qualities you believe you will need to get through this.""
(D): ""Share with me how can I help you can get through this.""","""Tell me about the last time you successfully got through a similar situation.""",A,"Strength-based interview questions or exhortations should be aimed at helping Leah consider what she has done that has worked in her past, based on her existing strengths, to give her the confidence that she can be successful again. Answer a) asks Leah to review a time she has come out of a similar difficult situation, review the things she did that helped, and consider herself to be someone who can conquer challenges. Asking her to list qualities she thinks will help her get through this is a good first step, but you would need to follow through with helping her reflect on the fact she already has those qualities. This could backfire in Leah not being able or willing to identify if she has what she believes it takes to get through her current problem. Explaining why she does not think she will resolve her issues can be part of a cognitive behavioral based approach at discovering her cognitive distortions and helping her reframe them and asking her how you can help is causing her to be dependent on you for her needs. Therefore, the correct answer is (A)",counseling skills and interventions
982,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,Which of the following is an appropriate response for the counselor?,Why would you get into a fight like that?,Tell me what happened and we can see how to get through this.,Do you want to talk about what happened?,"Well, this isn't like you at all!","(A): Why would you get into a fight like that?
(B): Tell me what happened and we can see how to get through this.
(C): Do you want to talk about what happened?
(D): Well, this isn't like you at all!",Tell me what happened and we can see how to get through this.,B,"This choice is the best response as it is an open-ended question with a statement that indicates hope. Choices a and b may cause feelings of defensiveness or guilt. Choice d is a closed question as the only response is ""yes"" or ""no"". Michael is already upset and can simply say no, that he does not want to talk about what happened. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
983,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client receives psychoeducation on various treatment interventions for agoraphobia. She understands the risks and benefits, and you review informed consent each session. The client would like to work on her fear of stairs first, which is less anxiety-provoking than elevators. She expresses an understanding of exposure exercises and is willing to give them a try. You and the client use a Subjective Units of Distress Scale (SUDs) to measure the intensity of each anxiety-provoking situation, which can range from 0 units (no distress) to 100 units (extreme distress).  You select interoceptive exposure exercises to address the client’s anxiety and panic",You select interoceptive exposure exercises to address the client’s anxiety and panic. How would you tailor this approach to match the client’s needs?,Use in vivo exposure by first standing in front of a high-rise building.,Imagine a staircase and vividly recount fear-evoking scenes.,Use virtual reality technology to recreate a computer-generated staircase.,Induce dizziness by spinning around in a swivel chair.,"(A): Use in vivo exposure by first standing in front of a high-rise building.
(B): Imagine a staircase and vividly recount fear-evoking scenes.
(C): Use virtual reality technology to recreate a computer-generated staircase.
(D): Induce dizziness by spinning around in a swivel chair.",Induce dizziness by spinning around in a swivel chair.,D,"An interoceptive exposure exercise that matches the client’s needs would be to have the client spin around in a swivel chair to induce dizziness. Interoceptive exposure exercises help recreate internal sensations associated with panic attacks. One of the client’s internal triggers is dizziness. Individuals with agoraphobia respond to somatic stimuli (eg, dizziness) by avoiding situations or engaging in safety behaviors. Individuals must stay with internal sensations during the exposure until they dissipate or reach a lower, predetermined SUD rating. Exposure exercises can be interoceptive, in vivo, imaginal, or experienced through virtual reality. Therefore, the correct answer is (B)",counseling skills and interventions
984,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day.  You are conducting research for your part-time job at a university",You are conducting research for your part-time job at a university. All of the following are areas that your private practice client needs to know or consider as a participant EXCEPT:,The payment he will receive for research,That withdrawal from research can happen at any time,"Any discomfort, power differentials, or risks that are involved in the research",The limitations of confidentiality,"(A): The payment he will receive for research
(B): That withdrawal from research can happen at any time
(C): Any discomfort, power differentials, or risks that are involved in the research
(D): The limitations of confidentiality",The payment he will receive for research,A,"The ACA Code of Ethics does not cover any payments for research because the clinician will still be providing therapy and the client will be paying for therapy (2014, p 16). The client will be informed about how he can withdraw from the research at any time; of any discomfort, power differentials, or risks involved in the research; and also the limits of confidentiality in the research process (ACA Governing Council, p 16). Therefore, the correct answer is (D)",professional practice and ethics
985,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ",What short-term goal would be important to work on first?,Identify effective coping skills,Decrease symptoms of depression,Eliminate anxiety when the client is home alone,Increase the frequency or duration of separations from major attachment figures,"(A): Identify effective coping skills
(B): Decrease symptoms of depression
(C): Eliminate anxiety when the client is home alone
(D): Increase the frequency or duration of separations from major attachment figures",Identify effective coping skills,A,"The client would benefit from learning some coping skills he can use when experiencing feelings of anxiety. These coping skills can be identified in the short term. Therefore, the correct answer is (B)",treatment planning
986,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.","From a solution-focused therapy viewpoint, what technique would best enable you to identify the client's wants for the future and develop therapeutic goals to get there?",Ask the client to rate his depression on a scale of 1-10,Ask the client to tell you about a time when he did not feel depressed,Ask the client to share what he has done in the past to manage difficult emotions,"Ask the client the ""Miracle Question""","(A): Ask the client to rate his depression on a scale of 1-10
(B): Ask the client to tell you about a time when he did not feel depressed
(C): Ask the client to share what he has done in the past to manage difficult emotions
(D): Ask the client the ""Miracle Question""","Ask the client the ""Miracle Question""",D,"The “Miracle Question” is a technique used in solution-focused therapy to help identify the client's wishes for the future, and explore how to work towards those goals in therapy. It involves asking the client what would be different if their problem were solved overnight. Therefore, the correct answer is (D)",counseling skills and interventions
987,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing.  Some of the client’s sessions are being provided via telehealth","Some of the client’s sessions are being provided via telehealth. All of the following are unique considerations for telehealth sessions that are different than in-person sessions, EXCEPT:",Body language,"Orientation to person, place, time, and situation",Confidentiality,Cost,"(A): Body language
(B): Orientation to person, place, time, and situation
(C): Confidentiality
(D): Cost","Orientation to person, place, time, and situation",B,"Orientation to person, place, time, and situation can be observed and assessed regardless of the session being provided via telehealth. Body language is a unique consideration in telehealth, and you might have more difficulty assessing the client’s body language, such as hand gestures, bouncing legs, shaking hands, etc. The counselor’s body language and the counseling room environment are not as important or impactful, aside from what the client sees behind you on his or her computer screen. Costs for telehealth sessions can be cheaper at times than in-person sessions. An additional cost for the counselor might be a HIPAA-compliant telehealth medium. Confidentiality remains the same in that sessions should remain confidential; however, you cannot guarantee that no one is listening in or is in the room in the client’s location. Therefore, the correct answer is (C)",professional practice and ethics
988,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.",,Which of these issues would you address first?,Impulse control and emotional self-regulation,Difficulty with communication and boundaries,Lack of interpersonal skills,Unwillingness to deal with problematic behavior in the past,"(A): Impulse control and emotional self-regulation
(B): Difficulty with communication and boundaries
(C): Lack of interpersonal skills
(D): Unwillingness to deal with problematic behavior in the past",Impulse control and emotional self-regulation,A,"This is the most critical issue, as the client's inability to manage his behavior and his emotions are affecting him in a negative way. His lack of impulse control and lack emotional self-regulation put him at risk for being in harmful and dangerous situations. Therefore, the correct answer is (B)",counseling skills and interventions
989,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","You meet with the client, and she reports that she started dating someone. You and the client spend some time talking about the man who she is dating and agree that he sounds like a nice person that is not taking advantage of her personality. You and the client discuss her having an increased awareness of the behaviors that she has engaged in in the past that she did not like. The client identifies that she has engaged in behavior that worries her with this boyfriend. She went out for lunch and felt compelled to buy him lunch also, even though he was not there. After exploring why the client feels an obligation to buy her boyfriend lunch when he is not present with her, it becomes clear that it is motivated by the fear that he will be offended that she bought herself lunch without thinking of him. You support the client in identifying more helpful thoughts related to this and ask her to complete a behavioral experiment regarding this situation. The client becomes frustrated that she is still struggling with relationships and says, “I think I’ll just date who I want and how I want from here on out. It’s definitely the easiest choice instead of doing all of this.” You remind the client that therapy takes some time but can be really beneficial and you praise her for engaging fully so far","Using the ABC model, the client’s belief that her behavior will be offensive leads to all of the following consequences, EXCEPT:",Her own perceived reduction in anxiety when she buys her boyfriend lunch.,Buying lunch more often for her boyfriend even if he is not around.,Her boyfriend will be happy in the relationship,Anxiety if she is unable to buy her boyfriend lunch.,"(A): Her own perceived reduction in anxiety when she buys her boyfriend lunch.
(B): Buying lunch more often for her boyfriend even if he is not around.
(C): Her boyfriend will be happy in the relationship
(D): Anxiety if she is unable to buy her boyfriend lunch.",Her boyfriend will be happy in the relationship,C,"The ABC model is used often in CBT and demonstrates the different areas of distress in thought processesAstands for antecedent or an event that occurred,Bstands for the client’s beliefs about the situation, andCstands for the consequences of the beliefs. The client’s beliefs about the antecedent (buying lunch for herself in the past and being punished for not thinking to do so for her boyfriend) stem from past relationships and lead to her generally being more anxious, feeling as if she has to continue this pattern, and a reduction in anxiety in the moment by doing so but increased anxiety over time. Although her new boyfriend might be happier in the relationship because of these tokens of thoughtfulness, his happiness is not a consequence of her internal belief, which is the focus of the ABC model. Therefore, the correct answer is (A)",counseling skills and interventions
990,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.",Which of the following interventions will not be as effective given the client's diagnosis?,Have the client journal about his emotions between sessions,Explore the client's somatic connections to different emotions,Educate the client on the connection between anxiety and ambivalence,Help client identify different emotions and how he experiences them,"(A): Have the client journal about his emotions between sessions
(B): Explore the client's somatic connections to different emotions
(C): Educate the client on the connection between anxiety and ambivalence
(D): Help client identify different emotions and how he experiences them",Have the client journal about his emotions between sessions,A,"Ambivalence results from holding two opposing feelings about a person, thing, or a situation. This causes the individual to have difficulty making decisions and knowing which feeling to follow. The anxiety of ambivalence makes it easier for the individual to disregard engaging with emotions in order to lessen the anxiety. Because of his ambivalence, the client is least likely to follow through with journaling about his emotions outside of sessions and this would cause him to encounter the duality of emotions that are stressful for him. A better process would be to educate the client on ambivalence and how it can be normal and healthy, but when it becomes chronic, it can become debilitating. Helping the client name and identify different emotions and how he might know when he experiences them would then be helpful for the client who avoids emotions. Concentrating on where in his body he feels specific emotions will provide him with a way to distinguish which emotion he is feeling in the moment. Therefore, the correct answer is (D)",treatment planning
991, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.","Using the information provided, which action is most appropriate in working with this client?","Obtaining release of information to talk with client's school, physician, and family members.",Referring the client for testing and possible accommodations due to her academic difficulties.,Assessing the client for early childhood or current traumatic events.,Helping the client's mother set appropriate guidelines and rules for this client.,"(A): Obtaining release of information to talk with client's school, physician, and family members.
(B): Referring the client for testing and possible accommodations due to her academic difficulties.
(C): Assessing the client for early childhood or current traumatic events.
(D): Helping the client's mother set appropriate guidelines and rules for this client.","Obtaining release of information to talk with client's school, physician, and family members.",A,"Each of the responses are appropriate, however the most important will be to obtain a release of information to talk with others involved in working with this client. The intake information is being provided from the mother and the client appears limited in her responses. The counselor will gain a more holistic view of the client through speaking with the client's teachers to best understand the client in her academic setting, understanding any physical or psychological concerns that may have been previously identified by her physician, and speaking with grandmother as she is the client's caregiver for part of each week. Based on discussions with the client's school and physician, testing may be required. It will also be appropriate to assess for trauma and mother may need assistance with setting appropriate guidelines for this client, however these will need to occur after more data is gathered from additional sources. Therefore, the correct answer is (C)",professional practice and ethics
992,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What is an effective conflict resolution skill the couple can use to improve their communication and relationship?,Making a list of positive attributes that each partner exhibits,Taking a time out,Taking turns speaking and listening,Having each partner assume role reversal for a given time,"(A): Making a list of positive attributes that each partner exhibits
(B): Taking a time out
(C): Taking turns speaking and listening
(D): Having each partner assume role reversal for a given time",Taking turns speaking and listening,C,"Taking turns speaking and listening is an effective conflict resolution skill that the couple can use to improve their communication and relationship. This involves each partner taking turns to express their feelings and needs in an honest, respectful, and non-judgmental way. Therefore, the correct answer is (B)",counseling skills and interventions
993,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,Ineffective treatments of generalized anxiety disorder include?,Journaling,Psychoeducation,Benzodiazepine,Stimulants,"(A): Journaling
(B): Psychoeducation
(C): Benzodiazepine
(D): Stimulants",Stimulants,D,"Stimulants would not be effective in treating someone with generalized anxiety disorder. Benzodiazepine can be used for tension relief and relaxation. Psychoeducation on symptoms and effective treatments can be helpful. Journaling can also be helpful as an outlet for anxious thoughts. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
994,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.","Given the level of information Taylor has shared in her e-mail, what is the appropriate response?",Inform that e-mail is for scheduling purposes only and that it is unethical to see her brother.,Do not respond and discuss virtual safety and protocols in the next session.,Send new client documentation for her brother to sign prior to the next session.,E-mail a detailed itinerary of your next session's goals and activities for both siblings.,"(A): Inform that e-mail is for scheduling purposes only and that it is unethical to see her brother.
(B): Do not respond and discuss virtual safety and protocols in the next session.
(C): Send new client documentation for her brother to sign prior to the next session.
(D): E-mail a detailed itinerary of your next session's goals and activities for both siblings.",Inform that e-mail is for scheduling purposes only and that it is unethical to see her brother.,A,"You must make mention of the inappropriate use of e-mail. E-mail communications regarding symptoms (or in Taylor's case her mention of crying spells and driving emotionally) increase the safety risk of your client and could end up causing a liability issue. Answer a is not best practice as it neglects to set boundaries, which could complicate the next session if she decides to have her brother present. Answer b only further encourages this type of communication for clinical discussion and unless you have worked out an arrangement where assignments will be delivered via e-mail, inclusive of a signed Telemedicine consent form outlining these details, it is not best practice. Answer c neglects to address any of these aforementioned factors and focuses solely on getting legal permission to see Taylor's brother next session. It is furthermore unethical to be her brother's counselor, especially since Taylor's presenting problems for counseling involved her complex feelings about her brother. Therefore, the correct answer is (D)",professional practice and ethics
995,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","It has been 1 month since you last saw the client because he has canceled many sessions in a row without explanation. You process attendance with him and then ask him for updates regarding how symptoms have been over the last month. The client says that there were many reasons for cancellations, such as going to dinner with friends, being too tired, and forgetting about the session and making other plans. The client says that he got a new job and states that he is doing much better managing his ADHD symptoms in the new position. You and the client process what was difficult about his last position and then identify that these tasks are not present in the current position. A majority of this session was spent assessing the level of symptomatology experienced over the past month and the client reporting on events that occurred since the last session","Due to the client’s inconsistency in attending sessions, which one of the following areas might you focus on in order to improve his attendance?",Scheduling conflicts,Organization skills,Goals that are meaningful to the client,Different or additional diagnoses,"(A): Scheduling conflicts
(B): Organization skills
(C): Goals that are meaningful to the client
(D): Different or additional diagnoses",Goals that are meaningful to the client,C,"The client is not prioritizing counseling, as evidenced by his list of activities he is participating in that have interrupted his ability to attend. It would be important to focus on how to make sessions meaningful to the client by identifying goals and interventions that matter to him. You have explored depression as another diagnosis; however, there is a possibility that this is not the priority issue because interventions have not motivated the client to continue to attend his sessions. The client’s organizational skills are an issue secondary to his ADHD diagnosis; however, you would still want to find a way to engage him in therapy by making it meaningful for him. Scheduling conflicts are not likely an issue because the client is finding time to attend a long list of other activities that do not seem to be impacted by scheduling conflicts. Therefore, the correct answer is (A)",treatment planning
996,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","From a behavioral therapy perspective, what type of reinforcement would you use to prevent the client from developing an unhealthy reliance on eating lunch in your office instead of in public?",Variable ratio intermittent reinforcement,Fixed interval reinforcement,Variable interval reinforcement,Fixed-ratio reinforcement,"(A): Variable ratio intermittent reinforcement
(B): Fixed interval reinforcement
(C): Variable interval reinforcement
(D): Fixed-ratio reinforcement",Variable ratio intermittent reinforcement,A,"Variable ratio intermittent reinforcement is the most effective schedule to reinforce a behavior. This kind of schedule results in high, steady rates of responding. Clients are persistent in responding because of the hope that the next response might be one needed to receive reinforcement. Therefore, the correct answer is (C)",counseling skills and interventions
997,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.  Sixth session You have seen the client every week since the initial intake. During today's session, the client tells you she has written a suicide note and left it in her room. Her mother is waiting in the lobby for the session to end. You tell the client you must bring her mother into the session and discuss the suicide note. You explain to the client that her mother's presence is necessary to explore and understand why the suicide note was written. The client expresses frustration and says, “You can’t bring my mom in here! She won’t understand why I wrote the note!” You empathize with her feelings, but also explain that it is important to discuss the reasons for writing the suicide note with her mother present. You reassure the client that you will guide the conversation to explore why she wrote the note and support her in addressing any underlying issues. You explain that understanding these reasons is an essential step toward moving forward and developing healthier coping strategies. The client reluctantly agrees, but insists on speaking with you alone first before bringing her mother into the session. You emphasize that it is important for her to be honest about her emotions and to talk about her experiences in order to identify the root cause of her distress. Throughout the conversation, you provide validation and affirmation in order to create a safe space for her to express her feelings. You remind her that she does not have to face the situation alone, and that you can work together to find a way forward.    Once the client has had an opportunity to share her thoughts and feelings, you ask if she is ready for you to invite her mother in. She agrees, and the mother joins you in session. You explain to the mother that her daughter wrote a suicide note and that the two of you have been discussing the suicide note and why it was written. You emphasize that your goal is to better understand the circumstances leading up to this situation, so that you can work together to find a way forward. You state that your primary focus is on finding solutions, rather than assigning blame or judgment. The mother looks at you in disbelief and says, ""What do you mean, she wrote a note saying she was going to kill herself? What are we doing here? I'm paying you to help my daughter, not make things worse!"" She grabs her daughter's hand and storms out, after expressing her anger loudly the whole way to her car.    You are unsure of how to proceed, so you discuss the case with your supervisor. Your supervisor listens and notes your concerns, offering advice and guidance on better handling the situation. He then suggests that you reach out to the client's primary care physician to discuss the possibility of hospitalization and other forms of support that might be available to the client. After further discussion, you call the client's physician and discuss the options.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",What is your primary motivation when seeking supervision with this case?,To understand the psychology of suicide in depth,To address the complexity of the issues and ensure that all possible resources are being utilized.,To elicit validation and affirmation regarding your clinical decision making skills,To obtain legal protection in the event of a malpractice lawsuit,"(A): To understand the psychology of suicide in depth
(B): To address the complexity of the issues and ensure that all possible resources are being utilized.
(C): To elicit validation and affirmation regarding your clinical decision making skills
(D): To obtain legal protection in the event of a malpractice lawsuit",To address the complexity of the issues and ensure that all possible resources are being utilized.,B,"Supervision can be a useful tool for exploring challenges, developing strategies, and finding ways to move forward with solutions. The primary benefit of seeking supervision with this case as a counselor is to gain insight into the client's situation from an objective, experienced perspective. Supervision provides an opportunity for reflection and guidance on how to approach the client and their family in a manner that is most helpful and beneficial. The supervisor can provide valuable advice on how to effectively manage the situation and assist with crisis management if necessary. Therefore, the correct answer is (D)",professional practice and ethics
998,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","The client’s formal assessment, along with informal observations, warrants a psychiatric evaluation to assess for ADHD, and the PGM has agreed to this. The client has done well in therapy and has met her short-term counseling goals. She has processed grief and loss concerning separation from her parents and shows improvement with emotional regulation. The use of brief strategic family therapy (BSFT) has helped address patterns of interaction between the client and her PGM, and the client is having fewer tantrums. The PGM reports that the client continues to talk back, and she is not completing her chores. You plan to conduct a series of home visits to assist the PGM with parent management skills but receive word from your agency’s office indicating the client has lost insurance coverage",Which is the best course of action upon discovering the client has lost insurance coverage?,Suspend services indefinitely and resume when the client’s insurance is reinstated.,Initiate bartering with the client in exchange for the continuation of services.,Terminate the counseling relationship and offer appropriate referrals.,Provide the remaining services pro bono to avoid client abandonment.,"(A): Suspend services indefinitely and resume when the client’s insurance is reinstated.
(B): Initiate bartering with the client in exchange for the continuation of services.
(C): Terminate the counseling relationship and offer appropriate referrals.
(D): Provide the remaining services pro bono to avoid client abandonment.",Terminate the counseling relationship and offer appropriate referrals.,C,"The best course of action is to terminate the counseling relationship and offer appropriate referrals. The client has met her short-term goals and her treatment is nearing completion. Policies related to termination, payment, and insurance coverage are all part of informed consent. Informed consent is reviewed during the initial intake and continues throughout treatment. According to the American Mental Health Counselor Association (AMHCA) Code of Ethics (2020), “CMHCs may terminate a counseling relationship when clients do not pay fees charged or when insurance denies treatment. In such cases, appropriate referrals are offered to the clients” Bartering is unethical in this situation because it is initiated by the counselor. According to the American Counseling Association (ACA) code of ethics (2014), “Counselors may barter only if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract” There is not a need to avoid client abandonment due to the conditions outlined in the informed consent. While providing pro bono services is encouraged, there are potential downfalls with providing services free or at a reduced cost. If you are not applying the same rate to all of your clients, this may be perceived as discrimination. Suspending services indefinitely is problematic simply because you may not know if or when the client’s insurance will be reinstated. Additionally, medical necessity may be questioned because of the requirement to provide medically justifiable treatment (ie, the right intensity, duration, and frequency) matching the client’s current needs. Therefore, the correct answer is (A)",professional practice and ethics
999,]Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,How should the counselor proceed?,Tell Darrel he may need more than vocational counseling,Offer Darrel a vocational assessment,Ask Darrel if he has been feeling depressed,Ask open ended questions while trying to gain trust,"(A): Tell Darrel he may need more than vocational counseling
(B): Offer Darrel a vocational assessment
(C): Ask Darrel if he has been feeling depressed
(D): Ask open ended questions while trying to gain trust",Ask open ended questions while trying to gain trust,D,"Although Daniel came into the counseling center for vocation counseling, it seems like there may be more going on than the need for a vocational assessment. However, the counselor does not know how Daniel feels about therapy, so it is best to try to gain more information while gaining Darrel's trust. Although Darrel may need a vocational assessment, the information doesn't necessarily suggest that and ethically, assessments should only be given if needed. The counselor should not immediately tell Daniel that he may need more than vocational counselor or ask him if he is feeling depressed, as these may be off-putting to Darrel, and he may end the session altogether. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1000,Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.","You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.","Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.","The attorney also asks that you provide regular updates on the client, which will be used in preparing for the trial. How should the counselor respond to the attorney's request?",State that regular summaries can be provided since the client was referred by her attorney.,State that the attorney will need to provide a release of information signed by the attorney as well as a letter stating that the client has retained the attorney for litigation.,State that the attorney will need to provide a release of information signed by the client.,State that regular summaries can be provided to the attorney because the client is involved in litigation and represented by the referring attorney.,"(A): State that regular summaries can be provided since the client was referred by her attorney.
(B): State that the attorney will need to provide a release of information signed by the attorney as well as a letter stating that the client has retained the attorney for litigation.
(C): State that the attorney will need to provide a release of information signed by the client.
(D): State that regular summaries can be provided to the attorney because the client is involved in litigation and represented by the referring attorney.",State that the attorney will need to provide a release of information signed by the client.,C,"Counselors disclose information for non-mandated clients only with appropriate, written consent from the client or their legal guardians, in the case of minors or incapacitated clients. Representing a client's interests in court is not equivalent to a court-order and only the client may provide release of information. Therefore, the correct answer is (D)",professional practice and ethics
1001,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",What would be necessary for effectively dealing with the school administrative team regarding the client's current experience with bullying?,Ask his school counselor to attend your next session so the client has a safe space to explain what is happening at school,"Request a firm date and meeting with the school counselor and administrative team and the child's parents, so they can express their consent and concerns in person.",Request a release of information from the parents to the school so you can speak freely to the administrative team about the client's progress and the concerns you have about his safety,Add a release of information sentence in your informed consent forms at the beginning of intake,"(A): Ask his school counselor to attend your next session so the client has a safe space to explain what is happening at school
(B): Request a firm date and meeting with the school counselor and administrative team and the child's parents, so they can express their consent and concerns in person.
(C): Request a release of information from the parents to the school so you can speak freely to the administrative team about the client's progress and the concerns you have about his safety
(D): Add a release of information sentence in your informed consent forms at the beginning of intake",Request a release of information from the parents to the school so you can speak freely to the administrative team about the client's progress and the concerns you have about his safety,C,"A release of information is a powerful tool that enables you, the outside therapist, to speak to the school counseling and admin team. This allows your client to feel supported and protected in the school environment. Therefore, the correct answer is (D)",professional practice and ethics
1002,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,"Prior to the next counseling session, the therapist felt weary about seeing Harold again. Upon reflection, the counselor realized that Harold reminded him of a past coworker who did not treat the counselor well. The best thing for the counselor to do in this situation is?",Speak to Harold about the issue,Terminate with Harold,Ignore the issue,Speak to his supervisor about the issue,"(A): Speak to Harold about the issue
(B): Terminate with Harold
(C): Ignore the issue
(D): Speak to his supervisor about the issue",Speak to his supervisor about the issue,D,"Countertransference occurs when the client brings up feelings in the therapist that have nothing to do with the client themselves but has to do with something within the therapist. In this instance it would be best for the counselor to speak to his/her supervisor to process what is occurring. Countertransference is a common occurrence, and it is not necessary for the counselor to terminate with Howard currently. Speaking to Harold about the issue would be inappropriate as the cause of the discomfort has nothing to do with what Harold has done and that would make the session about the counselor and not Harold. Ignoring the issue can result in negative consequences and would affect the quality of care Harold receives. Therefore, the correct answer is (B)",professional practice and ethics
1003,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","Fifth Session, 5 Weeks After the Initial Intake The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening.  While managing this couple’s therapy, you are also supervising an intern at the clinic who is seeing their own clients. You have recently received several complaints regarding this intern that include talking on their phone during sessions, late progress notes, and inconsistent communication with clients. You think the intern is not responding well to feedback and has not tried to make changes. Additionally, several of the intern’s clients have terminated their counseling services","While managing this couple’s therapy, you are also supervising an intern at the clinic who is seeing their own clients. You have recently received several complaints regarding this intern that include talking on their phone during sessions, late progress notes, and inconsistent communication with clients. You think the intern is not responding well to feedback and has not tried to make changes. Additionally, several of the intern’s clients have terminated their counseling services. Which of the following is the most ethical response in this supervisory relationship?",Consider termination of the supervisor/intern relationship.,Provide further coaching to improve their professionalism.,Sit in on a session to observe the intern’s behavior.,Initiate termination of the supervisor/intern relationship.,"(A): Consider termination of the supervisor/intern relationship.
(B): Provide further coaching to improve their professionalism.
(C): Sit in on a session to observe the intern’s behavior.
(D): Initiate termination of the supervisor/intern relationship.",Initiate termination of the supervisor/intern relationship.,D,"Despite providing coaching, the intern continues the problem behaviors, which has resulted in several clients aborting their sessions. It is apparent, at this point, that the intern is not willing to make changes and is actively harming clients, demonstrated by the client absences. For this reason, termination of the supervisor/intern relationship should be initiated (and not simply considered). If the intern is just starting to demonstrate unethical behavior, providing coaching and considering termination are appropriate actions, but these steps have already been taken. Observing a session would not be helpful because the intern likely would not engage in the problem behaviors during the session that you are watching. Furthermore, observation does not prioritize the best interest of the clients because the intern continues to engage in behavior that is harmful to them. Therefore, the correct answer is (C)",professional practice and ethics
1004,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",What information precludes you from diagnosing this client with Posttraumatic Stress Disorder (PTSD)?,The disorder does not cause enough significant dysfunction in the client’s life.,The client does meet the criteria for PTSD.,The traumatic event is too recent.,The client’s family issues seem to be part of the problem; a diagnosis is not needed.,"(A): The disorder does not cause enough significant dysfunction in the client’s life.
(B): The client does meet the criteria for PTSD.
(C): The traumatic event is too recent.
(D): The client’s family issues seem to be part of the problem; a diagnosis is not needed.",The traumatic event is too recent.,C,"The traumatic event occurred within the past two weeks. For a diagnosis of PTSD, the symptoms must last at least one month. Because the event is recent, the client's prognosis is better than having a PTSD diagnosis. Intervening soon after a traumatic event is important and can lead to better treatment outcomes. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1005,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Since the intake, you have provided professional development training for school staff on transgender and gender nonconforming (TGNC) individuals. The administration supports your recommendations for keeping the client and others safe at school. The client continues to miss school, but they have had fewer absences this month. You learn that the client’s desire to be rid of their male secondary sex characteristics has become more persistent. They say that they have seen media coverage of individuals who have undergone sex reassignment surgeries and wondered what that would be like. The client also states they are confused about their sexual orientation. The client appreciates being an active participant in their treatment, and together you create relevant treatment plan goals. You discuss the upcoming family session with the client’s parents. The client articulates appropriate topics for this session and reports increased anxiety concerning their father’s participation.  Counselors must carefully examine the benefits and risks associated with medical interventions for adolescents with gender dysphoria",Counselors must carefully examine the benefits and risks associated with medical interventions for adolescents with gender dysphoria. Which ethical principle considers the client’s capacity to participate in the decision-making process?,Fidelity,Justice,Autonomy,Beneficence,"(A): Fidelity
(B): Justice
(C): Autonomy
(D): Beneficence",Autonomy,C,"Autonomy is the right of an individual to participate in decisions affecting the direction of their life. Autonomy is an integral part of informed consent. Informed consent is the process by which one understands the benefits and risks of a specific treatment and freely consents to that treatment. Counselors who work with TGNC teens are tasked with providing accurate information on the pros and cons of medical treatment for gender dysphoria. In general, counselors must educate families on the detrimental effects of withholding medical interventions, including increased psychiatric comorbidity (eg, suicidality, substance abuse). Alternatively, there are risks inherent in hormonal or surgical interventions, including the timing of administration and the irreversible nature of some of these interventions. Because the client is 13 years old, their ability to make an informed decision may not be developmentally appropriate, particularly for hormonal and surgical interventions. The principle of beneficence is honored by working for the good of the client’s overall mental health and wellbeing. Fidelity is the ethical principle that is used when keeping commitments and promises. Fidelity is most commonly practiced when conducting research and engaging with other professionals. Therefore, the correct answer is (D)",professional practice and ethics
1006,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling.  You colead the client’s process-oriented group with a trained counselor",You colead the client’s process-oriented group with a trained counselor. Which one of the following is LEAST indicative of a process-oriented group?,Identifying and discussing group themes and patterns,Allowing for the use of silence,Assessing intragroup interactions,Teaching the importance of medication compliance,"(A): Identifying and discussing group themes and patterns
(B): Allowing for the use of silence
(C): Assessing intragroup interactions
(D): Teaching the importance of medication compliance",Teaching the importance of medication compliance,D,"Teaching the importance of medication compliance is least indicative of a process-oriented group. Psychoeducational groups are content oriented and focus on teaching and conceptual learning. According to Yalom & Leszcz (2005), “While content involves looking at what specifically was said, process involves looking at the how and the why behind what was said” Trained counselors use process-oriented groups to assess interpersonal or intragroup interactions, introduce silence, and identify and discuss group themes and patterns. Although psychoeducation can be integrated into process groups, it is content oriented rather than process oriented. Therefore, the correct answer is (A)",counseling skills and interventions
1007,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","   e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family.  The client reports being treated for separation anxiety disorder in kindergarten",The client reports being treated for separation anxiety disorder in kindergarten. You think that the diagnosis is likely based on which of the following DSM-5-TR criteria?,Selective mutism when anticipating being away from home,Persistent and excessive fear of teachers and peers,"Hypervigilance, poor concentration, and sleep disturbance",Repeated nightmares involving being away from home,"(A): Selective mutism when anticipating being away from home
(B): Persistent and excessive fear of teachers and peers
(C): Hypervigilance, poor concentration, and sleep disturbance
(D): Repeated nightmares involving being away from home",Repeated nightmares involving being away from home,D,"Repeated nightmares involving being away from home are criteria for separation anxiety disorder. Separation anxiety disorder is characterized by excessive fear of either being apart from or losing an attachment figure (eg, away from home). Persistent and excessive fear of teachers and peers is better explained by a specific phobia, whereas hypervigilance, poor concentration, and sleep disturbance may indicate a generalized anxiety disorder. Selective mutism is a form of anxiety in children associated with the failure to speak in social situations where there is the expectation that a child would do so. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1008,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","   fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend",Which of the following assessments would be the most effective in evaluating ADHD for this client?,An organizational assessment,Vineland Adaptive Behavior Scales,Vanderbilt ADHD Diagnostic Rating Scale,Conners Abbreviated Symptom Questionnaire,"(A): An organizational assessment
(B): Vineland Adaptive Behavior Scales
(C): Vanderbilt ADHD Diagnostic Rating Scale
(D): Conners Abbreviated Symptom Questionnaire",Conners Abbreviated Symptom Questionnaire,D,"According to a meta-analysis of ADHD questionnaires and assessment tools performed in 2016, the Conners Abbreviated Symptom Questionnaire is the most effective tool for screening for ADHD due to its ability to assess for positive and negative symptoms. This tool will be the most helpful because it probes functioning in many areas including work, home, school, and social functioning with ADHD. The Vanderbilt ADHD Diagnostic Rating Scale would not be appropriate for this patient because it assesses ages 6 through 12 for ADHD. The Vineland Adaptive Behavior Scales would also be inappropriate for this client because it is used for people ages 3 through 21. Although an organizational assessment may be helpful, it is not an approved means of diagnosing ADHD. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1009,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",Which action demonstrates empathy for the client?,You acknowledge her feelings about her father.,You ask open-ended questions.,You share a story about your relationship with your father.,You assist her in identifying negative thought patterns.,"(A): You acknowledge her feelings about her father.
(B): You ask open-ended questions.
(C): You share a story about your relationship with your father.
(D): You assist her in identifying negative thought patterns.",You acknowledge her feelings about her father.,A,"Empathy is a powerful tool when used properly because the therapeutic relationship is considered curative in nature. The function of empathy is not merely to label emotional states but to recognize what it feels like to experience something. Empathy is considered the ability to understand and share the feelings of another. Kohut considers empathy to be the major tool of therapy. Therefore, the correct answer is (B)",counseling skills and interventions
1010,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors.  Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor.    You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings.  Seventh session Today, you meet with Becky and both of her parents. Her father demands to be included in the treatment process. He is adamantly opposed to his daughter being placed in special classes, but the mother expresses her belief that placement in a special class is the best solution. The parents continue to disagree. Finally, Becky screamed out her support for her father's side of the argument.    Becky's reaction in support of her father's position only further escalated the disagreement between her parents. Her mother seemed to be taken aback by Becky's outburst and tried to explain calmly why she believed special classes would be the best solution for their daughter. At this point, the conversation became more heated. Her mother expressed her frustration with her husband, saying he always seemed to take Becky's side regardless of the situation. This further agitated the father, and he began to raise his voice in protest. Sensing the tension in the room, Becky suddenly crossed the room and sat on her father's lap. The parents' discussion escalated into an argument, with Becky's mother finally walking out of the office."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",The father has been forceful in stating his opinion regarding his daughter being placed in special classes. The daughter has shown an affinity for the father during the session. What would be the most appropriate response to this situation?,"Recognizing that the parents are at an impasse and no further interactions are advisable, you should conclude therapy sessions.","You should engage the father to establish rapport and considering the strength of his opposition to special education classes, you should agree to his demands.","You should engage the father and find out the source of his antagonism toward special education classes, as well as discuss his responses to the daughter's behavior in school.","You should engage the father to lead him to affirm the mother, as she seems to have the daughter's best interest in mind.","(A): Recognizing that the parents are at an impasse and no further interactions are advisable, you should conclude therapy sessions.
(B): You should engage the father to establish rapport and considering the strength of his opposition to special education classes, you should agree to his demands.
(C): You should engage the father and find out the source of his antagonism toward special education classes, as well as discuss his responses to the daughter's behavior in school.
(D): You should engage the father to lead him to affirm the mother, as she seems to have the daughter's best interest in mind.","You should engage the father and find out the source of his antagonism toward special education classes, as well as discuss his responses to the daughter's behavior in school.",C,"Both parents have a right to express their opinions and feelings and to have a full explanation regarding the direction of their child's educational disposition. It is also important to be able to explore the nature of parental relationships in therapy. Therefore, the correct answer is (D)",counseling skills and interventions
1011, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.",What focus of interventions would help Raul stay out of trouble in school?,delayed gratification,thought stopping,aversion therapy,mindfulness,"(A): delayed gratification
(B): thought stopping
(C): aversion therapy
(D): mindfulness",delayed gratification,A,"Teaching Raul how to delay gratification can greatly improve his impulse control while still helping him rationalize getting his needs met. This can be accomplished by practicing several skills after helping Raul prioritize his ""wants"" over his ""needs"" and working to achieve a ""greater goal"" later, rather than meeting lesser needs immediately. Working with Raul on what motivates him as well as helping him identify how he feels after he has indulged in an impulsive or compulsive action are ways to begin this process. Mindfulness would be challenging for Raul with inattentive type ADHD as he is unable to remain on task without constant guidance or direction. Aversion therapy contains tactics to help clients train their brains to avoid stressful stimuli (ie, snapping a rubber band on their wrist whenever they recognize they are having negative thoughts, with the intention that eventually they can redirect their thoughts without a snap to avoid the pain of the rubber band). Thought stopping technique has similar intentions in that it can help with intrusive negative thoughts or worry that often accompany phenomena like anxiety or panic attacks. Therefore, the correct answer is (D)",counseling skills and interventions
1012,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations",How would an Adlerian therapist address the client’s depressive symptoms resulting from significant time spent on social media?,Examine the client’s unhealthy life position of “I’m not okay; you’re okay.”,"Identify the activating event, beliefs, and consequences (i.e., the ABC model).","Emphasize the importance of social interest and a purposeful, goal-oriented “lifestyle.”",Transform a failure identity into a success identity.,"(A): Examine the client’s unhealthy life position of “I’m not okay; you’re okay.”
(B): Identify the activating event, beliefs, and consequences (i.e., the ABC model).
(C): Emphasize the importance of social interest and a purposeful, goal-oriented “lifestyle.”
(D): Transform a failure identity into a success identity.","Emphasize the importance of social interest and a purposeful, goal-oriented “lifestyle.”",C,"Adlerian therapists emphasize the importance of social connection, asserting that all individuals strive for “superiority,” which is achieved through a purposeful, goal-oriented lifestyle. Adlerian therapists view maladjustment as the development of a mistaken style of life leading to feelings of inferiority. Transactional analysis uses positions such as “I’m not okay; you’re okay” to describe how one views themselves and others. Reality therapists would work to transform a failure identity into a success identity by emphasizing personal choice and a commitment to change. REBT therapists identify the activating event, behavior, and consequences of the behavior (ie, the ABC model) to help address irrational thinking. Therefore, the correct answer is (D)",counseling skills and interventions
1013,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",Which option is the best course of action to take when dealing with minors and confidentiality?,Let the minor know that you will inform his parent of session content to maintain open communication. because he has no right to privacy.,"Let the minor know that you will maintain confidentiality, regardless of his parent's requests for access to session information","Let the minor know that you will maintain confidentiality to the extent that you are able, but that his right to privacy in therapy is limited.",Let the minor know that you will not share your personal therapy notes of the session with his parents.,"(A): Let the minor know that you will inform his parent of session content to maintain open communication. because he has no right to privacy.
(B): Let the minor know that you will maintain confidentiality, regardless of his parent's requests for access to session information
(C): Let the minor know that you will maintain confidentiality to the extent that you are able, but that his right to privacy in therapy is limited.
(D): Let the minor know that you will not share your personal therapy notes of the session with his parents.","Let the minor know that you will maintain confidentiality to the extent that you are able, but that his right to privacy in therapy is limited.",C,"A minor's privacy in therapy is limited. Individuals under eighteen do not typically have a right to confidentiality in therapy. Therefore, the correct answer is (D)",professional practice and ethics
1014,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",The client reports that a worker from the local child protective services office met with her and that she is worried about what the coach will do in response when he finds out that she reported him. The client says that she has not returned to school but that the school has provided the classwork and homework needed to keep up; she feels like the school is supporting her well enough to not fall behind. The client confirms that all of the symptoms that she described during her last session are still present,Which one of the following is an appropriate short-term goal for post-traumatic stress disorder?,Improve the client’s ability to talk about her traumatic experience.,Significantly reduce negative symptoms associated with the trauma.,Use cognitive behavioral strategies to reduce the daily impact of the trauma.,Reduce avoidance of triggers for trauma symptoms.,"(A): Improve the client’s ability to talk about her traumatic experience.
(B): Significantly reduce negative symptoms associated with the trauma.
(C): Use cognitive behavioral strategies to reduce the daily impact of the trauma.
(D): Reduce avoidance of triggers for trauma symptoms.",Use cognitive behavioral strategies to reduce the daily impact of the trauma.,C,"Using cognitive behavioral strategies to reduce the daily impact of trauma is the most relevant short-term goal for this client because it is achievable in the most immediate future. Reducing negative symptoms in a significant manner is not likely to occur in the short term, nor is reducing the avoidance of triggers, because it takes time to process a traumatic event and implement the coping skills necessary to achieve these goals. Talking about a traumatic experience is not always beneficial for clients and may, in fact, cause more harm. In the early stages of treatment following a traumatic event, it is often more beneficial to manage the effects of the trauma than to force conversations about it. Therefore, the correct answer is (D)",treatment planning
1015,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",John appears to be responding to Cognitive Behavioral Therapy approaches. What is the best CBT-based intervention of the choices below for inclusion into John's treatment plan?,Selecting an effective medication proven to reduce anxiety and anger-related conditions,Processing his negative automatic thoughts in the form of a Thought Record,Learning and practicing meditation and deep breathing,Trauma-focused CBT treatment in which his daughter participates,"(A): Selecting an effective medication proven to reduce anxiety and anger-related conditions
(B): Processing his negative automatic thoughts in the form of a Thought Record
(C): Learning and practicing meditation and deep breathing
(D): Trauma-focused CBT treatment in which his daughter participates",Processing his negative automatic thoughts in the form of a Thought Record,B,"Medication selection does not belong underneath the scope of CBT-based interventions but can be considered and concurrently followed up with by a psychiatric provider. Meditation and deep breathing are practices incorporated within Mindfulness-Based Cognitive Therapy (MBCT). Mindfulness can alter one's attitude towards one's thoughts so that their feelings and behaviors are affected less intensely or frequently, however CBT is focused on restructuring cognitive distortions and reframing beliefs towards more adaptive perspectives. TF-CBT is a family-focused treatment that does not seem to be appropriate without John having any form of relationship with his daughter or communication with her mother; although his daughter is of legal age to participate without parental consent. It is reasonable to select c) as the best option during this phase of John's treatment to assist him with identifying triggering events, understanding his feelings, and to become capable of differentiating between healthy and irrational patterns of thinking. Therefore, the correct answer is (C)",treatment planning
1016,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","When considering the possibility of implementing an experimental treatment with this client in the future, what is your initial responsibility towards the client?",Provide the client with the statistics that will positively influence his acceptance of the treatment due to the severity of the detrimental effects of his substance use.,Obtain informed consent before implementing procedures.,Contact the client's insurance company to determine if the treatment is covered or will be fee-for-service.,Consult with your supervisor regarding your intended treatment plan.,"(A): Provide the client with the statistics that will positively influence his acceptance of the treatment due to the severity of the detrimental effects of his substance use.
(B): Obtain informed consent before implementing procedures.
(C): Contact the client's insurance company to determine if the treatment is covered or will be fee-for-service.
(D): Consult with your supervisor regarding your intended treatment plan.",Obtain informed consent before implementing procedures.,B,"To fulfill your ethical responsibility as a therapist, you must inform the client of the procedures, risks, and possible outcomes of any alternative therapies implemented. Therefore, the correct answer is (A)",professional practice and ethics
1017,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.  Eighth session You have been seeing the client for a few months now, and she has consistently come to therapy and has made some progress, but some areas still need work. Regarding the death of her friend, she remains in the denial stage of his passing. She had been prescribed medication to help with her insomnia and depression, which seemed to be helping somewhat. In addition, she is limiting her alcohol intake, but she has not stopped drinking altogether. She had also been working on identifying her triggers for anxious distress, and you discussed several of them during previous sessions.    Today, you focus on the stress the client reports in relationship to her job. You ask, ""What has been going on at work that has been making you feel stressed out?"" She starts to talk about her boss and seems to be caught up in the details, getting lost in her story. You notice her becoming agitated. You ask her to explain what she is feeling and she says, ""overwhelmed, frustrated, and like I can't keep up."" She tells you that just talking about it makes her feel physically uncomfortable. You offer the client some grounding techniques to help her stay in the present moment. You suggest she take a few deep breaths and focus on her breathing. You then ask her to focus on her physical sensations, including any tension or tightness in her body and gently encourage her to release that tension. You suggest she identify something in the room that can help her stay grounded and focus on it if her mind starts to wander.    When she appears to be calm again, you ask her to describe the situation at work that is causing her the most distress in simple terms, without getting caught up in details. The client goes on to explain that her supervisor is often critical of her and she feels as though he does not appreciate the hard work she puts in. You listen to her and empathize, then encourage her to think about specific ways she can address the situation at work. You suggest that she start by making a list of her skills and competencies, so that she can remind herself of her worth when feeling attacked.    Throughout the session, you mirror the client's body language by following her lead. When she leans forward, you lean forward. When she furrows her brows or crosses her arms, you do the same. You also make eye contact with the client, giving her your undivided attention.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",What intervention are you using when you provide the client with an article about anxiety and depression in the workplace and the struggles employees face due to stress?,Exposure therapy,Reattribution,Psychoeducation,Paradoxical intervention,"(A): Exposure therapy
(B): Reattribution
(C): Psychoeducation
(D): Paradoxical intervention",Psychoeducation,C,"Psychoeducation provides the client with tools and knowledge on the issues they are facing to help them cope. Therefore, the correct answer is (B)",counseling skills and interventions
1018,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that her husband’s patience continues to wear thin, so she has explored the possibility of alternate employment. She states that she applied for a position as a curriculum sales representative but did not get an interview. The client reports that the company used a personality inventory to prescreen job applicants. She says that someone in human resources told her she was not selected for an interview because the company was looking for someone who was more extraverted and a “thinker” rather than a “feeler.” The client explains that she was under the impression that they were looking for a male. She expresses an interest in using personality inventories to help identify employment that would be a good fit for her",Which is NOT true of the legal and ethical considerations for using personality inventories to conduct preemployment screening?,The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those age 50 or over.,"Unless the employer can prove otherwise, using personality inventories can violate antidiscrimination laws for people belonging to certain groups (e.g., sex, race).",Interpretation and feedback for specific personality inventories must allow questions and clarification and avoid biased terms indicating that a particular personality preference is “not desirable.”,"The reliability, validity, and psychometric limitations and appropriateness of instruments must be considered when selecting assessments for preemployment screening.","(A): The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those age 50 or over.
(B): Unless the employer can prove otherwise, using personality inventories can violate antidiscrimination laws for people belonging to certain groups (e.g., sex, race).
(C): Interpretation and feedback for specific personality inventories must allow questions and clarification and avoid biased terms indicating that a particular personality preference is “not desirable.”
(D): The reliability, validity, and psychometric limitations and appropriateness of instruments must be considered when selecting assessments for preemployment screening.",The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those age 50 or over.,A,"The Age Discrimination in Employment Act prohibits preemployment screening instruments from being used as a means for discriminating against those over the age of 40 rather than 50. The US Equal Employment Opportunity Commission bans employers from intentionally using personality tests and other selection procedures to discriminate against individuals based on religion, race, nationality, disability, sex, age, or color. Ethical guidelines for using personality tests, such as the Myers-Briggs Type Indicator, state that feedback and clarification must be sought when interpreting results. Test administrators must set aside time for questions and avoid biased terms indicating that a particular personality preference is “not desirable” Lastly, the ACA Code of Ethics states, “Counselors carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting assessments and, when possible, use multiple forms of assessment, data, and/or instruments in forming conclusions, diagnoses, or recommendations”. Therefore, the correct answer is (B)",professional practice and ethics
1019,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,The counselor was able to get Elaina to relax by?,Defending the therapeutic process,Challenging the client,Establishing rapport,Establishing trust,"(A): Defending the therapeutic process
(B): Challenging the client
(C): Establishing rapport
(D): Establishing trust",Establishing rapport,C,"Rapport building is one of the first stages of the therapeutic process. Rapport is built when there is a positive feeling between counselor and client, there is a mutual understanding and positive communication. Challenging the client and defending the therapeutic process would not be advisable as way to put a client, who is frustrated, at ease. It is too early in the therapeutic process to have established trust. Therefore, the correct answer is (D)",counseling skills and interventions
1020,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter",How would a client with OCPD most likely approach termination?,"Have a measured external reaction, is self-congratulatory, is indifferent toward the counselor","Feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence","Terminate too early, deny emotional reactions, and act dismissively toward the counselor",Attempt to delay termination and desperately cling to the counselor,"(A): Have a measured external reaction, is self-congratulatory, is indifferent toward the counselor
(B): Feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence
(C): Terminate too early, deny emotional reactions, and act dismissively toward the counselor
(D): Attempt to delay termination and desperately cling to the counselor","Terminate too early, deny emotional reactions, and act dismissively toward the counselor",C,"Individuals with OCDP experience pathological personality traits marked by avoidance and detachment. Individuals with avoidant attachment styles would react to termination in the same way they react to close romantic partners or interpersonal relationships, which is to remain emotionally detached. Individuals with disorganized attachment styles feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence. Individuals with ambivalent attachment styles attempt to delay termination and desperately cling to the counselor. Lastly, individuals with varied attachment styles, particularly those associated with narcissistic personality disorder, are self-congratulatory and detached. Therefore, the correct answer is (D)",professional practice and ethics
1021,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.  Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered.",,"According to the Corey and Corey stages of group therapy model, what stage is this group currently in, and what stage might they move to next?","The group is experiencing anxiety and some members are having difficulty establishing trust with others.They are currently in the transition phase, not the initial phase. During the initial phase, the group members are getting acquainted with each other and establishing groups rules and norms.",Transition; Working,Initial; Transition,Working; Final,"(A): The group is experiencing anxiety and some members are having difficulty establishing trust with others.They are currently in the transition phase, not the initial phase. During the initial phase, the group members are getting acquainted with each other and establishing groups rules and norms.
(B): Transition; Working
(C): Initial; Transition
(D): Working; Final",Transition; Working,B,"The group is experiencing anxiety and some members are having difficulty establishing trust with others. During the transition stage, group members may experience anxiety, difficulty establishing trust with other group members and the group leader, and defensiveness. There may be conflicts between members and problem behaviors may become evident. The issues that have cropped up during the transition phase must be dealt with in order for the group to successfully navigate to the working stage. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1022, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,Treatment of eating disorders include which of the following?,Both a and b,Teach coping skills to target anxiety of eating in front of others,Address addiction issues,Provide psychoeducation on the effect of social media on body image,"(A): Both a and b
(B): Teach coping skills to target anxiety of eating in front of others
(C): Address addiction issues
(D): Provide psychoeducation on the effect of social media on body image",Both a and b,A,"One of the main causes of eating disorders is the unrealistic portrayal of body images on social media. By providing psychoeducation about what a normal body looks like as well as how common eating disorders are, this may help Autumn realize that she is not alone. Teaching Autumn effective coping skills to manage her anxiety may allow her to feel more comfortable eating in front of others and allowing her to be part of the social setting of her cafeteria. There are no addiction issues indicated. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1023,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals",Which of the following rational-emotive behavioral therapy (REBT) techniques is used to help identify the salient aspects of the client’s delusional belief system?,Normalizing,Emotion-based reasoning,Inference chaining,Linking,"(A): Normalizing
(B): Emotion-based reasoning
(C): Inference chaining
(D): Linking",Inference chaining,C,"Inference chaining is an REBT technique used to explore personal meanings associated with delusions. Inference chaining is used in rational-emotive therapy and is particularly effective for individuals experiencing delusions. The technique is used at the beginning of treatment to understand the underlying belief used to sustain the delusion. Linking is then used to gradually test reality by introducing other plausible explanations, with the overarching goal of decreasing distress created by the delusion. Normalizing is an effective cognitive-behavioral technique used to help process hallucinations. The stress-vulnerability model is used to normalize experiences associated with the onset of hallucinations and co-occurring stressors. Emotion-based reasoning was used by Aaron Beck, credited for developing cognitive-behavioral therapy. Emotional-based reasoning describes the maladaptive process in which delusions are categorized and involves believing that one’s emotional experiences dictate reality. Therefore, the correct answer is (A)",counseling skills and interventions
1024,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""  Fourth session The client has been ""looking forward to working with you"" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is ""hard on her.""    She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father.","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ","When planning for the next session with the client and her father, what information should you ask your client to help make the best use of the joint session?",Exactly what patterns of interaction between the client and her father are creating distress for the client,What the client would like you to say to her father,What the client would like to say to her father with your support,"If the client has thought of responses to her father, due to the high likelihood that it will end in conflict.","(A): Exactly what patterns of interaction between the client and her father are creating distress for the client
(B): What the client would like you to say to her father
(C): What the client would like to say to her father with your support
(D): If the client has thought of responses to her father, due to the high likelihood that it will end in conflict.",Exactly what patterns of interaction between the client and her father are creating distress for the client,A,"This information will be valuable in planning behavioral interventions and can compare the client's perceptions with her father's. Therefore, the correct answer is (D)",counseling skills and interventions
1025,Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.","You guide Taylor through the process of identifying her emotional reactions to her stressors, recognizing automatic thoughts, and challenging her underlying irrational belief systems through filling out a Thought Record. What is the end goal of this exercise?",To highlight her negative her core beliefs,To demonstrate how her feelings are irrational,"To create a new, healthier thought process",To analyze each cognitive distortion individually,"(A): To highlight her negative her core beliefs
(B): To demonstrate how her feelings are irrational
(C): To create a new, healthier thought process
(D): To analyze each cognitive distortion individually","To create a new, healthier thought process",C,"If Taylor concludes that her unhelpful thinking styles are longer-term patterns that have been pervasive over time, this can be useful for her as motivation to change. Helping Taylor learn how her emotions affect her cognitions, which then affect her behaviors, is the purpose of Cognitive Behavioral therapy. The ""Thought Record"" is intended to support Taylor's cognitive restructuring process with the goal of training her mind to automatically develop healthier thoughts when faced with triggering situations. Within this process, her core beliefs, cognitive distortions, and irrational thoughts might be highlighted; but this is not the end goal. Additionally, feelings should never be presented as ""irrational""; all feelings should be validated regardless of its origin of irrational thought. Therefore, the correct answer is (A)",counseling skills and interventions
1026,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","    plan. Family History: The client’s parents are divorced and he lives with his mother and two younger siblings. There is a history of child protective services (CPS) involvement due to reports of domestic violence between his parents. The client witnessed these incidents between that ages of 10 and 12. His parents subsequently divorced and the client has had minimal contact with this father since. The client’s maternal aunt is diagnosed with obsessive-compulsive disorder. His mother previously attended therapy for anxiety and other trauma-related symptoms. The client began experiencing symptoms of body dysmorphic disorder at age 13, with symptoms worsening after starting high school",Which of the following is NOT is an established evidence-based component of a client’s safety plan?,Create an accessible list of emergency contacts and social supports to use when feeling suicidal.,Establish a “no suicide” safety contract.,"Identify distractions to use when feeling suicidal (e.g., take a walk, call a friend).","Identify early warning signs (e.g., body shaming, isolation).","(A): Create an accessible list of emergency contacts and social supports to use when feeling suicidal.
(B): Establish a “no suicide” safety contract.
(C): Identify distractions to use when feeling suicidal (e.g., take a walk, call a friend).
(D): Identify early warning signs (e.g., body shaming, isolation).",Establish a “no suicide” safety contract.,B,"There is no empirical evidence supporting no-suicide contracts for safety. Historically, clinicians have asked clients to sign no-suicide contracts indicating that they would not act on suicidal thoughts or reach out for support when experiencing suicidality. Not only do no-suicide contracts lack empirical evidence, but critics believe there can be an implication of coercion from the counselor due to concerns over professional protection and liability. Instead, a collaborative, strengths-based approach to safety planning is thought to empower the client and enhance the therapeutic alliance. There are various evidence-based components to treatment planning, including but not limited to: identifying early warning signs, using distractions when feeling suicidal, identifying social and emergency supports, identifying coping strategies, and making the environment safe. Therefore, the correct answer is (B)",treatment planning
1027,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ","Overall, what are you executing when you demonstrate positive communication techniques that the couple could use with each other?",Narrative Therapy,Appropriate confrontation techniques,Exposure Therapy,Modeling Behavior,"(A): Narrative Therapy
(B): Appropriate confrontation techniques
(C): Exposure Therapy
(D): Modeling Behavior",Modeling Behavior,D,"By modeling, you will be able to demonstrate positive communication techniques which the client and her husband could begin to use with each other. Therefore, the correct answer is (C)",counseling skills and interventions
1028,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.  11th session As the session begins, you sit calmly in your office, virtually watching as the client pounds her fists on her desk and speaks angrily. The client informs you that she is ""not happy"" with you as a therapist. ""You therapists are all the same!"" she yells. She accuses you of being responsible for her break-up, saying that her boyfriend left her because she had been hospitalized on your recommendation.    Her facial expressions convey feelings of hurt and disappointment, and you attempt to normalize her reaction. You remain calm, opting to validate the client's feelings rather than respond defensively or deny responsibility for what has happened between the client and her partner.    As the session continues, you take a deep breath and give yourself a moment to gather your thoughts. You recognize that the client's emotional pain and distress have created a lens through which she now views your professional relationship.    Reflecting on the session and past interactions, you remember your concerns that prompted the recommendation for hospitalization. The client had exhibited signs of severe emotional distress and potential self-harm. As a therapist, you prioritized her safety and well-being. You understand her feelings of abandonment from her partner and try to determine who represents both care and potential harm in her life.    However, no matter how much empathy you try to show or how many times you attempt to normalize the client's feelings of anger, she refuses any further discussion on the topic; instead, she declares firmly that she does not want to see you again and abruptly logs out of the session.    You make a note to reach out to the client in a few days to check in on her well-being and see if she's open to discussing her feelings further. Given the intensity of her reaction, it's crucial to ensure that she has a support system during this challenging time. While she might not be receptive to your outreach initially, she needs to know that she is not alone and that help is available should she seek it.    Later, you discuss the situation with your supervisor, seeking guidance on best handling her response and processing your feelings about the matter. The supervisor reminds you that therapeutic relationships can mirror many aspects of clients' other relationships. The anger and feelings of betrayal the client is experiencing could have been elicited by any number of events in her life. The most important thing is to continue offering support while respecting her boundaries.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.","How should you proceed, as the client has not completed the required number of mandated treatment sessions with you?","As a mandated reporter, immediately contact law enforcement or the courts to ensure she continues her sessions with you.",Inform the client that your agency will have to report to the appropriate legal entities that the client discontinued services and that it would be better if she stayed.,You are not responsible for the client's decisions. The client is accountable for her actions.,"Encourage her to continue treatment, provide alternative options, and inform her that your agency will report if the client discontinues services.","(A): As a mandated reporter, immediately contact law enforcement or the courts to ensure she continues her sessions with you.
(B): Inform the client that your agency will have to report to the appropriate legal entities that the client discontinued services and that it would be better if she stayed.
(C): You are not responsible for the client's decisions. The client is accountable for her actions.
(D): Encourage her to continue treatment, provide alternative options, and inform her that your agency will report if the client discontinues services.","Encourage her to continue treatment, provide alternative options, and inform her that your agency will report if the client discontinues services.",D,"This method respects the client's autonomy while also providing information about her treatment and the agency process (which requires informing entities that need to know about a client's treatment and progress). Therefore, the correct answer is (C)",treatment planning
1029,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process.  You gather information to identify factors impeding the client’s progress","You gather information to identify factors impeding the client’s progress. How would you incorporate the influence of emotional, cognitive, and behavioral factors on the client’s clinical presentation and plan of care?",Summarize the client’s reasons for feeling stuck.,Obtain an interdisciplinary consultation.,Conduct a functional behavioral analysis.,Construct a case conceptualization.,"(A): Summarize the client’s reasons for feeling stuck.
(B): Obtain an interdisciplinary consultation.
(C): Conduct a functional behavioral analysis.
(D): Construct a case conceptualization.",Construct a case conceptualization.,D,"The best way to identify factors affecting the client’s clinical presentation and treatment plan goals is to construct a case conceptualization. Cognitive therapists promote the use of biopsychosocial assessments to assist in building a sound clinical presentation. Sperry and Sperry (2020) promote using the eight P’s when formulating the client’s case conceptualization; these include presentation, predisposition (including culture), precipitants, protective factors and strengths, pattern, perpetuants, (treatment) plan, and prognosis. Summarizing the client’s reasons for feeling stuck may help provide context to help understand the client’s views of himself, others, and the world; however, this option is incorrect because the client’s reasons for feeling stuck serve as the impetus for revisiting and updating the case conceptualization. Although it is also helpful, an interdisciplinary consultation is not the best process because there is no indication that the counselor lacks the skill set. Instead, the need arose due to the client’s shift in clinical presentation. The purpose of a functional behavioral analysis is to identify the client’s behavioral chain to determine which behaviors are desirable and which ones are undesirable. Once this is determined, the chain can be broken down and areas can be targeted to help lead to an improved outcome. By contrast, the case conceptualization analyzes a wide range of influences that change the client’s clinical presentation rather than looking at smaller components leading to behavioral change. Therefore, the correct answer is (A)",treatment planning
1030,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,Which of the following would be an inappropriate intervention at this time?,Assisting Kathleen and Tony in communicating to each other without blaming either,Providing psychoeducation on Tony's diagnosis,Focusing on trying to change Tony's behavior,Exploring Tony and Kathleen's support system,"(A): Assisting Kathleen and Tony in communicating to each other without blaming either
(B): Providing psychoeducation on Tony's diagnosis
(C): Focusing on trying to change Tony's behavior
(D): Exploring Tony and Kathleen's support system",Focusing on trying to change Tony's behavior,C,"Interventions in couples counseling should focus on the couple, aligning with the counseling modality. By assisting Kathleen and Tony in communicating in a more efficient manner, they can see each other's perspectives without becoming defensive. An example of this would be the use of ""I"" statements. By providing both with psychoeducation on Tony's diagnosis they can both have a common understanding and address misconceptions. By building up their natural supports, Tony and Kathleen will develop a support system which can continue when therapy ends. Therefore, the correct answer is (A)",counseling skills and interventions
1031,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.",Which of the following interventions will be most beneficial for the client in this session?,"Have the client make a list for why women are or are not ""nuts or evil""",Relaxation exercises to help the client stay calm when he feels frustrated,Empty chair exercises allowing the client to talk to women he used to date,Role plays to help the client identify another person's perspectives,"(A): Have the client make a list for why women are or are not ""nuts or evil""
(B): Relaxation exercises to help the client stay calm when he feels frustrated
(C): Empty chair exercises allowing the client to talk to women he used to date
(D): Role plays to help the client identify another person's perspectives",Relaxation exercises to help the client stay calm when he feels frustrated,B,"The client had demonstrated in this session that he struggles to allow others to have any control in relationships with him that interrupt having his needs met. This sense of entitlement demonstrates a tendency to see people as objects rather than individuals with their own needs, feelings, and perspectives. Role playing with the client can teach him how to listen and observe others in order to view them as people separate from him but still in relationship with him. Having the client list why or why not women are ""nuts or evil"" could be a good practice in helping him to see how he generalizes feelings about some women into all women. This may be helpful at another time but at this time, is not as important as helping relate to others to whom he has connections, such as in his current relationship. Relaxation exercises are helpful for managing negative emotions, but in this session, helping him control his emotions takes the focus away from the content that triggered his feelings. Empty chair exercises, like relaxation exercises, may be helpful later but currently it refocuses the session away from the triggering content that will be best processed immediately. Therefore, the correct answer is (B)",professional practice and ethics
1032,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning.  In order to solidify your diagnosis of bipolar I disorder, the criteria for a major depressive episode must be met","In order to solidify your diagnosis of bipolar I disorder, the criteria for a major depressive episode must be met. All of the following are included on the list of possible criteria for a major depressive episode EXCEPT:",Suicidal thoughts,Catatonia,Decreased interest or pleasure in all activities,Difficulty concentrating,"(A): Suicidal thoughts
(B): Catatonia
(C): Decreased interest or pleasure in all activities
(D): Difficulty concentrating",Catatonia,B,"Catatonia is characterized by abnormal movement—either through a complete lack of movement or through repetitive movements—and it is not characteristic, nor a criterion, of a major depressive episode. Decreased interest or pleasure in activities, suicidal thoughts, and difficulty concentrating are all included in the DSM-5-TR list of possible criteria for the diagnosis of a major depressive episode. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1033,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",Which defense mechanism is the client illustrating by pretending he is The Flash?,Rationalization,Deflection,Reaction formation,Sublimation,"(A): Rationalization
(B): Deflection
(C): Reaction formation
(D): Sublimation",Sublimation,D,"Sublimation is a defense mechanism in which socially unacceptable impulses or idealizations are transformed into socially acceptable actions or behavior. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1034,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.","You begin to see John's unhealthy thought patterns re-emerge, inciting him to frustration. You respond, ""Well despite your frustrations it shows great progress that you are willing to work on yourself before seeing them again. What motivates you to continue counseling?"" This response is an example of?",Emphasizing personal choice and control,"Foundational listening, attending, and reflecting skills",Encouragement and validation,Empathic responding and attunement,"(A): Emphasizing personal choice and control
(B): Foundational listening, attending, and reflecting skills
(C): Encouragement and validation
(D): Empathic responding and attunement",Emphasizing personal choice and control,A,"By pointing out John's choice to address his treatment plan goals before making further destructive choices that might negatively affect his family, you are reinforcing John's level of control in his life and relationships. Asking him to reflect on his motivation further emphasizes his commitment to working on achieving his goals. Therefore, the correct answer is (D)",counseling skills and interventions
1035,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group for the sixth session, and they are focused and appear to be more respectful toward you because it appears that you can get their attention more easily to start the session. You separate the group into dyads at the start of the session and prompt the group members to talk about feelings related to the pros and cons of engaging in school. You overhear client 4 telling client 3 that it does not matter if client 3 does well in school because he is in juvenile detention for sexual assault and therefore he cannot redeem himself. You intervene and remind client 4 of the group rules about respecting others.  Many members of your group are diagnosed with conduct disorder",Many members of your group are diagnosed with conduct disorder. Which one of the following is a key characteristic of conduct disorder?,"Patterns of behavior in which the basic rights, rules, or norms of others are violated",Opposition to authority and rules,Persistent failure to resist the urge to steal objects that are not needed from others,Impulsive anger outbursts with rapid onset,"(A): Patterns of behavior in which the basic rights, rules, or norms of others are violated
(B): Opposition to authority and rules
(C): Persistent failure to resist the urge to steal objects that are not needed from others
(D): Impulsive anger outbursts with rapid onset","Patterns of behavior in which the basic rights, rules, or norms of others are violated",A,"A key characteristic of conduct disorder is the violation of the rights, rules, or norms of others. This characteristic is also present with antisocial personality disorder; however, conduct disorder is often the more appropriate diagnosis for adolescents and children. Opposition to authority and rules is a characteristic of oppositional defiant disorder. Impulsive anger outbursts with rapid onset are characteristics of intermittent explosive disorder. The difficulty with refraining from taking others’ items is characteristic of kleptomania. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1036,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","   . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation","Of the following diagnoses, which is highly comorbid with BED?",Borderline personality disorder,Generalized anxiety disorder,Post-traumatic stress disorder,Obsessive-compulsive disorder,"(A): Borderline personality disorder
(B): Generalized anxiety disorder
(C): Post-traumatic stress disorder
(D): Obsessive-compulsive disorder",Generalized anxiety disorder,B,"There is a high comorbidity rate with general anxiety disorder and BED. According to the DSM-5-TR, the most common comorbid disorders for BED include bipolar disorders, depressive disorders, anxiety disorders, with substance use disorders occasionally found as well. Borderline personality disorder is a differential diagnosis rather than a comorbid condition. The DSM-5-TR includes binge eating in the impulsive behavior criterion as part of borderline personality disorder. Both diagnoses should be assigned if an individual meets full criteria for borderline personality disorder and binge-eating disorder. Post-traumatic stress disorder and obsessive-compulsive disorder are no longer classified as anxiety disorders. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1037,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","   e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services.  The client readily provides consent for you to speak to his mother; however, he tells you he will just meet with you for the intake and does not wish to sign an informed consent","The client readily provides consent for you to speak to his mother; however, he tells you he will just meet with you for the intake and does not wish to sign an informed consent. How should you proceed?",Do not move forward with the intake due to the need to honor the client’s autonomy.,Do not move forward with the intake due to the client’s limited capacity to provide consent.,Move forward with the intake without signed consent due to the need to assess safety and risk.,Move forward with the intake after obtaining the mother’s written consent.,"(A): Do not move forward with the intake due to the need to honor the client’s autonomy.
(B): Do not move forward with the intake due to the client’s limited capacity to provide consent.
(C): Move forward with the intake without signed consent due to the need to assess safety and risk.
(D): Move forward with the intake after obtaining the mother’s written consent.",Move forward with the intake without signed consent due to the need to assess safety and risk.,C,"While the client refuses to sign an informed consent, he already verbally agreed to participating in the intake, therefore moving forward with that intake and assessing for safety and risk is the most appropriate next steps. Informed consent is not required in rare instances when there is a significant risk instead of a slight or remote risk. Considerations for determining significant risk include its frequency, type, severity, and duration. Additionally, there must be a determination that the behavior can or cannot be mitigated by reasonable interventions. The APA Code of Ethics (2014) defines informed consent as “a process of information sharing associated with possible actions clients may choose to take, aimed at assisting clients in acquiring a full appreciation and understanding of the facts and implications of a given action or actions” Clients must be deemed competent and have the capacity to provide voluntary consent. The client has a 36 GPA and an unremarkable mental status exam, indicating competency. Allowing the mother to provide informed consent is incorrect due to the client’s competency and the fact that he is now 18. Therefore, the correct answer is (C)",professional practice and ethics
1038,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",Which statement best represents the use of paraphrasing?,"""Sounds like you believe drinking is not an issue for you, but I believe that it is actually a problem.""","""So, you use alcohol to cope with stress, and you see no problem with having a drink before work and at lunch. Further, you suspect that your boss has it in for you.""","""I am interested in understanding more about why you feel that drinking is not the problem. Can you tell me more about that?""","""Drinking is not the problem. It appears that the job and everybody else is the problem. Is that right?""","(A): ""Sounds like you believe drinking is not an issue for you, but I believe that it is actually a problem.""
(B): ""So, you use alcohol to cope with stress, and you see no problem with having a drink before work and at lunch. Further, you suspect that your boss has it in for you.""
(C): ""I am interested in understanding more about why you feel that drinking is not the problem. Can you tell me more about that?""
(D): ""Drinking is not the problem. It appears that the job and everybody else is the problem. Is that right?""","""Drinking is not the problem. It appears that the job and everybody else is the problem. Is that right?""",D,"The idea is to communicate by seeing the issue from the client's perspective and going from there. Paraphrasing can be a helpful way to do this. With paraphrasing, you affirm the client's view with empathy and support whether you agree with it or not. Paraphrasing helps you say what you heard in a non-­judgmental way. Therefore, the correct answer is (C)",counseling skills and interventions
1039,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","   ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years.  The client is unsure of his insurance benefits and allotted counseling sessions",The client is unsure of his insurance benefits and allotted counseling sessions. You review his benefits plan and any associated fees as part of which of the following?,The confidentiality agreement,The process of informed consent,An explanation of limitations,The client’s privacy rights,"(A): The confidentiality agreement
(B): The process of informed consent
(C): An explanation of limitations
(D): The client’s privacy rights",The process of informed consent,B,"The process of informed consent includes reviewing with the client payment, fees, and insurance benefits, including policies and procedures for nonpayment. Practitioners provide informed consent on an ongoing basis throughout the counseling relationship. Informed consent includes all of the essential information for the client to make an informed decision about receiving services. Other aspects of informed consent include the potential risks and benefits of counseling, emergency procedures, the overall purpose and goals, counselor credentials, and the role of technology. The confidentiality agreement is also part of informed consent. Privacy involves keeping confidential information secure. Therefore, privacy and confidentiality fall under the client’s rights and responsibilities section of informed consent. Lastly, an explanation of limitations is part of the confidentiality agreement and refers to informing clients of the circumstances in which a breach of confidentiality may occur. Therefore, the correct answer is (D)",professional practice and ethics
1040,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.  Ninth session The client's one-on-one aide presents to this session with the client. The client is crying and having difficulties following the aid's directives in the hallway. You walk into the hall and show the client a picture with ""a quiet sign."" You open your door, and he reluctantly walks in and begins to kick the toy bins. You show him the ""no"" visual sign and shake your head no. You sit on the floor quietly until he joins you on the floor. You pull out a deck of visual cue cards and place them in front of him. He points to a picture of a boy being mean to another classmate, then starts to cry harder.    You allow some extra time for the client to process his emotions. You then explain to him that it is not okay to kick the toy bin, and that he can use his words or draw pictures of what he feels instead. You provide reassurance that you are there to help him learn how to control his feelings in a better way. You then select some calming activities such as squeezing the stress ball and playing a matching game. As he begins to gain control of his emotions, you reinforce positive behaviors with verbal praise and approval. Throughout the session, you actively listen and provide opportunities for him to express himself in whatever manner is comfortable to him. You end the session by drawing a picture of yourself and your client, with both of you smiling together. You explain that this is what happens when you work together to find positive ways to cope with emotions.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What will work best in facilitating trust and safety at school for this client?,Role play the bullying and explore appropriate responses with the visual cards,Contact the client's parents and school regarding the potential bullying issues,Allow the client to take the stress ball with him to class,Monitor the client's routine to provide more supervised relational time,"(A): Role play the bullying and explore appropriate responses with the visual cards
(B): Contact the client's parents and school regarding the potential bullying issues
(C): Allow the client to take the stress ball with him to class
(D): Monitor the client's routine to provide more supervised relational time",Contact the client's parents and school regarding the potential bullying issues,B,"Addressing the bullying directly would be the most appropriate choice to facilitate trust and safety at school for this client. Therefore, the correct answer is (A)",professional practice and ethics
1041,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.  Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior.    Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships.",,What would be the best method to evaluate the client's current relational interactions?,Suggest that he invite his children to attend the next session,Invite him to create a family genogram,Explore his early childhood patterns of communication,Discuss instances in which he feels a positive connection with others,"(A): Suggest that he invite his children to attend the next session
(B): Invite him to create a family genogram
(C): Explore his early childhood patterns of communication
(D): Discuss instances in which he feels a positive connection with others",Suggest that he invite his children to attend the next session,A,"The idea is to see how he interacts in a relational context. Ultimately, the intention is to improve the client's relationships and to provide him with the skills necessary to build closeness with others. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1042,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.  Sixth session The wife presents for today's session without her husband. She reports that two nights ago, he was taken to the emergency room for pain. He had been drinking, and test results at the hospital liver indicated that his liver functioning was impaired. He continues to deny that he is drinking, but she knows this is untrue as she has been finding half-full liquor containers hidden around the house. She starts to cry, ""I don't know what I will do without him. I had to call a babysitter and get a cab to come here. I'm worried about how I'll pay for the mortgage if my husband can't work. We'll end up losing the house and our health insurance! I'm going to have to sell off everything to make ends meet!"" You respond to her fears with empathy and understanding. You are respectful of the client's thoughts and feelings and seek to understand her experience. You also explore the cognitive error that your client has made and how this is affecting her emotions.    You continue the session by asking her what her most immediate concerns are at the moment and what she needs help with. She pauses for a moment and then starts to explain how she is feeling overwhelmed by the situation and feeling helpless in being able to help her husband. She expresses a lot of fear and anxiety about her family's financial security and the potential loss of the house and health insurance if her husband's drinking continues. She expresses a need for support and understanding and worries about how she will cope without her husband. She feels isolated and alone, stating, ""I feel like my worst nightmare has come true. I've been worrying about my husband's drinking for a long time. I've heard horror stories about how addiction can ruin people's marriages, and I don't want that for us. I know it's hard for him, but it's hard for me, too."" You offer her some resources that could help her with her financial situation and ask her to put together a list of a few people she feels she can talk to for emotional support.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",How would you demonstrate congruence with the wife during this session?,"Show genuine interest in her thoughts, feelings, and experiences",Ask her clarifying questions to further understand her situation,Discuss resources to help her with her financial situation,"Sit up, lean toward the client, and make eye contact as she speaks.","(A): Show genuine interest in her thoughts, feelings, and experiences
(B): Ask her clarifying questions to further understand her situation
(C): Discuss resources to help her with her financial situation
(D): Sit up, lean toward the client, and make eye contact as she speaks.","Show genuine interest in her thoughts, feelings, and experiences",A,"Congruence is a technique used in counseling that focuses on creating a genuine connection between the counselor and the client. It involves being fully present with the client and honest about one’s reactions and feelings without judgment. In this session, you demonstrate congruence by offering the client emotional support and empathy. You acknowledge her feelings without judgment and let her know you are there to listen and support her. Therefore, the correct answer is (A)",counseling skills and interventions
1043,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",Shania often reprimanded her daughter before communicating her desired behaviors and became frustrated easily when she did not respond immediately. What suggestion should you not offer Shania?,Try setting expectations and giving Malia adequate time to follow through.,Look into free parenting seminars online or in your local community.,Consider joining a social media group for moms of kids with ADHD.,Don't reprimand Malia when she does not follow directions.,"(A): Try setting expectations and giving Malia adequate time to follow through.
(B): Look into free parenting seminars online or in your local community.
(C): Consider joining a social media group for moms of kids with ADHD.
(D): Don't reprimand Malia when she does not follow directions.",Don't reprimand Malia when she does not follow directions.,D,"All these suggestions would be helpful for Shania with the exception of answer d), as it may be appropriate at times to reprimand Malia for defiance. However, working with Shania on how to recognize defiance from inattention or lack of comprehension will be useful in addressing her frustration tolerance and improving communication with her daughter. Therefore, the correct answer is (D)",counseling skills and interventions
1044,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",Which of the following assessments would be the most appropriate tool to use to evaluate the client's behavioral issues?,Conners Rating Scale,Social Responsiveness Scale,Child Behavior Checklist,The TWEAK Test,"(A): Conners Rating Scale
(B): Social Responsiveness Scale
(C): Child Behavior Checklist
(D): The TWEAK Test",Child Behavior Checklist,C,"This checklist is used to detect behavioral and emotional problems in children and adolescents and would be most appropriate to use in this case. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1045,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”",Why was Lottie diagnosed with code F43.9 instead of F43.1?,It is an error; F43.1 is the correct code for Reaction to severe stress,F43.1 is a milder stress condition,She did not meet criteria for diagnosis of F43.1,She must show symptoms of F43.9 for over 6 months to qualify for F43.1,"(A): It is an error; F43.1 is the correct code for Reaction to severe stress
(B): F43.1 is a milder stress condition
(C): She did not meet criteria for diagnosis of F43.1
(D): She must show symptoms of F43.9 for over 6 months to qualify for F43.1",She did not meet criteria for diagnosis of F43.1,C,"F431 is the diagnostic code in the DSM-5 for Post-traumatic stress disorder (PTSD) and Lottie did not meet criteria when assessed for symptoms. Answers a), b) and d) are all false. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1046,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.","In planning treatment goals for this client, which of the following would be the most effective counseling goal for this diagnosis?",Encourage client's husband to attend marital counseling to strengthen relationship,"Explore childhood neglect and/or abuse, often related to body dysmorphic disorder",Challenge automatic negative thoughts about body image,Identify a support system that reassures client that she is attractive,"(A): Encourage client's husband to attend marital counseling to strengthen relationship
(B): Explore childhood neglect and/or abuse, often related to body dysmorphic disorder
(C): Challenge automatic negative thoughts about body image
(D): Identify a support system that reassures client that she is attractive",Challenge automatic negative thoughts about body image,C,"Cognitive behavioral interventions such as challenging automatic thoughts is the standard treatment for body dysmorphic disorder. Childhood neglect and abuse are often related to body dysmorphic disorder, and exploring these may facilitate client insight, which can be helpful in actual treatment. Effective treatment of this disorder requires the client to reduce reassurance seeking behaviors. Having a support system that provides the reassurance the client constantly is seeking does not help the client reduce her own anxiety about her body image or the need for constant reassurance. Having the client's husband attend therapy to focus on the relationship is not likely to reduce the client's body dysmorphia symptomatology as it is an ingrained pattern. Therefore, the correct answer is (A)",counseling skills and interventions
1047,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","The client no-showed for her last session without calling to cancel. She arrives today, appearing disheveled and irritable. The client states that she has not been sleeping well. She explains that she was talking to someone on an online dating site and had planned a face-to-face meeting this past weekend. She says she waited at the bar for more than an hour and finally realized that her date had stood her up. She explained that she was in so much shame after the incident that she engaged in self-harm. The client reveals superficial razor cuts on her thigh and upper arm. She says she feels like she is a failure and undeserving of love.  You model a dialectical stance for the client by providing acceptance while simultaneously facilitating change",You model a dialectical stance for the client by providing acceptance while simultaneously facilitating change. This is a process known as which of the following?,Validation,Clarification,Confirmation,Affirmation,"(A): Validation
(B): Clarification
(C): Confirmation
(D): Affirmation",Validation,A,"Validation refers to a counselor’s ability to provide acceptance while simultaneously facilitating change. Engaging in this paradox exemplifies a dialectical stance, which is to hold two seemingly opposed truths. It is a practice of dialectical behavior therapy that can help decrease the client’s physiological and psychological arousal. In general, affirmations are statements acknowledging an individual’s positive qualities or capabilities. Counselors use confirmation when establishing truth or certainty. Clarification is used when counselors seek understanding when ideas are expressed when statements are contradictory or difficult to understand. Therefore, the correct answer is (A)",counseling skills and interventions
1048,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Which of the following will be most helpful for assessing this client for ADHD?,Vanderbilt Assessment Scales (VAS),Behavior Assessment System for Children (BASC) Parent Rating Scale,Test of Variables of Attention (TOVA),Conners Rating Scale for ADHD (CRS),"(A): Vanderbilt Assessment Scales (VAS)
(B): Behavior Assessment System for Children (BASC) Parent Rating Scale
(C): Test of Variables of Attention (TOVA)
(D): Conners Rating Scale for ADHD (CRS)",Test of Variables of Attention (TOVA),C,"The TOVA is a computerized test system that can be used to assess adults (and children) for both inattentive and hyperactive types of attention deficit disorder. The BASC, CRS, and VAS are rating scales for testing children only. The BASC Parent Rating scale is used for the parent to provide observations of their child's attention and activity, which a clinician will use with other data to determine or rule out a potential ADHD diagnosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1049,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.",Which of the following treatment areas can be ruled out?,Conduct disorder,Eating disorder,Complicated grief,Post-traumatic reaction,"(A): Conduct disorder
(B): Eating disorder
(C): Complicated grief
(D): Post-traumatic reaction",Conduct disorder,A,"Conduct disorder is typically given to children under age 18 and is a repetitive and persistent pattern of behavior in which the basic rights of others or societal norms or rules are violated and at least three of fifteen criteria are met over the past 12 months; Millie is over 18, and while she has two areas of conduct-like behaviors, they might also be better explained by other contributing factors. Millie's case presents with several pieces of information that could warrant treatment in the areas of eating disordered behavior, grief and loss, and treatment of post traumatic reactions. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1050,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ",You find it difficult to establish rapport with the client during the intake session as she spends most of the time talking and not listening to anything that you say. Which of the following is least helpful for building rapport?,Affirm the client's willingness to start therapy,Assess the client's presenting problem,Help the client understand the therapy process,Discuss what the client can expect in therapy,"(A): Affirm the client's willingness to start therapy
(B): Assess the client's presenting problem
(C): Help the client understand the therapy process
(D): Discuss what the client can expect in therapy",Assess the client's presenting problem,B,"Assessing the client's presenting problem is not an appropriate method to build rapport with the client as it does not help you relate to the client. Instead, it is an assessment tool. In addition, building rapport requires communication and conversation, so assessing the client's presenting problem would not be an effective way to connect with the client. Instead, more open-ended questions or statements that invite the client to talk and share their thoughts, feelings, and experiences are a better way to build rapport. Questions about the client's interests, hobbies, or family can also be used to start building a connection with them. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1051,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","   ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression.  You meet with the client and her grandmother to create a genogram so you can assess the family’s multigenerational transmission process",You meet with the client and her grandmother to create a genogram so you can assess the family’s multigenerational transmission process. Which one of the following family theorists is known for this technique?,Jay Haley,Murray Bowen,Salvador Minuchin,Virginia Satir,"(A): Jay Haley
(B): Murray Bowen
(C): Salvador Minuchin
(D): Virginia Satir",Murray Bowen,B,"Murray Bowen is known for multigenerational (extended) family systems therapy. The multigenerational transmission process is a Bowenian technique used to assess how a family’s dysfunctional interactions can be handed down from generation to generation. Bowen was the first to introduce the genogram, a visual depiction of a family’s generational interactions, and significant patterns of relationships. Salvador Minuchin is associated with structural family therapy. Jay Haley is known for strategic family therapy. Finally, Virginia Satir pioneered the human validation process model of family therapy. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1052,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client.  While in session with the couple, you state, “You’re telling me that you value your marriage and family, yet you remain unwilling to change behaviors that are causing you to lose them","While in session with the couple, you state, “You’re telling me that you value your marriage and family, yet you remain unwilling to change behaviors that are causing you to lose them.” This is an example of which one of the following?",Confrontation,Reframing,Interpretation,Empathetic attunement,"(A): Confrontation
(B): Reframing
(C): Interpretation
(D): Empathetic attunement",Confrontation,A,"This statement is an example of confrontation. Effective confrontation promotes greater awareness and insight by pointing out discrepancies in clients’ thoughts, words, or actions. The goal of confrontation is to reduce resistance by calling attention to the incongruence between clients’ expressed values and their behaviors. Counselors use interpretation to test a hypothesis or theory about a client’s experiences or inner thoughts and feelings. Reframing is used when counselors rephrase a client’s statement in a way that offers a different perspective or optimistic viewpoint. Counselors express empathetic attunement by becoming in sync with a client’s inner feelings or emotional state. Therefore, the correct answer is (B)",counseling skills and interventions
1053,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”","Disagreeing with Lottie's mom's opinion on her medication needs, you decide to speak with her later about it. How should you explain to mom the reasons for your psychiatric referral?",She will not be successful without medication.,Medication will also resolve her oppositional defiance.,Untreated symptoms of ADHD are hindering growth.,You can't get her to do your assignments.,"(A): She will not be successful without medication.
(B): Medication will also resolve her oppositional defiance.
(C): Untreated symptoms of ADHD are hindering growth.
(D): You can't get her to do your assignments.",Untreated symptoms of ADHD are hindering growth.,C,"Lottie has endorsed that medication was once helpful to her, and that she wants to return to using it. She is clearly having undesired difficulty with her symptoms and is not progressing in treatment as she should. You recall the family's insurance is now active and can therefore possibly cover the cost of medications, should a psychiatric evaluation warrant them. Submitting a referral for her evaluation is appropriate and her mother's refusal to do so without good reason could be considered neglect. Medication will not necessarily resolve Lottie's ODD symptoms but can aid in her impulse control. Lottie can become successful with interventions other than use of medication, but her unwillingness to do work with you in session is not criteria for prescribing medication. The consequence of not working on assignments could be a lack of growth, which is why in speaking to Lottie's mom, who may be resistant to the idea of medication, the idea of submitting a referral for her evaluation should be prioritized. Either way, without properly treating ADHD, it will be much harder to isolate and treat symptoms from other disorders. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1054,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy",Which one of the following is NOT a characteristic method of CBT?,The assignment of homework,Use of Socratic questioning,An emphasis on unconscious experiences,An approach that is structured and directive,"(A): The assignment of homework
(B): Use of Socratic questioning
(C): An emphasis on unconscious experiences
(D): An approach that is structured and directive",An emphasis on unconscious experiences,C,"Unlike therapies such as psychoanalysis, CBT does not emphasize unconscious experiences. Completing homework is an expectation of CBT, which is necessary for applying what is learned in therapy to real-world experiences. CBT practitioners use Socratic questioning to help understand the client’s underlying cognitions. CBT is a structured and directive approach, with the counselor working collaboratively with the client and functioning as a coach or teacher. Therefore, the correct answer is (C)",counseling skills and interventions
1055,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.","When a client presents with a mild neurocognitive disorder (NCD) due to traumatic brain injury and meets criteria for an affective disorder, which is the most appropriate method to relay diagnosis to the client and other professionals?",Create and code the diagnosis for the affective disorder.,The primary concern should not include the diagnosis of the affective disorder.,"Diagnose the affective disorder and pay no attention to NCD, as affective disorders require more extensive treatment.",Include a diagnostic specifier stating that criteria for an affective disorder are met.,"(A): Create and code the diagnosis for the affective disorder.
(B): The primary concern should not include the diagnosis of the affective disorder.
(C): Diagnose the affective disorder and pay no attention to NCD, as affective disorders require more extensive treatment.
(D): Include a diagnostic specifier stating that criteria for an affective disorder are met.",Create and code the diagnosis for the affective disorder.,A,"If full criteria for an affective disorder are met, this is the most appropriate method to relay the information. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1056,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ","While in the initial assessment interview with the client, what action would you take to devise a provisional diagnosis for Borderline Personality Disorder?",Apply assessment instruments that evaluate the client's needs,Assess the support network the client utilizes,Gather information about the client’s history of the presenting problem,Provide psychoeducation related to Borderline Personality Disorder and assess whether the client can relate to the diagnosis,"(A): Apply assessment instruments that evaluate the client's needs
(B): Assess the support network the client utilizes
(C): Gather information about the client’s history of the presenting problem
(D): Provide psychoeducation related to Borderline Personality Disorder and assess whether the client can relate to the diagnosis",Gather information about the client’s history of the presenting problem,C,"Gathering information about the client's history of the presenting problem is the correct choice because this can lead you to a provisional diagnosis for BPD. When considering a diagnosis, it is necessary to determine the frequency, intensity, and duration of symptoms, functioning level, and medication or substance use. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1057,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.",Which of the following will be most helpful for the client to initially manage his intense feelings when he hears something that is perceived as criticism?,Exposing the client slowly to greater amounts of negative feedback while in session,"Help client determine when ""tuning out"" is appropriate",Work with client on empathy exercises so he can see other perspectives,Teaching and practicing relaxation exercises with the client during aroused states,"(A): Exposing the client slowly to greater amounts of negative feedback while in session
(B): Help client determine when ""tuning out"" is appropriate
(C): Work with client on empathy exercises so he can see other perspectives
(D): Teaching and practicing relaxation exercises with the client during aroused states",Teaching and practicing relaxation exercises with the client during aroused states,D,"Teaching the client and having him practice relaxation exercises is the most appropriate intervention at this time. By implementing relaxation exercises in the moment, he is more likely to not speak or act out of hurt and anger, but will provide himself time to gather his feelings prior to responding. This is a helpful behavioral step initially, and in the future, will be combined with empathy training and self-esteem work to strengthen his own intrapsychic feelings about himself. Prolonged exposure helps an individual to gradually become more comfortable with situations that cause high emotions or anxiety. However, using criticism as exposure to a client with fragile self-esteem will cause greater self-esteem injuries and will threaten the therapeutic relationship. Encouraging one to use a defense mechanism that threatens one's relationships is not an appropriate intervention. Therefore, the correct answer is (A)",counseling skills and interventions
1058, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.",What is a question you should ask Leah to help diagnose or rule out PTSD?,Did you experience any physical injuries to the head?,Do you experience recurrent triggering dreams since any of your traumas?,Do you frequently have unpleasant memories?,Do you feel the urge to share your traumatic experiences with everyone?,"(A): Did you experience any physical injuries to the head?
(B): Do you experience recurrent triggering dreams since any of your traumas?
(C): Do you frequently have unpleasant memories?
(D): Do you feel the urge to share your traumatic experiences with everyone?",Do you experience recurrent triggering dreams since any of your traumas?,B,"The presence of intrusion symptoms such as recurrent distressing dreams involving the content of the dream related to the traumatic event is a noted diagnostic criterion for PTSD as per the DSM-5. Frequent, unpleasant memories are not a noted criteria for PTSD, nor is the feeling or urge to share about traumatic experiences. While these may be symptoms alerting to a psychologically distressing event or difficulty in achieving emotional resolution, they would not in and of themselves qualify for indications of PTSD. Traumatic brain injuries (TBI) are diagnosed separately from PTSD, therefore asking about TBI does not help rule out PTSD. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1059,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ","As a mandated reporter, who is the most appropriate person for you to contact regarding the client's depressive state?",The client's husband,Your supervisor,The client's psychiatrist,The client's mother,"(A): The client's husband
(B): Your supervisor
(C): The client's psychiatrist
(D): The client's mother",The client's mother,D,"The client's mother is the safest choice as the client's husband has left the family. The client listed her mother as an emergency contact on the intake form. Therefore, the correct answer is (B)",professional practice and ethics
1060,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.  Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, ""On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life."" The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, ""Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!""    You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now.    At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her.",,"As part of your yearly performance evaluation, you are asked to list examples of when you showed advocacy for client issues. Which of the following would be appropriate to include in your summary?",You provide therapeutic services at a reasonable cost for members of your community.,You were instrumental in procuring continued funding for a community senior center.,You have been the author of several well-received articles in a respected psychological journal.,You provided a free workshop about the importance of the counseling profession.,"(A): You provide therapeutic services at a reasonable cost for members of your community.
(B): You were instrumental in procuring continued funding for a community senior center.
(C): You have been the author of several well-received articles in a respected psychological journal.
(D): You provided a free workshop about the importance of the counseling profession.",You were instrumental in procuring continued funding for a community senior center.,B,"A facility that helps seniors is a client issue, and procuring continued funding for the community senior center demonstrates advocacy for clients on your part. Therefore, the correct answer is (D)",professional practice and ethics
1061,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Which of the following approaches is likely to be most effective for Shawn?,Creating pros and cons lists for hanging out with his friends,Asking challenging questions for Shawn to debate,Listing positive qualities and past successes for motivation,Pointing out Shawn's cognitive distortions to help increase insight,"(A): Creating pros and cons lists for hanging out with his friends
(B): Asking challenging questions for Shawn to debate
(C): Listing positive qualities and past successes for motivation
(D): Pointing out Shawn's cognitive distortions to help increase insight",Listing positive qualities and past successes for motivation,C,"Conducting this exercise will most likely improve Shawn's self-esteem, which is quite low. Approaches in answers a and b are quite confrontational and may only increase Shawn's sensitivity to his perceived criticism from his parents. Answer d might seem like a helpful intervention, however, pointing out anything negative that Shawn is already struggling with might only increase his anxiety and hyper focus on his existing resistance to spend time with his friends. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1062,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling",Which concept would a gestalt therapist use to explain the client’s tendency to blame his parents for his current situation?,Introjection,Projection,Retroflection,Confluence,"(A): Introjection
(B): Projection
(C): Retroflection
(D): Confluence",Projection,B,"Gestalt therapists would use the concept of projection to explain the client’s interaction with his parents. Projection is the tendency to discount one’s role in an event and instead assign blame to others. Projection is common among individuals who, like the client, exhibit paranoia and suspicion. Introjection is the opposite of projection in that blame is assigned to oneself rather than the environment. Introjection involves psychologically swallowing information in the environment without proper analysis, judgment, or discernment. Introjection consists of doing what others would like one to do. Retroflection, which is translated into “turning back sharply against,” is doing to oneself what one would do to others. Lastly, confluence occurs when there is no delineation between self and others. Confluence can manifest into resentment and intolerance of oneself and others. Therefore, the correct answer is (A)",counseling skills and interventions
1063,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,"When a counselor encounters clinical issues that he is not familiar with, he should?",Hope for the best,Conduct internet research,Refer out to another therapist,Consult with supervisor/colleagues,"(A): Hope for the best
(B): Conduct internet research
(C): Refer out to another therapist
(D): Consult with supervisor/colleagues",Consult with supervisor/colleagues,D,"It is not uncommon for counselors to encounter clinical issues that they are not familiar with. Other licensed clinicians, especially one's supervisor can help to inform/train counselors. Referral out should only be chosen if it is determined that the counselor does not have the capacity to work with the client and shouldn't be a first option. Being hopeful that positive changes can occur is an important trait for a counselor, but they should not just hope that they will gain the knowledge they need. This would be to the detriment to the client. Only professional or peer reviewed research should be conducted in this situation. Therefore, the correct answer is (C)",professional practice and ethics
1064,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",Which assessment would provide additional information related to the client's presenting problems?,World Health Organization Disability Schedule 2.0,Hamilton Anxiety Rating Scale (HAM-A),The client's substance use,Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale,"(A): World Health Organization Disability Schedule 2.0
(B): Hamilton Anxiety Rating Scale (HAM-A)
(C): The client's substance use
(D): Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale",Hamilton Anxiety Rating Scale (HAM-A),B,"Given the client's diagnosis and presenting symptoms, this would be appropriate. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1065, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,An appropriate response from the counselor to Li's situation would be?,How much can you pay?,We must use your name for our records.,We can use a pseudo name if that is what you are most comfortable with.,"Don't worry, if we use your real name, nothing will happen.","(A): How much can you pay?
(B): We must use your name for our records.
(C): We can use a pseudo name if that is what you are most comfortable with.
(D): Don't worry, if we use your real name, nothing will happen.",We can use a pseudo name if that is what you are most comfortable with.,C,"There may be times when a client may not want to use their real name. If they are not paying through insurance, this should be accommodated. A client should not be forced to use their legal name. In this instance the client is concerned because they are not documented. It would be misleading to tell client to not worry and that nothing would happen to them. Asking about payment is not addressing the client's question and is insensitive to what the client is expressing. Therefore, the correct answer is (C)",counseling skills and interventions
1066,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.  Fourth session When you arrive at your office today, you realize that you inadvertently left therapy notes on your desk after work on Friday, which included information about Michael's case, and the notes are not where you left them. The weekend cleaning crew lets you know that the notes were discarded in the trash. You take the appropriate action in managing this breach of confidentiality, following your practice's guidelines and policies. You also take time to reflect on how this incident could have been prevented and use it as a learning opportunity for yourself.    When you met with Michael and his parents during the previous two sessions, you gathered additional information about his symptoms, thoughts, and feelings. You provided psychoeducation about separation anxiety and recommended that Michael's parents make an appointment for him to see his pediatrician. You also began to formulate a treatment plan with the overall goal of tolerating separation from his parents without severe distress.    Michael and his parents present for today's session on time. The parents begin by reporting that their son's symptoms continue to be a problem. School refusal is still an issue. His mother has had to come home from work three times this past week. His outbursts were so loud that the neighbors came by to check on him. The mother says, ""My boss has been patient with me so far, but pretty soon, I'm going to be at risk of losing my job if we can't get a handle on our son's behavior. What are we doing wrong?"" Your focus during this session is on helping the parents understand their role in the therapy process. You start by reviewing some of the psychoeducation you provided in prior sessions, focusing on the importance of consistency in parenting approaches and providing structure for Michael at home. You discuss different strategies they can use at home to help build their son's coping skills. You also provide some relaxation exercises that Michael can do when he feels anxious.    At the end of the session, you thank Michael and his parents for coming in today and assure them that they are on the right track. You take time to summarize the key points of the session and emphasize the importance of follow-through with what was discussed in order for progress to be made. You provide them with resources to further support their efforts and suggest a follow-up appointment in one week.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ",What immediate step(s) should you take in response to the loss of your notes?,You should only contact the client to report the incident.,You should report the loss to the insurance company covering the sessions.,You should contact your supervisor and your client to explain the potential breach of confidentiality.,You should only contact the supervisor to report the incident.,"(A): You should only contact the client to report the incident.
(B): You should report the loss to the insurance company covering the sessions.
(C): You should contact your supervisor and your client to explain the potential breach of confidentiality.
(D): You should only contact the supervisor to report the incident.",You should contact your supervisor and your client to explain the potential breach of confidentiality.,C,"This is the best answer as any breach of confidentiality, including your notes being thrown away in the trash, should be reported to both the client and your supervisor. Therefore, the correct answer is (C)",professional practice and ethics
1067,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.","Several weeks later, John calls you to share that he has reconnected with his daughter and is very grateful for your help. He offers to take you out to dinner with him and his daughter Friday night as a personal thank you. Which is the best response that is both ethical and supportive?","""I am not allowed to have social engagements with clients, it is inappropriate, I'm sorry.""","""That's great news John! I cannot accept your invitation but thank you for offering!""","""That's great news John! I wouldn't be able to stay for long, but I can pop in to say hi.""","""I am so happy for you both, but I have a prior engagement so it will have to be a raincheck.""","(A): ""I am not allowed to have social engagements with clients, it is inappropriate, I'm sorry.""
(B): ""That's great news John! I cannot accept your invitation but thank you for offering!""
(C): ""That's great news John! I wouldn't be able to stay for long, but I can pop in to say hi.""
(D): ""I am so happy for you both, but I have a prior engagement so it will have to be a raincheck.""","""That's great news John! I cannot accept your invitation but thank you for offering!""",B,"This is the most straight forward response while also offering enthusiasm and support in celebrating your client's victory. Any other option suggests either that another social opportunity might be appropriate, or that you are more concerned with the ethics of the dinner invitation rather than the client's breakthrough news. Therefore, the correct answer is (D)",professional practice and ethics
1068, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.",Which of the following interventions would be the most effective for beginning the termination?,Summarize the gains the client has made during the past six weeks,Use self-disclosure to share your disappointment at not continuing to work with the client,Ask the client if she enjoyed the clinician who visited her recently,Tell the client and her mother that this will be your last session together,"(A): Summarize the gains the client has made during the past six weeks
(B): Use self-disclosure to share your disappointment at not continuing to work with the client
(C): Ask the client if she enjoyed the clinician who visited her recently
(D): Tell the client and her mother that this will be your last session together",Summarize the gains the client has made during the past six weeks,A,"Summarizing the gains made by the client is the most effective way of beginning the termination. This allows the counselor, client, and her mother to see the improvements that they have made in the client and in the family. This focuses the improvement on the client and family rather than on the skill or contributions of the clinician. During the conversation that follows, each of the other responses will be appropriate but the conversation should not lead with these. Leading with self-disclosure focuses on the counselor and your feelings, not the client. It also does not tell the client or her mother what is happening. Telling the client and her mother that this is the last session is appropriate but is an abrupt statement that will cause distress while explanations are made and further information is given. Asking the client if she enjoyed the recent clinician is a good way to transition into discussing who will be providing services in the future, but still leaves the termination of the current relationship undisclosed. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1069,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.  Seventh session It has been almost two months since you began therapy with the client. You suggested a session in which both she and her mother were present to discuss the client's progress. She presents to today's session with her mother. The client followed up with your referral from a previous session for her to see a psychiatrist and has provided you with a release of information to communicate with her psychiatrist. The client has been prescribed an antidepressant and says she does not feel any notable change yet but the psychiatrist told her it would take a few weeks to know if the medication was working. The mother states that since her daughter started taking the antidepressant, she is sleeping more than usual and struggles to get out of bed. She has been late to school several times. She is also having trouble with motivation. You reflect the client's current state and suggest she establish a daily routine to gain a sense of control in her life. You discuss the importance of making small achievable goals and explain that taking on too much can be overwhelming, so it is more beneficial to focus on one task at a time. The mother begins listing off potential activities that her daughter should take part in. The client closes her eyes and begins to sigh. When you ask her about her reaction, she says, ""See, yet another example of my mom trying to control everything."" The mother responds by saying, ""I'm not trying to control you. Believe it or not, I just want what's best for you!""    Understanding the tension between them, you suggest a compromise. You explain that if the client completes one activity each day, her mother will not pressure her to do more. The client appears hesitant but agrees to try it out. You then turn to the mother, thanking her for being willing to compromise and understanding. You encourage them to be patient with one another and remind them that progress takes time. You suggest they continue to have regular check-ins so that each party is aware of how the other is doing in following through on the agreement. You end the session by summarizing what was discussed, reinforcing the importance of communication between the client and her mother.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",What post-test measure would best determine the effectiveness of your treatment?,Thematic Apperception Test,Outcome Rating Scale (ORS),Problem-Oriented Screening Instrument for Teenagers,Beck Depression Inventory,"(A): Thematic Apperception Test
(B): Outcome Rating Scale (ORS)
(C): Problem-Oriented Screening Instrument for Teenagers
(D): Beck Depression Inventory",Outcome Rating Scale (ORS),B,"The ORS is a brief outcome measure which enables clients to provide feedback on their perceptions of their progress in achieving their therapeutic goals. Therefore, the correct answer is (D)",treatment planning
1070,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",Which of the following is considered a differential diagnosis for Social Anxiety Disorder?,Agoraphobia,Antisocial Personality Disorder,Paranoid Personality Disorder,Borderline Personality Disorder,"(A): Agoraphobia
(B): Antisocial Personality Disorder
(C): Paranoid Personality Disorder
(D): Borderline Personality Disorder",Agoraphobia,A,"Agoraphobia is a differential for Social Anxiety Disorder. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1071,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","   n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family.  The client says she felt like her soul left her body upon her grandmother’s death. This experience left her with feelings of sadness, loss, worthlessness, and suicidality","The client says she felt like her soul left her body upon her grandmother’s death. This experience left her with feelings of sadness, loss, worthlessness, and suicidality. This describes which of the following culturally bound conditions?",Ataque de nervios,Mal de ojo,Susto,Confianza,"(A): Ataque de nervios
(B): Mal de ojo
(C): Susto
(D): Confianza",Susto,C,"Susto, in particular interpersonalsusto, is characterized by feelings of abandonment, loss, sadness, suicidality, and poor self-worth. According to the DSM-5-TR, “Sustois an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness, as well as difficulties functioning in key social roles” (APA, 2022). The DSM-5-TR describes syndromic types to include interpersonalsusto, sustorelating to a traumatic event, andsustomarked by somatic symptomsAtaque de nervios(ie, “attack of nerves”) is an idiomatic expression used by Latinos to describe symptoms of intense anger, grief, worry, dissociation, or emotional distressAtaque de nervioscan escalate to the point of uncontrollable crying, seizures, shaking, and verbal or physical aggression. These attacks can occur as the result of a stressful event (eg, news of the death of a significant person, familial conflict) but can also happen in the absence of a stressful event or trigger for a minority of individualsConfianza is a Hispanic value that refers to the sense of comfort and ease when revealing oneself to another. For Hispanics, establishing trust within the confines of the therapeutic relationship can promote healing and restore ties within the context of personal relationships. Finally,mal de ojo,a Spanish term meaning “evil eye,” is associated with social conflict or jealousy and is believed to cause physical illness, misfortune, and death. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1072,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community.  You select Aaron Beck’s cognitive model for depression to address the client’s feelings of worthlessness","You select Aaron Beck’s cognitive model for depression to address the client’s feelings of worthlessness. According to Beck, causes of the client’s distorted thinking can be attributed to which of the following?",Feelings of inferiority due to a mistaken style of life,"Activating events, beliefs, and consequences",Unresolved unconscious conflicts,"View of oneself, the world, and one’s future","(A): Feelings of inferiority due to a mistaken style of life
(B): Activating events, beliefs, and consequences
(C): Unresolved unconscious conflicts
(D): View of oneself, the world, and one’s future","View of oneself, the world, and one’s future",D,"Beck would attribute causes of the client’s distorted thinking to their view of themselves, their world, and their future. These cognitive deficiencies are known as the “cognitive triad” Freud attributed maladaptive behavior to unresolved conscious conflicts. Adlerian therapists view maladjustment as the development of a mistaken style of life leading to feelings of inferiority. Known for rational-emotive therapy, Ellis suggests that irrational thinking can be deconstructed by recognizing an activating event, beliefs, and consequences. Therefore, the correct answer is (D)",counseling skills and interventions
1073,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises.  Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable.    You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times.    After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client.  Ninth session The client's parents were elated to see their daughter make significant progress in her reading at school. After careful consideration and collaboration between you, the client, her teachers, and the paraprofessional, the team has all devised a treatment plan tailored specifically to her needs. Incorporating a small group setting provided the client with the individualized attention she needed to become successful in her reading skills.    As the session came to an end today, it was clear that both the client and her parents were satisfied with the results of their hard work. To ensure that they felt comfortable moving forward and everybody was on the same page, you asked them, ""What I hear you saying is that you feel as though your daughter has met her educational goals and has the support to continue to succeed? Is that correct?"" Both of them smiled knowingly and nodded affirmatively.    With a sense of closure now achieved by this family team, the parents left feeling confident about continuing on this path towards helping their daughter reach success with reading deficits. Together they had created a practical plan which could be adapted as necessary along the way, one which would pave a brighter future for the client."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What resource would you recommend for continued support after termination?,Family Therapy,Peer Support Group for behavioral issues,Organization for families of children with learning disabilities,Medication referral for anxiety,"(A): Family Therapy
(B): Peer Support Group for behavioral issues
(C): Organization for families of children with learning disabilities
(D): Medication referral for anxiety",Organization for families of children with learning disabilities,C,"The parents and client will benefit from connecting with others in their community (whether it's in person or an online community) who are dealing with similar issues. Therefore, the correct answer is (B)",treatment planning
1074,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals.  The client blames his parents for his problems. You ask the client to add the phrase “… and I take responsibility for it” at the end of his statements to create present-moment awareness and help him assume responsibility for his current difficulties",The client blames his parents for his problems. You ask the client to add the phrase “… and I take responsibility for it” at the end of his statements to create present-moment awareness and help him assume responsibility for his current difficulties. This is a technique of which one of the following?,Acceptance and commitment therapy (ACT),MI,Transactional analysis,Gestalt therapy,"(A): Acceptance and commitment therapy (ACT)
(B): MI
(C): Transactional analysis
(D): Gestalt therapy",Gestalt therapy,D,"Gestalt therapists use the technique of adding, “… and I take responsibility for it” at the end of client statements. Gestalt therapy is centered in the present moment and is designed to raise awareness of blocks to self-growth through the promotion of personal responsibility. Transactional analysis therapists use parent, adult, and child ego states to represent patterns of thinking, feeling, and acting. Techniques for transactional analysis include game and script analysis. ACT combines mindfulness and behavioral therapy to assist individuals with greater self-acceptance of uncomfortable feelings. ACT techniques include cognitive diffusion and creating a life compass. Finally, MI is a counseling approach that uses multiple strategies to evoke change, including developing discrepancy and rolling with resistance. Therefore, the correct answer is (A)",counseling skills and interventions
1075,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","Sixth Session, 3 Weeks After the Initial Intake The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness",Which one of the following best defines acceptance and commitment therapy?,Notice and embrace the situation at hand.,Focus on human abilities and limitations.,Accept the situation and realize one’s ability to change thoughts and behaviors for a different outcome.,Focus on releasing repressed emotions and experiences.,"(A): Notice and embrace the situation at hand.
(B): Focus on human abilities and limitations.
(C): Accept the situation and realize one’s ability to change thoughts and behaviors for a different outcome.
(D): Focus on releasing repressed emotions and experiences.",Notice and embrace the situation at hand.,A,"Acceptance and commitment therapy focuses on accepting present emotions and staying present in those thoughts and emotions without judgment. Accepting the situation and realizing the ability to change it is a CBT approach. The focus on human abilities and limitations is key to existential therapy. A focus on repressed emotions and experiences is a feature of psychoanalysis. Therefore, the correct answer is (A)",counseling skills and interventions
1076,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,What historical data is important to gather currently?,Early family history,Immunization records,Seasonal mood patterns,Quality of Darlene and Tony's relationship,"(A): Early family history
(B): Immunization records
(C): Seasonal mood patterns
(D): Quality of Darlene and Tony's relationship",Early family history,A,"Destiny's early family history may fill in some important pieces of information such as attachment with early caregiving figures. Although health information is needed, immunization records are not needed. There are no patterns to Destiny's behaviors so there is no need to track seasonal mood patterns. Currently, there is no information to suggest that Darlene and Tony are having conflict. If there was some indication, it would important information to review as Destiny has lost parental figures in the past. Therefore, the correct answer is (A)",professional practice and ethics
1077, Initial Intake: Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.",Which of the following should you discuss with the client in preparation for counseling?,Counseling is only effective when the client feels safe enough to be themselves.,Counseling is hard work and sometimes she will leave feeling emotionally tired.,Counseling works best if the client commits to weekly sessions in the first few months.,Counseling only works if the client is completely truthful with the counselor.,"(A): Counseling is only effective when the client feels safe enough to be themselves.
(B): Counseling is hard work and sometimes she will leave feeling emotionally tired.
(C): Counseling works best if the client commits to weekly sessions in the first few months.
(D): Counseling only works if the client is completely truthful with the counselor.",Counseling is only effective when the client feels safe enough to be themselves.,A,"Research has shown that the therapeutic relationship between client and counselor is the most important element in effective counseling. When the client feels safe enough to be themselves, they will, in the therapy room, act in the same ways that they interact with others, which allows the counselor to help them look at their interpersonal style and skills. As a result, the client can choose new ways to think, feel, and behave. It is true that counseling is hard, clients will sometimes leave tired, and counseling can move faster if clients attend weekly at first. The latter is not a requirement for effective counseling however and slower gains are still beneficial. Counseling is easier and may work more effectively if a client is truthful with the counselor but it is not necessary. Clients may tell their stories from a skewed perspective and the truth they tell may not be what actually occurred. Counselors are trained to observe clients and through empathic attunement and responses may help clients work on ways of thinking, feeling, and behaving without knowing the full circumstances about an event. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1078,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Based on the client's history and self-report during the initial session regarding her symptoms and behavior, which diagnosis would you consider?",Social Anxiety Disorder,Avoidant Personality Disorder,Panic Disorder and Agoraphobia,Panic Disorder,"(A): Social Anxiety Disorder
(B): Avoidant Personality Disorder
(C): Panic Disorder and Agoraphobia
(D): Panic Disorder",Panic Disorder and Agoraphobia,C,"The client meets criteria for both Panic Disorder and Agoraphobia. She has reported having multiple panic attacks which are sudden episodes of intense fear or discomfort that peak within minutes, along with Agoraphobia which is an intense fear and avoidance of situations in which escape may be difficult or embarrassing. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1079,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.  Eighth session The client has been attending sessions weekly for two months. Today, you begin by reviewing the progress the client has made in therapy. She has joined a support group and has made some new friends but still feels anxious about her future. She has also joined a bridge group but is finding that she is having difficulty remembering what cards are being played. At your suggestion, she also made an appointment with a psychiatrist and was prescribed a low dosage of Paxil. She feels more positive and states that she may volunteer at a local animal shelter. The client also mentions that yesterday she received official divorce documents in the mail. As she tells you about this, you notice her mood shifts. She quietly shares, ""On some level, I think I've known that my marriage has been over for a while, but when I got the legal papers, it made it feel real for the first time. My thoughts are all over the place. I'm still very hurt by all of this, but I know that I need to move forward with my life."" The client tells you one of the friends she met in her support group suggested that she consider joining a dating app, and she asks if you could help her. She says, ""Technology has changed so much since I first started dating my soon-to-be ex-husband. I don't know how any of this works!""    You validate her feelings and offer her reassurance that these kinds of emotions are completely normal in this situation. You suggest she take some time to process and grieve the end of her marriage. You also remind her that it is important to focus on some of the positive aspects of starting a new chapter in her life. You talk about how she can use the skills she has learned in therapy to manage her negative emotions and focus on positive self-talk. Additionally, you suggest some healthy coping strategies for managing the stress of this transition including exercise, meditation, journaling, and spending time with her new friends. You then refocus on the topic of dating, and you provide some helpful tips such as creating a profile that accurately reflects her interests, making sure to be honest about who she is, and being mindful of safety when meeting people in person. Finally, you remind her that it is important to take things slow and enjoy the process of getting to know someone. You also encourage her to remember that relationships can take different forms and that it is okay if she is not ready for a romantic relationship right now.    At the end of the session, you check in with her and ask how she is feeling. She tells you that while she still feels overwhelmed, she is feeling more prepared to move forward with her life. You end the session with words of encouragement and remind her that you are here to support her.",,Which of the following counseling skills did you demonstrate in this session?,Interpretation,Active listening,Reflection of meaning,Rationalization,"(A): Interpretation
(B): Active listening
(C): Reflection of meaning
(D): Rationalization",Active listening,B,"You used active listening to help the client in this session. This is evidenced by you validating the client's feelings, offering reassurance, and providing helpful tips. Therefore, the correct answer is (B)",counseling skills and interventions
1080,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.  Sixth session The client has been making progress and has joined the track team at school. He is the fastest runner on the team and has already broken some school records. He says that the team is becoming like his family. The coach has become his mentor and provides stability for the client. According to the client, he does not have the support for his new activity from his parents. His mother is tired of picking him up from track practice, and his father is not very enthusiastic about his son's involvement on the track team either. The client expresses feeling sad about his parents' reaction. He says, ""I feel like my parents don't care about me."" You contact both parents and suggest a session with all the adults responsible for the client's care. The mother immediately agrees, but the father expresses reluctance to participate in therapy. The client's father expresses his concerns about his involvement in therapy sessions, saying that he does not see how that will help his son. He is also worried that you will ""side with"" the client's mother and that he will end up getting blamed for the problems in the family. Despite his reservations, he agrees to attend the session, along with his ex-wife.    You facilitate a session with the client's parents, focusing on helping them understand their child's point of view in order to develop more effective communication between them. You emphasize the importance of expressing love and support for the child, even if they are not able to provide a unified front when it comes to rules and expectations. You explain that having different rule systems is not uncommon among divorced couples but also encourages both parents to work together to come up with consistent boundaries that can be enforced by both households. The mother expresses understanding while the father remains skeptical.    In response to the father's skepticism, you explain that working together towards a common goal is essential in developing successful communication and strengthening the parent-child relationship. You encourage both parents to discuss their expectations with each other and come up with a plan of action that works for them as well as their son. You also suggest that they attend family counseling sessions if needed, as this can help them better understand one another's point of view and work through any unresolved issues that could be causing distress in their relationships. You remain hopeful that by taking these steps, the client will feel more secure in his environment and ultimately benefit from the unified support of both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",What would be the best structured activity to facilitate the client in expressing how he feels without confronting anyone?,Family system's approach with subsystems,Virginia Satir's family sculpting technique,Minuchin's joining technique,Whitaker's multi-family group,"(A): Family system's approach with subsystems
(B): Virginia Satir's family sculpting technique
(C): Minuchin's joining technique
(D): Whitaker's multi-family group",Virginia Satir's family sculpting technique,B,"This is a technique in family therapy and is will likely be the most helpful for the client. The therapist asks one or more family members to arrange the other members (and lastly themselves) in relation to one another in terms of posture, space, and attitude to portray the arranger's perception of the family. Therefore, the correct answer is (A)",counseling skills and interventions
1081,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.",rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives,Which of the following would be an appropriate short-term goal for the first month of the weekly therapy sessions?,Identify the ways in which borderline personality disorder affects the individuals’ relationships.,Reduce client urges to engage in self-harming behavior.,Improve the relationship quality with people of importance to the individuals.,Improve communication skills with people of importance to the individuals.,"(A): Identify the ways in which borderline personality disorder affects the individuals’ relationships.
(B): Reduce client urges to engage in self-harming behavior.
(C): Improve the relationship quality with people of importance to the individuals.
(D): Improve communication skills with people of importance to the individuals.",Identify the ways in which borderline personality disorder affects the individuals’ relationships.,A,"The first step will be assisting the clients with acknowledging that they have borderline personality disorder and understanding how it affects their life because this diagnosis can be difficult for an individual to accept. Improving relationship quality, reducing urges to self-harm, and improving communication will likely take more than a month to initiate and achieve. These goals will require you to first establish a secure relationship with the group, in order for them to feel comfortable enough to explore the required complexities of their condition and its impact on relationships and feelings toward themselves. Therefore, the correct answer is (A)",treatment planning
1082,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",What strategy would be most effective for the client to use to cope with feeling overwhelmed in math class?,Verbalizing negative thoughts about the teacher,Asking questions in class to clarify instructions,Suggesting more practice with extra math assignments at home,Taking regular breaks between short periods of focused work,"(A): Verbalizing negative thoughts about the teacher
(B): Asking questions in class to clarify instructions
(C): Suggesting more practice with extra math assignments at home
(D): Taking regular breaks between short periods of focused work",Taking regular breaks between short periods of focused work,D,"Taking regular breaks to regroup and refocus can help the client to better manage the stress and anxiety associated with feeling overwhelmed in a math class. This strategy allows the client to step away from the situation and take a few moments to refocus on the task at hand. Therefore, the correct answer is (D)",treatment planning
1083,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client",Which cognitive distortion operates from the premise that his wife’s refusal to conform to the client’s high standards is associated with ineptitude and defiance?,Personalization,Mind reading,Overgeneralization,Black and white thinking,"(A): Personalization
(B): Mind reading
(C): Overgeneralization
(D): Black and white thinking",Black and white thinking,D,"Black and white thinking is the cognitive distortion associated with the belief that anyone who refuses to conform to the client’s standards is seen as inept and defiant. Black and white thinking, also known as polarization or all or nothing thinking, is exhibited when shades of gray are not acknowledged. There is ridged inflexibility with others. If the wife agrees and conforms to the client’s perfectionistic standards, all is well in the relationship. If the wife dissents and refuses to comply with the client’s perfectionistic standards, she is inept and defiant. Something is either great or terrible; a person is either perfect or a failure. Overgeneralization, personalization, and mind-reading, generally result in self-blame, which is atypical for individuals with OCPD. Overgeneralization occurs when broad implications are based on one or two minor instances (eg, “I let down a friend. Now everyone thinks I’m a total disaster!”). Personalization happens when one assigns themselves blame without solid logistical evidence. As the name implies, mind-reading occurs when one jumps to conclusions or negatively interprets another person’s intentions, feelings, and actions. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1084,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",Why is it essential to assess for trauma when considering the client's provisional diagnosis and the potential influence of past traumatic experiences on her current psychological presentation and implications for your treatment plan?,"Trauma will lead to Borderline Personality Disorder symptoms, including emotional dysregulation.",A trauma assessment should be carried out as the client is mandated to therapy by the court.,High risk-taking in Borderline Personality Disorder leads to trauma.,Borderline Personality Disorder and Posttraumatic Stress Disorder have a high comorbidity.,"(A): Trauma will lead to Borderline Personality Disorder symptoms, including emotional dysregulation.
(B): A trauma assessment should be carried out as the client is mandated to therapy by the court.
(C): High risk-taking in Borderline Personality Disorder leads to trauma.
(D): Borderline Personality Disorder and Posttraumatic Stress Disorder have a high comorbidity.",Borderline Personality Disorder and Posttraumatic Stress Disorder have a high comorbidity.,D,"BPD and PTSD often do have high comorbidity with one another. Because of this correlation, assessing for trauma may reveal other pathologies that must be addressed in your treatment plan. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1085, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.",How would you motivate Raul to elaborate on his perspectives?,Direct him to share more about how he got in trouble at school,Pretend you agree with him to improve rapport,Completely disagree with him in hopes he argues his positions more,Ask him to explain further because you do not understand,"(A): Direct him to share more about how he got in trouble at school
(B): Pretend you agree with him to improve rapport
(C): Completely disagree with him in hopes he argues his positions more
(D): Ask him to explain further because you do not understand",Ask him to explain further because you do not understand,D,"Using this direct method of asking him to explain more to help you understand him is the best choice here. Feigning agreement or disagreement as tactics to get him to elaborate will not necessarily work as they may either unethically guide him towards thinking his perspectives are ""correct"" (while there should be no right or wrong answer) or make him feel alienated and judged by his counselor arguing with him. Directing him to tell you about his mistakes made in school in the middle of this exercise might cause Raul to shut down and not further participate in future exercises because of feeling like they are a ""trap"" or segue into sharing about himself. You can still be effective in providing Raul support during this conversation, even if Raul does not admit to his own feelings or experiences. Projecting his feelings and experiences to hypothetical scenarios may give you enough information for you to better understand him. Therefore, the correct answer is (C)",counseling skills and interventions
1086,"Name: Roger Clinical Issues: Physical/emotional issues related to trauma Diagnostic Category: Neurocognitive Disorders Provisional Diagnosis: F02.81 Major Neurocognitive Disorder Due to Traumatic Brain Injury, with Behavioral Disturbance Age: 36 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Outpatient clinic  ","The client presents as tired. He reports a mild headache at the intake appointment, which he says is likely due to coming in from the bright day outside. Memory is slightly impaired. Mood is depressed, though he says this is impermanent, and his mood changes within a day, though the depressed mood is more prevalent and longer-lasting.","First session The client returned home from Afghanistan last month after separating from the Navy after 12 years of service. He states he is tired of trying to get an appointment at the VA Hospital, so he Googled locations that treat brain injuries, and your office was on the results page. He called to arrange a consultation with you. You have been practicing as a licensed mental health therapist at the outpatient clinic for over a decade, and you have worked with many clients diagnosed with traumatic brain injury. The client complains about difficulty sleeping, bad headaches, and feeling like he is on a roller coaster - feeling happy one minute and then down in the dumps the next. He states that the happy times don't last long, and he is ""down in the dumps"" most of the time. When asked why he left the Navy, he replies: ""Toward the end of my last deployment, I just got sick and tired of everything and couldn't deal with it anymore. I couldn't sleep, was jumpy all the time, and didn't even want to go outside during the day."" Now, I'm finally back home, but things only seem worse. My wife keeps nagging me to get a job, my kids look at me like I'm a monster, and nobody understands how I feel. I want to lay in bed all day and drink a couple of beers. I think something isn't right, and I can't take it anymore."" Near the end of the session, the client asked what he could expect if a medical professional recommended medication management to treat NCD.  The client discloses experiencing a highly distressing and psychologically damaging event during his military service in Afghanistan. While on patrol with his unit, their convoy was ambushed, and a fellow soldier directly next to the client was seized by insurgents. The client painfully witnessed his peer and friend being brutally beheaded, describing the horrific sight and sounds as permanently seared into his memory. Helplessly observing the brutal murder firsthand left him stunned and overwhelmed with grief and terror at the moment. The grotesque violence and knowing that could have just as quickly been his fate continues haunting him years later.  The constant stress of combat and imminent danger already had the client in a perpetual state of hypervigilance and anxiety during his deployment. He shares that coming to terms with the abrupt, unfair loss of life was a daily reality there. While transporting supplies between bases in a standard jeep convoy, his vehicle triggered an IED explosion or was directly hit by artillery fire. The client was violently jolted and knocked completely unconscious as the blast disabled their jeep. He remained in and out of consciousness for over 24 distressing hours, being evacuated while critically injured to a military hospital. Once stabilized, he was thoroughly examined and diagnosed with a traumatic brain injury concussion along with other shrapnel wounds.  Fourth session You and the client decided to meet for weekly sessions based on his current needs. You have established a trusting relationship with him, and he feels more comfortable knowing that you have experience in working with military populations. You provided psychoeducation regarding the effects of traumatic brain injuries and what he can expect from the counseling process. You were able to instill hope that he could recover emotionally following his injury and learn new skills along with coping mechanisms. He presents for today's session in a depressed mood which he states began the previous night. He reports that his family appears to now better understand what he is going through and they are getting along better. He is still drinking three beers at night to help him fall asleep, and his headaches have decreased in intensity due to finally getting a medication consult from the VA. However, he is still sensitive to light. He shares that he is ready to look for work but is concerned about finding a job and performing due to his ongoing symptoms.","  The client drinks three beers every night before bed to help him fall asleep. He started this pattern a few years ago after struggling with insomnia and finding it challenging to relax his mind. Though effective at first in inducing drowsiness, he has built up a growing tolerance and now needs to drink three beers minimum to feel any sedative effects. He discloses that he knows consuming alcohol regularly can be unhealthy, but he feels dependent on having those beers to wind down from the stresses of his day and quiet his anxious thoughts enough to get adequate rest.  During his time serving in the military, the client reported smoking cannabis on occasion when it was available. However, he did not enjoy the experience or feel compelled to use it. He mainly partook when offered by peers to be social. Since his discharge five years ago, he states he has not had any cannabis.  The client currently smokes approximately one pack of cigarettes per week, a habit he picked up during his military service as a way to cope with boredom and nerves. He expresses some interest in trying to cut back for health reasons but also shares smoking provides a sense of relief and routine.",What empathetic response would be the most effective in addressing the client's concern?,"""I hear you when you say you are ready to look for work, do you really think you are prepared for that?""",It appears that you are prepared to start working but have some concerns. I recommend proceeding with it promptly.,I have complete confidence in your readiness for work. Let's focus on the task at hand and assist you in finding a job.,"""It sounds like you are ready for work but have a few concerns about how that work might actually look. I understand that and, if you are willing, I'm ready to make a plan of action.""","(A): ""I hear you when you say you are ready to look for work, do you really think you are prepared for that?""
(B): It appears that you are prepared to start working but have some concerns. I recommend proceeding with it promptly.
(C): I have complete confidence in your readiness for work. Let's focus on the task at hand and assist you in finding a job.
(D): ""It sounds like you are ready for work but have a few concerns about how that work might actually look. I understand that and, if you are willing, I'm ready to make a plan of action.""","""It sounds like you are ready for work but have a few concerns about how that work might actually look. I understand that and, if you are willing, I'm ready to make a plan of action.""",D,"This response reflects the client's concerns back at him while still allowing for the progression of therapy with the client's permission. Therefore, the correct answer is (B)",counseling skills and interventions
1087,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,Possible short-term goals may include?,Engage in family counseling with father,Identify stressors which precipitated event,Taking antipsychotic medication on his own without reminders,Implement an effective crisis plan,"(A): Engage in family counseling with father
(B): Identify stressors which precipitated event
(C): Taking antipsychotic medication on his own without reminders
(D): Implement an effective crisis plan",Identify stressors which precipitated event,B,"Short term goals are important because they are usually attainable and can build confidence in completing long term goals. A short-term goal may be for Mark to identify stressors that happen prior to an event. Mark may have difficulty taking medication on his own, without reminders, so this may be a long-term goal. Also, before implementing an effective treatment plan, the plan must be created first. Marc's father reaching out to him was a contributing factor to the stress Mark was facing prior to his first psychotic episode. Since Mark's father seems to be a trigger for him, this would be a long-term goal, if it is a priority for Mark. Therefore, the correct answer is (B)",treatment planning
1088,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","Based on the information gained in the intake, which of the following goals will be primary?",Client will experience no suicidal ideation or thoughts of self-harm,Client will obtain employment to meet his needs for independence,Client will develop a support system to meet his needs for community and support,Client will experience reduction in depression and anxiety,"(A): Client will experience no suicidal ideation or thoughts of self-harm
(B): Client will obtain employment to meet his needs for independence
(C): Client will develop a support system to meet his needs for community and support
(D): Client will experience reduction in depression and anxiety",Client will experience no suicidal ideation or thoughts of self-harm,A,"Each of the choices are excellent goals for the client described, however safety is always the priority goal. Because the client has a history of suicidal ideation with a plan, this is the goal that must be addressed first. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1089,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ","Besides a learning disability, what would you identify as an area of clinical concern?",Mathematical capabilities,Sleep patterns,Medical history,Lack of parental involvement,"(A): Mathematical capabilities
(B): Sleep patterns
(C): Medical history
(D): Lack of parental involvement",Medical history,C,"The client's medical history would be indicated as an area of clinical concern due to her seizures. If the client has a seizure in session, it is important to discuss with the parents what should be done to ensure her safety. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1090,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",Why would you tell the client that you believed you were a superhero when you were his age?,To promote the use of rationalization,To build the therapeutic relationship,To encourage reaction formation,To demonstrate positive self-regard,"(A): To promote the use of rationalization
(B): To build the therapeutic relationship
(C): To encourage reaction formation
(D): To demonstrate positive self-regard",To build the therapeutic relationship,B,"It can be valuable to self disclose personal information to build the therapeutic relationship. Many clients feel uneasy telling a stranger about their thoughts, feelings, and experiences. Getting to know their therapists better on a personal level can help ease this feeling. Self-disclosure on the therapist's part can be used to express empathy and help these clients feel that their emotions and experiences are being validated. During the intake, you noted that the client was wearing a DC Comic shirt, and he also expressed an interest in a superhero. Therefore, the correct answer is (D)",counseling skills and interventions
1091,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.","Based on the information provided, which of the following should the counselor ask about to narrow down the suspected diagnosis?","Fear and anxiety in social situations that he will be humiliated, embarrassed, and rejected","Recurring, distressing, and intrusive dreams, memories, or triggers beginning after the event",Developmentally inappropriate and excessive fear or anxiety being separated from others,"Severe recurrent temper outbursts, out of proportion with the situation, before the event","(A): Fear and anxiety in social situations that he will be humiliated, embarrassed, and rejected
(B): Recurring, distressing, and intrusive dreams, memories, or triggers beginning after the event
(C): Developmentally inappropriate and excessive fear or anxiety being separated from others
(D): Severe recurrent temper outbursts, out of proportion with the situation, before the event","Recurring, distressing, and intrusive dreams, memories, or triggers beginning after the event",B,"As PTSD is the suspected diagnosis, it would be important to ascertain whether the client meets the required criteria, one of which is Criterion B, the presence of intrusion symptoms associated with and beginning after the traumatic event. These can include memories, dreams, flashbacks, or exposure cues that trigger intense distress. Fear and anxiety in social situations with the potential of rejection is a required criterion of social anxiety disorder and is not apparent in this client's information. Temper outbursts that are out of proportion with the situation appear as described by the client but he states they began after his father's death, not before. This is a required criteria for disruptive mood dysregulation disorder, which must begin before age 10. The client states that prior to his father's death, he did not experience angry outbursts. Developmentally inappropriate and excessive fear or anxiety at separation from others is a required criterion for separation anxiety, which can occur in children and adults following a trauma; however, the client lives at a distance from his family but provides no indication of anxiety or fear related to separation from them. Therefore, the correct answer is (B)",counseling skills and interventions
1092,Initial Intake: Age: 35 Sex: Male Gender: Male Sexuality: Gay Ethnicity: African American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.","You are a counselor in a private practice setting.  During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships.  He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.","Family History:
The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.","Based on the information gained in the intake, what diagnoses are most appropriate to consider for this client?",Schizoid personality disorder; Alcohol use disorder,Alcohol use disorder; Paranoid personality disorder,Alcohol use disorder; Adjustment disorder,Major depressive disorder; Alcohol use disorder,"(A): Schizoid personality disorder; Alcohol use disorder
(B): Alcohol use disorder; Paranoid personality disorder
(C): Alcohol use disorder; Adjustment disorder
(D): Major depressive disorder; Alcohol use disorder",Major depressive disorder; Alcohol use disorder,D,"The client's symptoms are most closely related to a depressive disorder (MDD) including sadness, crying, lack of energy, feelings of failure. While the client may not yet have expressed all the symptoms needed for the diagnosis, MDD should be investigated along with alcohol use disorder (AUD) based on the clients' concerns about his drinking. While the client endorses suspiciousness based on his spouse's activities, these are not irrational suspicions and do not indicate paranoid personality disorder. The client expresses strained relationships with many family members and restricted range of emotional expression, but does desire close relationships, does not appear indifferent to praise or criticism, and does not endorse ""almost always choosing solitary activities"". The client reports moving this year, which could point to an adjustment disorder, however his spouse indicated through the client's report that the problems have been longstanding. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1093,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.  Fourth session The client presents for his fourth session. You were able to work out a payment plan with him which has relieved his immediate concerns about paying for therapy sessions. However, he reports ongoing tension about finances and says that his his wife packed a bag to leave after a ""big fight"" about money. She told him she needs some space to see if she wants a divorce. The client breaks down and begins to cry and shaking uncontrollably. While looking at the ground he laments, ""I don't know what to do. It wasn't always like this. We used to be happy, but now I'm just stressed and worried about everything. I'm never going to be able to make enough money to support my family."" He tells you that he works hard to provide for his family, but his wife does not appreciate or support him. He has been drinking more but knows that it is not helping. He has decided he needs to make some lifestyle adjustments; he is ready to make changes and work on his issues.    In the session, you provide a supportive environment, helping your client to see his anxiety from a place of self-awareness and empowerment. You offer him concrete strategies for managing anxiety including relaxation techniques, cognitive restructuring, and grounding exercises. You also explore how he can work towards building better communication with his wife by expressing himself in an assertive yet respectful way. You both discuss how alcohol serves as a distraction but ultimately leads to additional anxiety. Together you come up with a plan that includes reducing the amount of alcohol he consumes, engaging in positive self-talk, and scheduling weekly activities such as going on walks to help him reduce stress levels. At the end of this session, you encourage your client to continue making strides towards his goals and remind him of the progress he has already made. You assure him that anxiety is something that can be managed with regular practice and together you will continue to work towards positive change.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",How would you reframe the client's negative statement of never being able to make enough money to support his family?,"""You have found success in the past and I believe that you will do so in the future.""","""Money isn't everything. You can still be a successful provider even if your finances are not where you want them to be.""","“You're working hard and doing the best that you can, and with some additional strategies you will be able to improve your financial situation.”","""You need to make more money, but it's ok to take some time off to take care of yourself, too.""","(A): ""You have found success in the past and I believe that you will do so in the future.""
(B): ""Money isn't everything. You can still be a successful provider even if your finances are not where you want them to be.""
(C): “You're working hard and doing the best that you can, and with some additional strategies you will be able to improve your financial situation.”
(D): ""You need to make more money, but it's ok to take some time off to take care of yourself, too.""","“You're working hard and doing the best that you can, and with some additional strategies you will be able to improve your financial situation.”",C,"This statement helps the client to reframe his thinking in a more productive way. By acknowledging that he is doing his best and recognizing that he can take steps to improve his financial situation, he can move past the anxiety-inducing thought of never having enough money and focus on what actions he can take to make progress. This shift in perspective allows him to feel empowered to make a change, rather than feeling helplessly stuck or overwhelmed. It also reminds him that anxiety is something that can be managed with effort and practice. Therefore, the correct answer is (B)",counseling skills and interventions
1094,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Based on the information provided, which of the following diagnoses would the counselor not suspect for this client?",Major Depressive Disorder (MDD),Attention Deficit Disorder (ADHD),Obsessive Compulsive Disorder (OCD),Bipolar Disorder (BPD),"(A): Major Depressive Disorder (MDD)
(B): Attention Deficit Disorder (ADHD)
(C): Obsessive Compulsive Disorder (OCD)
(D): Bipolar Disorder (BPD)",Bipolar Disorder (BPD),D,"Hoarding disorders are often linked to OCD, OCPD, ADHD, Depression, and often begin after a traumatic experience. Bipolar I Disorder may be linked to clutter during manic phases, but is not generally associated with Hoarding disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1095,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","The client’s formal assessment, along with informal observations, warrants a psychiatric evaluation to assess for ADHD, and the PGM has agreed to this. The client has done well in therapy and has met her short-term counseling goals. She has processed grief and loss concerning separation from her parents and shows improvement with emotional regulation. The use of brief strategic family therapy (BSFT) has helped address patterns of interaction between the client and her PGM, and the client is having fewer tantrums. The PGM reports that the client continues to talk back, and she is not completing her chores. You plan to conduct a series of home visits to assist the PGM with parent management skills but receive word from your agency’s office indicating the client has lost insurance coverage",Brief Strategic Family Therapy (BSFT) uses which of the following?,Enactments and sculpting,Reframing and restructuring,Linking and pacing,Chaining and modeling,"(A): Enactments and sculpting
(B): Reframing and restructuring
(C): Linking and pacing
(D): Chaining and modeling",Reframing and restructuring,B,"Brief strategic family therapy (BSFT) uses reframing and restructuring after joining with the family and diagnosing the problem. BSFT is an evidence-based practice for ODD grounded in the here-and-now, emphasizes process over content, and includes techniques such as reframing and restructuring. Reframing, a form of restructuring, is used to help clients view situations, feelings, and relationships in a more positive light. Counselors use restructuring by instructing families to interact during the therapy session. This allows counselors to assess family dynamics (eg, boundaries and alliances) and restructure family systems by providing alternative ways for members to behave and communicate. Linking is a group leadership skill used to help members relate to one another’s challenges, solutions, and other shared experiences. Pacing occurs when counselors attend to the emotional intensity of a session. Brief strategic family therapists use enactments, while human validation process model family therapists use sculpting. Counselors use enactments by having family members talk to one another rather than the counselor. Enactments help illustrate relationship patterns and identify patterns and roles requiring modification. Sculpting is a non-verbal technique where the counselor physically arranges family members to help them envision aspects of emotional closeness or distance. Chaining, which refers to reinforcing the totality of a sequence of behaviors, is a behavioral therapy technique. Finally, modeling, which is necessary for imitation, is a component of social learning theory. Therefore, the correct answer is (B)",counseling skills and interventions
1096,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.  Sixth session The client has been making progress and has joined the track team at school. He is the fastest runner on the team and has already broken some school records. He says that the team is becoming like his family. The coach has become his mentor and provides stability for the client. According to the client, he does not have the support for his new activity from his parents. His mother is tired of picking him up from track practice, and his father is not very enthusiastic about his son's involvement on the track team either. The client expresses feeling sad about his parents' reaction. He says, ""I feel like my parents don't care about me."" You contact both parents and suggest a session with all the adults responsible for the client's care. The mother immediately agrees, but the father expresses reluctance to participate in therapy. The client's father expresses his concerns about his involvement in therapy sessions, saying that he does not see how that will help his son. He is also worried that you will ""side with"" the client's mother and that he will end up getting blamed for the problems in the family. Despite his reservations, he agrees to attend the session, along with his ex-wife.    You facilitate a session with the client's parents, focusing on helping them understand their child's point of view in order to develop more effective communication between them. You emphasize the importance of expressing love and support for the child, even if they are not able to provide a unified front when it comes to rules and expectations. You explain that having different rule systems is not uncommon among divorced couples but also encourages both parents to work together to come up with consistent boundaries that can be enforced by both households. The mother expresses understanding while the father remains skeptical.    In response to the father's skepticism, you explain that working together towards a common goal is essential in developing successful communication and strengthening the parent-child relationship. You encourage both parents to discuss their expectations with each other and come up with a plan of action that works for them as well as their son. You also suggest that they attend family counseling sessions if needed, as this can help them better understand one another's point of view and work through any unresolved issues that could be causing distress in their relationships. You remain hopeful that by taking these steps, the client will feel more secure in his environment and ultimately benefit from the unified support of both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",How would you reflect the client's feelings about his parents in the session?,"""It makes sense to me that you would feel like your parents don't care about you because they don't seem very supportive of you being on the track team.""","""I understand how you feel. There are times when I felt like my parents didn't care about me.""","""It sounds like you are feeling unloved and unimportant to your parents right now.""","""Thank you for sharing your thoughts with me. Can you tell me more about why you feel like your parents don't care about you?""","(A): ""It makes sense to me that you would feel like your parents don't care about you because they don't seem very supportive of you being on the track team.""
(B): ""I understand how you feel. There are times when I felt like my parents didn't care about me.""
(C): ""It sounds like you are feeling unloved and unimportant to your parents right now.""
(D): ""Thank you for sharing your thoughts with me. Can you tell me more about why you feel like your parents don't care about you?""","""It sounds like you are feeling unloved and unimportant to your parents right now.""",C,"One way to think about reflecting feelings is to imagine that you are holding up a mirror to the person's emotions. You are not trying to change or fix the emotions, but simply acknowledging and reflecting back what you see and hear. This can be an incredibly powerful therapeutic tool, because it helps the person feel heard and understood. It also allows the person to see their emotions from a different perspective, which can be helpful in managing and coping with them. Therefore, the correct answer is (B)",counseling skills and interventions
1097,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening","When the husband is crying, all of the following are helpful techniques for the couple, EXCEPT:",Practicing immediacy,Supporting the husband in using coping skills,Redirecting to the wife with questions about her response to his crying,Allowing space for him to cry,"(A): Practicing immediacy
(B): Supporting the husband in using coping skills
(C): Redirecting to the wife with questions about her response to his crying
(D): Allowing space for him to cry",Supporting the husband in using coping skills,B,"Supporting the husband in using coping skills is the least helpful technique in this situation because the husband needs to feel safe expressing his raw emotions in the manner that comes most naturally to him. Otherwise, repression of these feelings may occur. Muting those feelings with trained coping skills detracts from an important element of processing because the husband and wife both need to experience their emotions surrounding their situation to better understand and express their viewpoints. Immediacy would be helpful because it involves directly addressing the presenting emotions and behavior. Allowing space for the husband to experience his emotions is helpful for the husband (as a releasing process) and also for the wife (to allow her to actively experience how her spouse is feeling). Redirecting to the wife may also be helpful because this may provide her with appropriate tools for responding to her husband’s emotions in a way that makes him feel supported and less isolated. Therefore, the correct answer is (D)",counseling skills and interventions
1098,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",,adult immaturity,ruminating,poor insight and judgment,PTSD,"(A): adult immaturity
(B): ruminating
(C): poor insight and judgment
(D): PTSD",poor insight and judgment,C,"Davone's lack of ability to identify cause and effect of his behaviors is a result of a defect in reflective functioning, otherwise known as having low insight and poor judgment or decision-making skills. These factors do present as immature for an individual of age 35, however answer a) is not a clinical term as the question requests. Repetitive arguing indicates rumination. PTSD, or post-traumatic stress disorder, can cause several problematic cognitive and emotional manifestations but also does not answer the question as much as it suggests a condition that he could be suffering from. Therefore, the correct answer is (D)",
1099,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ","You state, ""It sounds like you are feeling conflicted about taking on the role of caregiver for your mother. Can you tell me more about your relationship with your mother and siblings?"" What are you demonstrating with this response?",Exploration of problem,Unconditional positive regard,Non-judgmental stance,Simple restatement,"(A): Exploration of problem
(B): Unconditional positive regard
(C): Non-judgmental stance
(D): Simple restatement",Exploration of problem,A,"By asking the client to provide further information about her relationship with her mother and siblings, you are exploring the problem. Remember that the client seeks help to resolve inner conflict and address dysfunctional family dynamics. Therefore, the correct answer is (D)",counseling skills and interventions
1100,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.  Sixth session The wife presents for today's session without her husband. She reports that two nights ago, he was taken to the emergency room for pain. He had been drinking, and test results at the hospital liver indicated that his liver functioning was impaired. He continues to deny that he is drinking, but she knows this is untrue as she has been finding half-full liquor containers hidden around the house. She starts to cry, ""I don't know what I will do without him. I had to call a babysitter and get a cab to come here. I'm worried about how I'll pay for the mortgage if my husband can't work. We'll end up losing the house and our health insurance! I'm going to have to sell off everything to make ends meet!"" You respond to her fears with empathy and understanding. You are respectful of the client's thoughts and feelings and seek to understand her experience. You also explore the cognitive error that your client has made and how this is affecting her emotions.    You continue the session by asking her what her most immediate concerns are at the moment and what she needs help with. She pauses for a moment and then starts to explain how she is feeling overwhelmed by the situation and feeling helpless in being able to help her husband. She expresses a lot of fear and anxiety about her family's financial security and the potential loss of the house and health insurance if her husband's drinking continues. She expresses a need for support and understanding and worries about how she will cope without her husband. She feels isolated and alone, stating, ""I feel like my worst nightmare has come true. I've been worrying about my husband's drinking for a long time. I've heard horror stories about how addiction can ruin people's marriages, and I don't want that for us. I know it's hard for him, but it's hard for me, too."" You offer her some resources that could help her with her financial situation and ask her to put together a list of a few people she feels she can talk to for emotional support.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What would be the most appropriate referral for the wife?,Group therapy,Family therapy,Psychiatrist,Individual therapy,"(A): Group therapy
(B): Family therapy
(C): Psychiatrist
(D): Individual therapy",Individual therapy,D,"Individual therapy could provide the wife with a safe and confidential space to process her feelings of anxiety, fear, and helplessness around her husband's drinking. In individual therapy, the therapist could also assist in providing her with practical skills for coping, such as problem solving and stress management. Therefore, the correct answer is (C)",treatment planning
1101,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",What was the best practice that you used to facilitate progress in this session?,Offered relaxation techniques to reduce physical symptoms of distress.,Acknowledged her vulnerable feelings.,Worked collaboratively with the client to develop coping skills and increase self-care practices.,Discussed potential treatment options such as cognitive behavioral therapy.,"(A): Offered relaxation techniques to reduce physical symptoms of distress.
(B): Acknowledged her vulnerable feelings.
(C): Worked collaboratively with the client to develop coping skills and increase self-care practices.
(D): Discussed potential treatment options such as cognitive behavioral therapy.",Worked collaboratively with the client to develop coping skills and increase self-care practices.,C,"This was the best practice used in this session to facilitate progress as it allowed the client to take more ownership over her recovery journey through increased self-awareness and understanding of which strategies can help her manage her feelings more effectively. Therefore, the correct answer is (B)",counseling skills and interventions
1102,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","The client discusses how his case manager has gotten him into a shelter and is currently working on securing housing for him. The client processes feelings surrounding the shelter and has begun a detox program for his fentanyl addiction. The client verbalizes that he is experiencing anxiety surrounding being at meetings with the case manager, talking with other residents, reintegrating into a “more normal life,” and worrying about whether he can ever have a relationship with his kids or ex-wife if he gets sober. Through processing, you realize that this anxiety was present prior to drug use and that he has experienced anxiety throughout his life",All of the following criteria are associated with a diagnosis of generalized anxiety disorder EXCEPT:,Being easily fatigued,Symptoms that occur for at least 6 months,Irritability,Excess energy,"(A): Being easily fatigued
(B): Symptoms that occur for at least 6 months
(C): Irritability
(D): Excess energy",Excess energy,D,"Excess energy is not associated with generalized anxiety disorder. This should not be confused with restlessness, which is a common symptom of generalized anxiety disorder, but it is associated with the inability to relax due to anxiety. Irritability, being easily fatigued, and having symptoms of anxiety lasting at least 6 months are the criteria for generalized anxiety disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1103,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Which of the following would you not want to share with the client when educating him about his diagnosis?,"In moderation, OCPD behaviors can be helpful in high performance situations.",OCPD is a pervasive and maladaptive pattern of excessive perfectionism and control.,OCD includes intrusive thoughts and compulsions that temporarily relieve anxiety.,Men are diagnosed with OCPD twice as often as women.,"(A): In moderation, OCPD behaviors can be helpful in high performance situations.
(B): OCPD is a pervasive and maladaptive pattern of excessive perfectionism and control.
(C): OCD includes intrusive thoughts and compulsions that temporarily relieve anxiety.
(D): Men are diagnosed with OCPD twice as often as women.",OCPD is a pervasive and maladaptive pattern of excessive perfectionism and control.,B,"Telling a client that their disorder is pervasive and maladaptive will not facilitate hope for change in a client. Personality disorders tend to be life-long, but treatments have shown that some personality disorders, including OCPD, are able to be moderated with the correct therapy. In this case, the client has met some criteria for OCPD though not all of the required criteria, so would be noted as demonstrating traits of OCPD. This makes it more likely that with work, the client can modify his behavior. Since the client has been told that he is ""OCD,"" it will be helpful to clarify what that disorder is so that he can understand he does not fit into that category. Telling the client that men are diagnosed at twice the rate of women with OCPD, may help him feel his OCPD trait diagnosis is not so rare that he is ""abnormal"". Letting the client know that some of his behaviors have been helpful for him in succeeding and that it is only when he becomes too focused on them that they become problematic. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1104,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client contacted you to reschedule a session sooner than the one you had originally scheduled. The client reported that he continues to have difficulty getting to work on time and was told that he needs to meet with his supervisor on Friday. The client expresses anxiety surrounding this because he worries about getting fired. The client began to cry during the session when talking about worry regarding being unemployed. The client came to the session in clothes that had stains on them, and his hair was messy and appeared greasy",Which assessment would be helpful in monitoring progress in this client’s management of depressive symptoms?,Five Facet Mindfulness Questionnaire,Minnesota-Multiphasic Personality Inventory-2,Patient Health Questionnaire-9,Pittsburgh Sleep Quality Index,"(A): Five Facet Mindfulness Questionnaire
(B): Minnesota-Multiphasic Personality Inventory-2
(C): Patient Health Questionnaire-9
(D): Pittsburgh Sleep Quality Index",Patient Health Questionnaire-9,C,"Focusing on mindfulness and sleep will be important in treatment; however, the Patient Health Questionnaire-9 is helpful in monitoring ongoing progress in depression symptoms and their effects on functioning. The Minnesota-Multiphasic Personality Inventory-2 is used to assess the client’s mental state or the presence of psychiatric illness, and it does not specifically measure depressive symptoms or their effects on functioning. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1105, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,"To be culturally sensitve, the counselor should not?",Role play conversations with his boss,Provide psychoeducation on his symptoms and developmental stage,Encourage autonomy from his parents,Encourage the practice of hobbies and interests,"(A): Role play conversations with his boss
(B): Provide psychoeducation on his symptoms and developmental stage
(C): Encourage autonomy from his parents
(D): Encourage the practice of hobbies and interests",Encourage autonomy from his parents,C,"Although Darrel is at the stage where he is developing autonomy from his parents, it is important for the counselor to remember that traditional Chinese families emphasize obedience of parental wishes. It may be more beneficial to provide Darrel with psychoeducation about possible dissonance with his culture and feelings of autonomy at his developmental stage. Darrel is also hesitant about speaking to his boss about changing his hours. The counselor can role play the conversation to help Darrel become more comfortable. Darrel mentioned his desire to return to the hobbies he used to enjoy doing. Helping Darrel find ways to reincorporate these things in his life would be beneficial as a coping mechanism. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1106,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with client 3 for his individual therapy session. The client continues to be resistant, stating that he does not need to meet with you. You spend the session trying to build rapport with the client and are successful in taking down some of his walls. The client says he knew client 2 from back when he was in high school and began telling you that she slept with a bunch of guys and did a lot of drugs. You redirect the client back to focusing on himself. The client starts to open up about his relationship with his parents growing up and how he thinks they did not really try to show him affection and this made him sad talking about it. The client concludes by saying “I feel overwhelmed sharing all of this because I’ve never talked about it before.” You thank the client for sharing and you empathize with him","With new information about client 2, which of the following would be the most appropriate response to this information?",Be aware of how this information affects your unbiased interactions with client 2.,Explore why this information matters to client 3.,Bring this up when you have an individual session with client 2 to determine if it is true information.,Keep this information in mind because it may help you support client 2.,"(A): Be aware of how this information affects your unbiased interactions with client 2.
(B): Explore why this information matters to client 3.
(C): Bring this up when you have an individual session with client 2 to determine if it is true information.
(D): Keep this information in mind because it may help you support client 2.",Explore why this information matters to client 3.,B,"This could be an instance of triangulation, in which client 3 is using deflection to client 2’s behavior to ease client 3’s stress in the session. For this reason, exploring why client 2’s behavior is of concern to client 3 is the most client-centered and important focus to begin with. It might be good to keep this report in mind because it may be brought up during a group session or client 2’s individual session, but you also do not know the validity of the statement unless client 2 self-reports. It is important to make sure that you do not let this information bias you, but this would not be the most pressing factor. Sharing information from your session with client 3 with client 2 would be a breach of confidentiality. Confidentiality is an important aspect to consider about DBT groups because you also provide individual therapy and need to ensure that you do not share information revealed in individual sessions in the group setting. Therefore, the correct answer is (D)",counseling skills and interventions
1107,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,"Despite the counselor's prior feelings, he can put this aside and try to put himself in Harold's shoes to better understand his perspective. This is called?",Congruence,Empathy,Genuineness,Self-awareness,"(A): Congruence
(B): Empathy
(C): Genuineness
(D): Self-awareness",Empathy,B,"Empathy is the ability for someone to put themselves in the shoes of another and is a critical quality for a counselor to have. Although the counselor is not familiar with the issues Harold is presenting, by being empathetic he can gain a deeper understanding. Congruence occurs when a counselor gives feedback to a client in a genuine manner. For the counselor to be genuine, he/she must be sincere in their statements and not be pretentious. Self-awareness of a counselor is important but is not accomplished by the counselor putting himself in Harold's shoes. Therefore, the correct answer is (B)",core counseling attributes
1108,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex."," Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother.  You are supervising an intern, and he is also your employee. Your intern reports that he recently experienced a breakup with a significant other, and this has made him late to several sessions; in turn, several clients have canceled upcoming sessions due to his unreliability","You are supervising an intern, and he is also your employee. Your intern reports that he recently experienced a breakup with a significant other, and this has made him late to several sessions; in turn, several clients have canceled upcoming sessions due to his unreliability. According to the ACA Code of Ethics, which of the following would be the best course of action as a clinical supervisor/manager in order to prevent harm to clients?","The intern is causing harm to clients; therefore, employment consequences must be enforced to remove the source of harm.",Consider either reducing the intern’s caseload or putting him on a short-term leave in order to reduce harm to clients.,Support your intern through the breakup in order to prevent harm to current clients.,Sit in sessions with the intern and his clients to provide accountability.,"(A): The intern is causing harm to clients; therefore, employment consequences must be enforced to remove the source of harm.
(B): Consider either reducing the intern’s caseload or putting him on a short-term leave in order to reduce harm to clients.
(C): Support your intern through the breakup in order to prevent harm to current clients.
(D): Sit in sessions with the intern and his clients to provide accountability.",Consider either reducing the intern’s caseload or putting him on a short-term leave in order to reduce harm to clients.,B,"The ACA Code of Ethics notes that if services to clients are impaired due to physical, mental, or emotional issues, then the termination of supervisory efforts may be considered. The code also states that the intern should seek assistance with these kinds of problems in order to prevent harm to clients. Therefore, a combination of supporting the intern (by reducing his caseload) combined with the consideration of employment or supervision consequences (such as a short-term leave) is the most appropriate course of action. Simply terminating supervision would not be indicated at this time because an effort needs to be made to support the intern. Sitting in the sessions might provide accountability for the intern to be on time; however, it does not address the root of his issues. Therefore, the correct answer is (D)",professional practice and ethics
1109,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,"Carlos is displaying symptoms indicative of all the following, except?",Adjustment Disorder,"Unspecified Disruptive, Impulse Control and Conduct Disorder",Intermittent Explosive Disorder,Conduct Disorder,"(A): Adjustment Disorder
(B): Unspecified Disruptive, Impulse Control and Conduct Disorder
(C): Intermittent Explosive Disorder
(D): Conduct Disorder",Adjustment Disorder,A,"Carlos does not meet the criteria for adjustment disorder. Although symptoms started after a significant event (his parents' divorce), symptoms remain six months after the termination of the stressor or its consequences. Adjustment disorder is ruled out since he meets the criteria for conduct disorder. Intermittent explosive disorder does show high rates for aggression; however, this is often impulsive and not premeditated. Unspecified, Disruptive, Impulse Control and Conduct Disorder is only diagnosed when someone does not fully meet criteria for all other disorders. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1110,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","During the session, the client discloses information that she has not shared with anyone else. As part of this process, you note that she has shown emotional fragility in sharing her status. You also note that she has expressed emotional distance from her parents. In light of the client's situation, which of the following services would you recommend as a priority?",Psychiatrist for medication evaluation,Teenage pregnancy support group,Physician for a complete medical work up,Crisis Pregnancy Center,"(A): Psychiatrist for medication evaluation
(B): Teenage pregnancy support group
(C): Physician for a complete medical work up
(D): Crisis Pregnancy Center",Physician for a complete medical work up,C,"When working with an adolescent who just found out that she is pregnant, it is important that she see a physician to evaluate her medical needs. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1111,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",What is the most appropriate response when the client expresses that he does not want to go to school anymore due to the bullying from other boys?,"“I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Those boys should not be allowed to act in such a negative manner. Give me the names of the boys bullying you, and I will report them.”","""I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Perhaps changing schools is an option we can explore with your parents. I'm sure they would not want you to be in such hurtful situations. How would you feel about transferring to a different school?""","“I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Even though we want others to understand, sometimes they take a little longer to get there. What is something about school that you look forward to?”",“I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. It could be that they don't understand how hurtful they are being. Maybe you should tell them how you feel and tell them to stop.”,"(A): “I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Those boys should not be allowed to act in such a negative manner. Give me the names of the boys bullying you, and I will report them.”
(B): ""I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Perhaps changing schools is an option we can explore with your parents. I'm sure they would not want you to be in such hurtful situations. How would you feel about transferring to a different school?""
(C): “I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Even though we want others to understand, sometimes they take a little longer to get there. What is something about school that you look forward to?”
(D): “I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. It could be that they don't understand how hurtful they are being. Maybe you should tell them how you feel and tell them to stop.”","“I understand it’s frustrating when you hear those hurtful words from those boys. I am sorry you are going through that. Even though we want others to understand, sometimes they take a little longer to get there. What is something about school that you look forward to?”",C,"This response demonstrates empathy for what he is going through but also reframes school into a positive experience. It gives him a chance to look at the benefits of school. This statement then further explores current coping skills and what the client perceives as a positive experience. Therefore, the correct answer is (C)",counseling skills and interventions
1112,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.",Which is the most appropriate means of determining whether counseling with this client is effective?,There is no need to discuss efficacy if the client continues to return for appointments,Administer the Minnesota Multiphasic Personality Inventory 2 (MMPI-2),Ask the client if they find the work to be effective and if they would like to continue,Ask the client to casually survey people with which he is in a relationship for feedback,"(A): There is no need to discuss efficacy if the client continues to return for appointments
(B): Administer the Minnesota Multiphasic Personality Inventory 2 (MMPI-2)
(C): Ask the client if they find the work to be effective and if they would like to continue
(D): Ask the client to casually survey people with which he is in a relationship for feedback",Ask the client if they find the work to be effective and if they would like to continue,C,"BPD is not a diagnosis that will improve dramatically nor will changes in the client's personality appear quickly. Determining if the client feels safe working with the counselor to build new relational skills and whether they want to continue with treatment, is the best way to determine if counseling is effective at this time. Additionally, the counselor will be able to observe very small changes even though they may not be consistent. The MMPI2 will help diagnose a personality disorder but will not show changes or improvement in the diagnosis. Personality disorders are long-lasting personality characteristics that are used to interact with others, and research shows that it takes time for clients to make significant changes. Asking the client to survey others will put him in a vulnerable position with those he believes may reject him or who may not see changes in him, which could lead to increased ambivalence and anxiety. Counseling efficacy should always be discussed with clients to determine if their experience with the counselor is successful at meeting their goals. Therefore, the correct answer is (A)",counseling skills and interventions
1113, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,What information should be gathered first to rule out medical complications?,Family history,Health information,School progress and achievement,Supportive relationships,"(A): Family history
(B): Health information
(C): School progress and achievement
(D): Supportive relationships",Health information,B,"It is always important to first rule out any health complications such as gastrointestinal diseases or hypothyroidism to account for Autumn's weight loss. After ruling out a medical issue, a thorough assessment should also include family history of disorders, as genetic loading may be risk factors. Since Autumn is falling asleep in class, it may be helpful to know her progress and achievement before and after symptoms occurred. Obtaining information on her support system is important as well to see if this is something that should be built up. Therefore, the correct answer is (A)",professional practice and ethics
1114,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.  Fifth session This is your fifth weekly session with the client, and she states that she likes the ""structure"" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, ""I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal.""    You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, ""I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships."" You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family.    During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she ""had other stuff going on.""",,"The client tells you that her roommate is the first girl she has ever kissed. She thinks she may be ""bisexual like her roommate"" but does not know much about what that means. What is the best approach to helping the client gain more insight on bisexuality?",Create a genogram,Suggest a book on bisexuality,Suggest she continues therapy with a bisexual therapist,Have the client invite her roommate to come to her next therapy session,"(A): Create a genogram
(B): Suggest a book on bisexuality
(C): Suggest she continues therapy with a bisexual therapist
(D): Have the client invite her roommate to come to her next therapy session",Suggest a book on bisexuality,B,"This would be a form of psychoeducation; the client can choose to get the knowledge and insight she wants through reading. Therefore, the correct answer is (C)",professional practice and ethics
1115,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",At what point in the therapeutic relationship is it appropriate to change your use of pronouns when working with a client with Gender Dysphoria?,The use of pronouns is a personal choice but should be altered from the norm only when dictated by therapeutic necessity.,The use of pronouns is a personal choice for the client and should be used in a way that is acceptable for them.,The use of pronouns is a personal choice but should be discussed when the client is older and better able to understand the societal norms involved.,The use of pronouns is a personal choice and should be altered when the client specifically requests a change.,"(A): The use of pronouns is a personal choice but should be altered from the norm only when dictated by therapeutic necessity.
(B): The use of pronouns is a personal choice for the client and should be used in a way that is acceptable for them.
(C): The use of pronouns is a personal choice but should be discussed when the client is older and better able to understand the societal norms involved.
(D): The use of pronouns is a personal choice and should be altered when the client specifically requests a change.",The use of pronouns is a personal choice for the client and should be used in a way that is acceptable for them.,B,"The client's use of personal pronouns should be up to the client and discussed when it becomes an issue for the client. Therefore, the correct answer is (C)",professional practice and ethics
1116,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",What therapeutic approach would be most appropriate for this client initially?,Adlerian therapy,Interpersonal therapy,Cognitive-behavioral therapy,Gestalt therapy,"(A): Adlerian therapy
(B): Interpersonal therapy
(C): Cognitive-behavioral therapy
(D): Gestalt therapy",Interpersonal therapy,B,"This approach might be most helpful. It focuses on building rapport, being nonjudgmental, and accepting of the client where he is. IPT is a form of psychotherapy that focuses on relieving symptoms by improving interpersonal functioning. It addresses current problems and relationships rather than childhood or developmental issues. Therapists are active, non-neutral, supportive, hopeful, and offer options for change. The key initial need of this client is to connect and relate personally to the therapist. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1117,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,An appropriate counselor response to Michael's description of his situation in the second session would be?,"""It shouldn't matter to you what they think""","""That must be difficult for you, what can we do?""","""Don't worry, I am sure they are not staring at you.""","""Who do you think can help with that?""","(A): ""It shouldn't matter to you what they think""
(B): ""That must be difficult for you, what can we do?""
(C): ""Don't worry, I am sure they are not staring at you.""
(D): ""Who do you think can help with that?""","""That must be difficult for you, what can we do?""",B,"Option C would be the most appropriate response at it acknowledges Michael's feelings and then presents a prompt to begin to problem solve. Option A may not be true. Option B is dismissive of Michael's feelings. It is developmentally appropriate for Michael to worry about what his peers think. Therefore, the correct answer is (C)",treatment planning
1118,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ","As you are developing your treatment plan, what information would be most important to evaluate?",The client's perception of the severity of her depressive episodes.,Length of time she spent in the hospital,Length of time she has been using drugs,How long she has been feeling depressed,"(A): The client's perception of the severity of her depressive episodes.
(B): Length of time she spent in the hospital
(C): Length of time she has been using drugs
(D): How long she has been feeling depressed",How long she has been feeling depressed,D,"Duration of symptoms is key information. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1119,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client receives psychoeducation on various treatment interventions for agoraphobia. She understands the risks and benefits, and you review informed consent each session. The client would like to work on her fear of stairs first, which is less anxiety-provoking than elevators. She expresses an understanding of exposure exercises and is willing to give them a try. You and the client use a Subjective Units of Distress Scale (SUDs) to measure the intensity of each anxiety-provoking situation, which can range from 0 units (no distress) to 100 units (extreme distress)",Which of the following exposure exercises would be most effective for this client?,Walk up and down the stairs with her son or a safe person during initial exposures.,Walk up and down the stairs with prescribed antianxiety medication to use PRN.,"Walk up and down the stairs, pausing to use relaxation strategies when the SUD rating increases",Walk up and down the stairs and repeat the exposure until the SUD rating drops by half.,"(A): Walk up and down the stairs with her son or a safe person during initial exposures.
(B): Walk up and down the stairs with prescribed antianxiety medication to use PRN.
(C): Walk up and down the stairs, pausing to use relaxation strategies when the SUD rating increases
(D): Walk up and down the stairs and repeat the exposure until the SUD rating drops by half.",Walk up and down the stairs and repeat the exposure until the SUD rating drops by half.,D,"Walking up and down the stairs and repeating the exposure until the SUD rating drops by half is the most effective exposure exercise. For exposure exercises to work, the client must experience increased levels of anxiety. The client’s ability to tolerate increased anxiety levels through prolonged exposure creates new neuropathways in the brain. This new neuropathway leads to the downregulation of the amygdala, which is responsible for the brain’s flight-or-fight response. Using relaxation strategies, using a safe person during the exposure, and having an escape plan by carrying medication are all contraindicated because they do not allow the client to experience the increased anxiety that is required for exposure therapy. Therefore, the correct answer is (B)",counseling skills and interventions
1120, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,"According to Racial Identity Development, Darrel is in the stage of?",Integrative awareness,Emersion,Dissonance,Introspection,"(A): Integrative awareness
(B): Emersion
(C): Dissonance
(D): Introspection",Dissonance,C,"Darrel is in the Dissonance stage of Racial Identity development which is characterized by confusion and conflict both in positive and negative feelings about the majority race and one's own minority race. The emersion stage is characterized by active rejection of the dominant society. Introspection occurs when there is conflict between the previous rejection of the dominant society, loyalty, and autonomy. Integrative awareness occurs when a person can maintain a sense of satisfaction with their cultural identity and also have a multicultural perspective. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1121,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client","Based on the information provided thus far, what is the best strategy for engaging the client in treatment planning?",Prioritize his diagnostic symptoms.,Enlist the help of his wife.,Determine his motivation to change.,Appeal to his goal-oriented personality.,"(A): Prioritize his diagnostic symptoms.
(B): Enlist the help of his wife.
(C): Determine his motivation to change.
(D): Appeal to his goal-oriented personality.",Appeal to his goal-oriented personality.,D,"Appealing to the client’s goal-oriented personality helps provide a familiar foundation for the client and allows him to see how aspects of his personality can be useful. Determining the client’s motivation to change is appropriate for individuals with ego-dystonic traits. Since the client has ego-syntonic traits, his motivation to change may be relatively non-existent. Prioritizing the client’s diagnostic symptoms is less effective because it does not engage them in mutual collaboration. Enlisting the help of his wife would not appeal to the client since he does not believe the problem originates with him, nor does he believe she has accurate insight into the problem. Therefore, the correct answer is (B)",counseling skills and interventions
1122,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,"A possible diagnosis includes all the following, except?",Abnormal movements due to a medical condition,Paroxysmal Dyskinesias,Tic disorders,Autism,"(A): Abnormal movements due to a medical condition
(B): Paroxysmal Dyskinesias
(C): Tic disorders
(D): Autism",Autism,D,"Although individuals diagnosed with autism may show repetitive movement, they often do not have. Tic disorders are characterized by the presence of motor and/or vocal tics absent of any known cause such as a medical condition or substance abuse. Paroxysmal Dyskinesias are involuntary movements usually following normal motor activity, said to be caused by exertion, stress of fatigue. It is possible that the voluntary movements Michael is experiencing may be a result from a medical condition. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1123,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","   atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together","All of the following are considered differential diagnoses for anorexia nervosa, EXCEPT:",Dependent personality disorder,Social anxiety disorder,Bulimia nervosa,Hyperthyroidism,"(A): Dependent personality disorder
(B): Social anxiety disorder
(C): Bulimia nervosa
(D): Hyperthyroidism",Dependent personality disorder,A,"Dependent personality disorder is characterized by feeling incapable of caring for or making decisions for oneself and is not a differential diagnosis for anorexia nervosa. Bulimia nervosa is similar to anorexia nervosa because it involves compensatory eating or exercise behavior; however, it is often accompanied by a more normal weight due to binges. Social anxiety disorder may also be a differential diagnosis if the client’s extreme eating habits result from fear with regard to the judgment of being watched while eating. Hyperthyroidism can be an undiagnosed cause of excessive weight loss. Pathophysiologic causes must always be ruled out if they are a suspected cause of a symptom. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1124,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that she and her husband have separated and she is now living with her parents. She is tearful and says that the past few days have been challenging. She reports an increase in headaches and stomachaches. The client has interviewed for a teaching position at a private school but doesn’t think she can afford a pay cut. Nevertheless, the client continues to be motivated to continue with counseling and believes that she will find a good career fit, but it may take some time. You discuss using a cognitive information processing approach with the client, and she is receptive. You explain that this approach will enable you to examine the communication, analysis, synthesis, valuing, and execution (CASVE) cycle of career decision-making skills","According to Nancy Schlossberg’s adult career development transitions model, which of the following is the client currently experiencing?",An expected transition,A never-occurring transition,An unexpected transition,A chronic transition or chronic “hassles”,"(A): An expected transition
(B): A never-occurring transition
(C): An unexpected transition
(D): A chronic transition or chronic “hassles”",An unexpected transition,C,"The client is currently experiencing an unexpected transition. Schlossberg’s categories of adult transition serve as the basis for her adult career development transitions model. An unexpected transition represents a change in one’s relationships, roles, expectations, or responsibilities. For the client, this unexpected transition is caused by relational conflict and marital separation. An expected transition is a predictable or scheduled transition. An expected transition can be marriage, going to college, or retirement. A chronic transition or chronic “hassles” would describe frequent job loss, recurring medical problems, or unmanaged mental health conditions. Finally, a never-occurring or nonoccurring transition is an expected or scheduled transition that never happens (eg, acceptance to graduate school, pregnancy). Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1125, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.","It is time to schedule the client's next session. Considering the client's past non-compliance with your scheduling and late policies thus far, what would be the best way to handle this issue moving forward?",Review with the client your policies and explain the reasons your agency has them,Review with the client your policies and enforce your boundaries as needed,Leave it alone for now as you are still working on gaining the client's trust,Accept this behavior is clinical and can be addressed throughout treatment,"(A): Review with the client your policies and explain the reasons your agency has them
(B): Review with the client your policies and enforce your boundaries as needed
(C): Leave it alone for now as you are still working on gaining the client's trust
(D): Accept this behavior is clinical and can be addressed throughout treatment",Review with the client your policies and enforce your boundaries as needed,B,"Not addressing administrative issues from the beginning of your counseling relationship may set a precedent that could lead to further infractions. Permitting or dismissing this behavior can ultimately harm the outcome of treatment you are providing your client. Demonstrating and maintaining boundaries is healthy and appropriate for professional practice and if done effectively is more clinically supportive than continually trying to treat a client who may not be entirely committed to the counseling process. The behavior may well be clinically rooted and can certainly be addressed throughout treatment; however, it is unnecessary to explain why your agency has boundaries since it is likely the client signed an agreement to follow rules in the intake process and has also been noted to have counseling experience in her past. Therefore, the correct answer is (B)",professional practice and ethics
1126,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher.  Ninth session The client, his parents, and the math teacher present to your office. The teacher reports that the client seems to be achieving academic success with the addition of having a separate location for tests and extra time to complete assignments. The parents state they see improvement at home after deciding to put him on Ritalin. They are smiling as they report that their son seems to have entered a ""new phase."" His progress is evident in his increased engagement in the classroom and his improved academic performance. He is able to follow instructions and complete assignments in a timely manner, and is better able to interact with his peers. His attitude towards class participation has improved and he is able to self-regulate his emotions better. He has also expressed an increased level of self-esteem and self-efficacy in math class. Overall, the client has demonstrated improved functioning in the academic arena and the addition of Ritalin has helped him to become more alert and focused. The client appears content and keeps asking if it is time to go back to class yet.    To further ensure successful progress and to provide additional support for the client, you suggest that the teacher and parents have consistent and frequent communication about the client’s academic progress. You recommend that the teacher provide regular feedback and encouragement to the client, and you suggest that the parents continue to provide a structured and supportive environment at home. Additionally, you discuss potential academic supports that the parents may consider to help the client maintain his academic progress. Finally, you suggest that the client continue to utilize his self-regulation strategies and other coping skills to manage any anxiety or other challenging emotions related to math class."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ","When would a client diagnosed with ADHD be considered ""in partial remission""?",Full criteria for the disorder has not been met for 6 months and there is no longer impairment in functioning,Full criteria for the disorder has not been met for 6 months but functional impairment still exists,"Few, if any, symptoms are present and result in only minor impairment in functioning",Full criteria for the disorder has not been met for 3 months but functional impairment still exists,"(A): Full criteria for the disorder has not been met for 6 months and there is no longer impairment in functioning
(B): Full criteria for the disorder has not been met for 6 months but functional impairment still exists
(C): Few, if any, symptoms are present and result in only minor impairment in functioning
(D): Full criteria for the disorder has not been met for 3 months but functional impairment still exists",Full criteria for the disorder has not been met for 6 months but functional impairment still exists,B,"""In partial remission"" is used to describe ADHD when the symptoms of ADHD have been reduced, but are not fully gone. Partial remission does not mean that the individual no longer has ADHD, only that their symptoms have lessened. If they no longer meet full criteria for the disorder for the past 6 months but still exhibit impaired functioning, this specifier is used. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1127,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Based on the information provided, which of the following statements would be most helpful at this point in the session?","Client, what are some of the goals that you want to focus on?",Are there goals you two can come up with that we three could work on together?,"DIL, what are some goals you'd like to see her work on in counseling?",Could we plan to sell some of the things you've collected and help you get better carpet?,"(A): Client, what are some of the goals that you want to focus on?
(B): Are there goals you two can come up with that we three could work on together?
(C): DIL, what are some goals you'd like to see her work on in counseling?
(D): Could we plan to sell some of the things you've collected and help you get better carpet?",Are there goals you two can come up with that we three could work on together?,B,"Inviting the two to work together on goals for counseling will be the best way to help the client get the therapy help she needs with someone she trusts supporting her. The client invited her DIL to the session and they interact in a manner which demonstrates a relationship of trust and care. That relationship will be helpful in counseling as the therapist works with the client. Asking the DIL if she has goals for the client removes the client's autonomy to make her own choices. While asking the client if she has goals of her own to focus on honors her autonomy but does not help her use one of her greatest supports, her DIL, to bring insight into what the client needs actually are. Suggesting that selling some of the client's things to buy carpet focuses on the counselor's need to fix things for the client rather than on the autonomy of the client to choose how she uses counseling. Therefore, the correct answer is (B)",treatment planning
1128,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ",What is the best course of action at this time for the client to take regarding her fear of driving?,The client should immediately start driving again.,The client should practice relaxation techniques while driving to reduce the risk of panic attacks.,The client should avoid driving altogether and rely on her husband or other transportation options when needing to travel.,The client should attempt to drive with an adult and her children in the car to simulate in vivo.,"(A): The client should immediately start driving again.
(B): The client should practice relaxation techniques while driving to reduce the risk of panic attacks.
(C): The client should avoid driving altogether and rely on her husband or other transportation options when needing to travel.
(D): The client should attempt to drive with an adult and her children in the car to simulate in vivo.",The client should avoid driving altogether and rely on her husband or other transportation options when needing to travel.,C,"At this point in the client's therapy, the client needs to avoid driving altogether if she experiences panic attacks while doing so. Panic attacks can cause physical symptoms such as dizziness, nausea, and chest pain which can impair her ability to safely operate the vehicle. Additionally, panic attacks can cause mental confusion and cloud judgment, further exacerbating the risk of an accident. The client should rely on her husband or other transportation options to ensure her safety and the safety of others on the road. Therefore, the correct answer is (A)",treatment planning
1129,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,An appropriate response from the counselor would be?,"""I see. Tell me what brought you in today.""","""It seems like you may have needed it sooner.""","""Mmm Hmmm...""","""Where did you hear that from?""","(A): ""I see. Tell me what brought you in today.""
(B): ""It seems like you may have needed it sooner.""
(C): ""Mmm Hmmm...""
(D): ""Where did you hear that from?""","""I see. Tell me what brought you in today.""",A,"Choice A acknowledges what Molly stated but the allows Molly to also give her reasons for changing her mind and attending counseling. Option B is defensive and option C is judgmental and assumptive. Although Option D indicates that the counselor is listening, it does not address Molly's statement. Therefore, the correct answer is (A)",treatment planning
1130,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",Which assessment instrument would be most relevant to further assess the client's symptoms?,Beck Anxiety Inventory (BAI),Beck Depression Inventory (BDI),ACORN Eating Disorder Scale,Michigan Alcohol Screening Test (MAST),"(A): Beck Anxiety Inventory (BAI)
(B): Beck Depression Inventory (BDI)
(C): ACORN Eating Disorder Scale
(D): Michigan Alcohol Screening Test (MAST)",Beck Depression Inventory (BDI),B,"The Beck Depression Inventory gauges depression and suicidality. It is the most relevant assessment instrument for this client as she has indicated that if therapy does not help, she is not sure she wants to go on living. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1131,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.  Sixth session The client has been making progress and has joined the track team at school. He is the fastest runner on the team and has already broken some school records. He says that the team is becoming like his family. The coach has become his mentor and provides stability for the client. According to the client, he does not have the support for his new activity from his parents. His mother is tired of picking him up from track practice, and his father is not very enthusiastic about his son's involvement on the track team either. The client expresses feeling sad about his parents' reaction. He says, ""I feel like my parents don't care about me."" You contact both parents and suggest a session with all the adults responsible for the client's care. The mother immediately agrees, but the father expresses reluctance to participate in therapy. The client's father expresses his concerns about his involvement in therapy sessions, saying that he does not see how that will help his son. He is also worried that you will ""side with"" the client's mother and that he will end up getting blamed for the problems in the family. Despite his reservations, he agrees to attend the session, along with his ex-wife.    You facilitate a session with the client's parents, focusing on helping them understand their child's point of view in order to develop more effective communication between them. You emphasize the importance of expressing love and support for the child, even if they are not able to provide a unified front when it comes to rules and expectations. You explain that having different rule systems is not uncommon among divorced couples but also encourages both parents to work together to come up with consistent boundaries that can be enforced by both households. The mother expresses understanding while the father remains skeptical.    In response to the father's skepticism, you explain that working together towards a common goal is essential in developing successful communication and strengthening the parent-child relationship. You encourage both parents to discuss their expectations with each other and come up with a plan of action that works for them as well as their son. You also suggest that they attend family counseling sessions if needed, as this can help them better understand one another's point of view and work through any unresolved issues that could be causing distress in their relationships. You remain hopeful that by taking these steps, the client will feel more secure in his environment and ultimately benefit from the unified support of both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",Which of the following responses demonstrates your use of constructive confrontation?,"""As parents, you are not making the changes to keep up with your son's progress. What are you going to do about it to get up to speed with his success?""","""Are both of you, as parents, up to the challenge of being better parents for your son?""","""It's time to make some changes as parents. As you watch your son's continued success, what can you do to match his progress?""","""As parents, what positive steps are you taking in your lives to ensure the continued success of your son with his obvious continued improvement and personal success?""","(A): ""As parents, you are not making the changes to keep up with your son's progress. What are you going to do about it to get up to speed with his success?""
(B): ""Are both of you, as parents, up to the challenge of being better parents for your son?""
(C): ""It's time to make some changes as parents. As you watch your son's continued success, what can you do to match his progress?""
(D): ""As parents, what positive steps are you taking in your lives to ensure the continued success of your son with his obvious continued improvement and personal success?""","""As parents, what positive steps are you taking in your lives to ensure the continued success of your son with his obvious continued improvement and personal success?""",D,"This is a good, soft example of beginning to initiate more confrontation of the parents in this case. Constructive confrontation can be a useful counseling intervention which can help clients become more self-aware. If used effectively, therapists can help their clients identify certain behaviors they may overlook as well as address unresolved issues which they may be avoiding. This will help improve their overall well-being. Therefore, the correct answer is (A)",counseling skills and interventions
1132,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","  You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown.  To help improve your clinical judgment, your supervisor suggests that you first rule out a substance use disorder diagnosis by using a standardized instrument","To help improve your clinical judgment, your supervisor suggests that you first rule out a substance use disorder diagnosis by using a standardized instrument. Which instrument provides a screening component followed by an assessment for those who screen positive?","TAPS (Tobacco, Alcohol, Prescription Medication, and other Substance use) tool","CRAFFT (car, relax, alone, forget, friends, trouble) screening test",MAST (Michigan Alcohol Screening Test),"CAGE (cut down, annoyed, guilty, and eye-opener) questionnaire","(A): TAPS (Tobacco, Alcohol, Prescription Medication, and other Substance use) tool
(B): CRAFFT (car, relax, alone, forget, friends, trouble) screening test
(C): MAST (Michigan Alcohol Screening Test)
(D): CAGE (cut down, annoyed, guilty, and eye-opener) questionnaire","TAPS (Tobacco, Alcohol, Prescription Medication, and other Substance use) tool",A,"The TAPS tool has a screening component followed by a short assessment. The first component (TAP-1) screens for tobacco, alcohol, prescription medication, and other substance use. If the individual has a positive screen, it can be followed by a brief substance-specific assessment (TAPS-2). The CRAFFT screening test is used with adolescents aged 12-21 to screen for risk factors associated with substance use. The CAGE is a brief (ie, four-question) screening instrument for alcohol use. Finally, the MAST is a screening instrument used to determine symptoms of alcohol dependency. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1133,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.","Noting the large number of conditions presented by Melanie, how would you order her treatment plan goals in terms of priority issues?","Depression, Anxiety, PTSD, Chronic Medical","Depression, Anxiety, PTSD","PTSD, Chronic Medical, Relational Issues","Depression, PTSD, Relational Issues","(A): Depression, Anxiety, PTSD, Chronic Medical
(B): Depression, Anxiety, PTSD
(C): PTSD, Chronic Medical, Relational Issues
(D): Depression, PTSD, Relational Issues","Depression, Anxiety, PTSD, Chronic Medical",A,"This is the best choice because it is a requirement to include a goal for each diagnosed condition, from primary to secondary conditions. Adding a goal for addressing her apparent chronic medical issues is also significant as it is part of treating the whole person concept, which is a Medicaid priority. Even if you are not specifically treating her medical conditions, her goals would be identified and then listed as ""deferred"" to the appropriate care providers. You may still address cognitive, emotional, and behavioral issues that stem from experiencing chronic conditions, as appropriate. Not addressing her medical concerns in a treatment plan can be considered neglectful, especially since this client mentions it is the driving reason behind her depression. Addressing Melanie's relational issues would be considered important as well, however this is likely to be presented subsequent to all her other treatment plan goals that have corresponding diagnoses since relational problems exist in every area of her life. Therefore, the correct answer is (C)",treatment planning
1134,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.",tion. Family History: The husband and wife have been married for 13 years. They report that they met when friends introduced them and that they dated for about 2 years before getting married. The couple have two children: two daughters (ages 7 and 10). The couple reports that they have been in “parent mode” for the past few years and have not been emotionally connected to each other because their attention has been predominantly focused on their children,Which of the following is the most important area for you to focus on first when counseling this couple?,Improving communication skills between the couple to facilitate conversations about how they got to this point in their marriage,Stabilizing the couple’s relationship so that the goals of counseling can be identified,Exploring thoughts and feelings about the affair so that counseling efforts can be targeted,Processing how the couple got to this point to determine what the couple’s needs are,"(A): Improving communication skills between the couple to facilitate conversations about how they got to this point in their marriage
(B): Stabilizing the couple’s relationship so that the goals of counseling can be identified
(C): Exploring thoughts and feelings about the affair so that counseling efforts can be targeted
(D): Processing how the couple got to this point to determine what the couple’s needs are",Stabilizing the couple’s relationship so that the goals of counseling can be identified,B,"Stabilizing the relationship is the most important goal at this point in the therapeutic relationship. It is important to determine each individual’s commitment to therapy and their goals for the therapy process. This could also be an opportunity to set rules or guidelines so that certain topics are only discussed in counseling sessions, allowing the sessions to be guided and managed more effectively. Although improving communication is important, this goal will take some time because the couple has likely not been communicating wants and needs well, which may have led to the affair. It will also be helpful to focus on how the couple got to this point because this can open up conversations about deficits and needs that the couple has, but the relationship must be stabilized first. Exploring thoughts and feelings about the situation is very important and is likely a short-term goal, but making sure the couple is committed to the process and identifying their goals (to include whether the couple hopes to remain together or separate) is more pressing. Otherwise, therapy will not be productive. Therefore, the correct answer is (C)",counseling skills and interventions
1135, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.",Which of the following would reveal more information about Maria's support network?,trauma narrative,mental status exam,safety plan,genogram,"(A): trauma narrative
(B): mental status exam
(C): safety plan
(D): genogram",genogram,D,"A genogram is a graphic representation of a family tree that displays detailed information on relationships and family dynamics among the individuals depicted. This would help you better understand how Maria is connected and whether there are others in her network that can help provide support. A safety plan would include information on how Maria copes with stress and what she would plan to do in triggering or unsafe situations. A mental status exam would not reveal information about Maria's support network. Trauma narrative would be used for the purposes of cognitive trauma therapy where this type of information would not likely be presented or at least not up front and all at once where it would be useful for learning about Maria's support network. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1136,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”",Which of the following would provide the counselor with the most effective means of determining this client's diagnosis and subsequent treatment plan?,Myers-Briggs Type Indicator (MBTI),Trauma Symptom Inventory 2 (TSI-2),Mann-Whitney U Test (MWW),Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),"(A): Myers-Briggs Type Indicator (MBTI)
(B): Trauma Symptom Inventory 2 (TSI-2)
(C): Mann-Whitney U Test (MWW)
(D): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)",Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),D,,"intake, assessment, and diagnosis"
1137,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What is the best summary of the couple's relationship dynamic during this session?,The couple's communication style is hostile with high levels of defensiveness,The couple shows signs of co-dependency,The couple exhibits a pattern of passive aggressive behavior,The couple's interactions with each other indicate distrust and tension,"(A): The couple's communication style is hostile with high levels of defensiveness
(B): The couple shows signs of co-dependency
(C): The couple exhibits a pattern of passive aggressive behavior
(D): The couple's interactions with each other indicate distrust and tension",The couple's interactions with each other indicate distrust and tension,D,"The couple's dynamic during this session is one of distrust and tension, stemming from the husband's past alcohol use and the wife's fear of abandonment. The husband is feeling overwhelmed by the perceived dependence his wife has on him, while the wife is struggling to trust her husband again. Both partners are seeking counseling to re-establish trust and respect in their marriage. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1138,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","   ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years",Which is true of the American Psychological Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) inclusion criteria for persistent depressive disorder (PDD) and major depressive disorder (MDD)?,PDD includes possible experiences of anhedonia; MDD does not.,PDD symptoms must persist for more days than not for at least 1 year; MDD symptoms must persist every day for at least 2 weeks.,PDD includes recurrent suicidality without a plan; MDD includes suicidality with a plan.,PDD includes feelings of hopelessness; MDD includes feelings of worthlessness or inappropriate guilt.,"(A): PDD includes possible experiences of anhedonia; MDD does not.
(B): PDD symptoms must persist for more days than not for at least 1 year; MDD symptoms must persist every day for at least 2 weeks.
(C): PDD includes recurrent suicidality without a plan; MDD includes suicidality with a plan.
(D): PDD includes feelings of hopelessness; MDD includes feelings of worthlessness or inappropriate guilt.",PDD includes feelings of hopelessness; MDD includes feelings of worthlessness or inappropriate guilt.,D,"The criteria for PDD criteria include feelings of hopelessness, and the criteria for MDD include feelings of worthlessness or inappropriate guilt. The DSM-5-TR criteria for PDD includes (in part): “The presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness” (APA, 2022). The MDD criteria for adults require at least five of nine qualifying criteria to be present over the course of a two-week period and represent a change in the individual’s behavior or functioning from baseline. These include “depressive symptoms, loss of interest/pleasure (one of these first two being required), in addition to weight loss/weight gain (not associated with diet) or a decrease in appetite, insomnia or hypersomnia, psychomotor excitement or delay, constant fatigue, excessive sense of guilt/worthlessness, inability to concentrate, and suicidal ideation/obsession/attempt” (APA, 2022). Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1139, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”","Considering the provided information, which of the following should be addressed first?",In what ways does the client think that the counselor will be able to help him,Whether the client would be willing to stop using alcohol so therapy can begin,What will be different in counseling this time as opposed to the client's previous therapy,The client's commitment to reducing his alcohol use before the next session,"(A): In what ways does the client think that the counselor will be able to help him
(B): Whether the client would be willing to stop using alcohol so therapy can begin
(C): What will be different in counseling this time as opposed to the client's previous therapy
(D): The client's commitment to reducing his alcohol use before the next session",In what ways does the client think that the counselor will be able to help him,A,"It is important for the counselor and client to explore the roles that each takes in counseling. The counselor will gain important information from the client by understanding what the client expects the counselor to help him accomplish. The question of what will be different is a good question but will need to be phrased in a non-judgmental way and addressed after the therapeutic relationship has begun. Helping the client understand what is (or isn't) different this time will be helpful in planning treatment. Clients who use alcohol to self-medicate are rarely able to decrease or stop their use until they have gained some coping skills to manage the emotions that they are trying to ignore through their alcohol use. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1140,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","The client comes in, sits down, and immediately says that she has been thinking and decided that she is now ready to talk about the physical abuse that she has experienced. She recounts that from age 18 until age 20 she was with a boyfriend who would smack her if she said something he did not like. She believes this is why she is so preoccupied with pleasing others. The client’s second relationship was when she was 25 with a man who would get drunk nightly and punch her in the stomach or in the back when he was upset. You empathize with the client and reflect her emotions regarding these events. The client states, “I didn’t deserve it when the drunk guy hit me, but I do feel I wasn’t the best girlfriend with the first guy. I often didn’t do enough for him and often said the wrong thing.” Throughout the session, the client was tearful and started shaking slightly when speaking several times. The client paused for long periods before sharing more difficult parts of the story. You decide to assess for PTSD during this session, but she does not meet the criteria. When closing the session, the client states that she is not able to pay for today’s session until the end of the week. The client has no history of nonpayment with you thus far",Which answer below best defines the level of responsibility that the client should take regarding physical abuse?,The client can learn what to do differently next time as a girlfriend to avoid abuse.,"The client can acknowledge that she did not always do things correctly, but she did not deserve to be abused.",The client should not take any responsibility for being abused.,"The client can acknowledge that she did not deserve to be hit, but that the second abuser was under the influence so he should not have to take full responsibility for his actions.","(A): The client can learn what to do differently next time as a girlfriend to avoid abuse.
(B): The client can acknowledge that she did not always do things correctly, but she did not deserve to be abused.
(C): The client should not take any responsibility for being abused.
(D): The client can acknowledge that she did not deserve to be hit, but that the second abuser was under the influence so he should not have to take full responsibility for his actions.",The client should not take any responsibility for being abused.,C,"Victims of abuse should never be supported in taking any responsibility for the abuse, even if there is evidence of explicit provocation. Although the ex-boyfriend was under the influence and may not have fully known what he was doing, he is responsible for putting himself in a state in which he is not in full control of his actions. The state of intoxication does not protect an individual from owning legal responsibility for their actions. Therefore, the correct answer is (D)",professional practice and ethics
1141, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,The counselor responds to Autumn's last statement with “Whatever you are most comfortable with is completely fine. Just know that it's an option.” This is an example of?,Alliance building,Creating an atmosphere of comfort and trust,Exploring religious and spiritual beliefs,Informed consent,"(A): Alliance building
(B): Creating an atmosphere of comfort and trust
(C): Exploring religious and spiritual beliefs
(D): Informed consent",Creating an atmosphere of comfort and trust,B,"Creating an atmosphere of comfort and trust is one of the first stages of counseling. By allowing Autumn a choice of not eating, even if is her lunch time, she is acknowledging and validating Autumn's feelings. Creating a physically comfortable environment is also important. Counselors should make the counseling area warm and inviting for the client. Alliance building is a process and occurs over some time. Informed consent is an explanation of the nature of counseling, what it will entail as well as the risks and benefits. Religious and spiritual beliefs should always be considered. In this case Autumn not wanting to eat stems from her anxiety and not her beliefs. Therefore, the correct answer is (B)",counseling skills and interventions
1142,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",Your private practice needs to shift to telehealth due to safety-based concerns in the community. What would you not implement with your client at this time?,Contact the client prior to the first online session to set up appropriate protocols within your virtual therapy environment,Contact the client and work out which online communication platform would be most convenient and comfortable for him.,"Contact the client and identify telehealth-based releases the client needs to sign, even though there were already several communication-related forms already signed.",Contact the client directly to make him aware of the need for this change in modality and to deal with any immediate issues.,"(A): Contact the client prior to the first online session to set up appropriate protocols within your virtual therapy environment
(B): Contact the client and work out which online communication platform would be most convenient and comfortable for him.
(C): Contact the client and identify telehealth-based releases the client needs to sign, even though there were already several communication-related forms already signed.
(D): Contact the client directly to make him aware of the need for this change in modality and to deal with any immediate issues.",Contact the client and work out which online communication platform would be most convenient and comfortable for him.,B,"The therapist must identify to clients the limitations and boundaries associated with using any social media. The use of FaceTime would lead to ethical violations with the release of Personal Health Information (PHI) as it is not a HIPPA-encrypted compliant platform. Therefore, the correct answer is (B)",professional practice and ethics
1143,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations","Given the client’s current clinical presentation, which approach would best address the client’s concerns?",Mindfulness based relaxation and stress reduction (MBSR),Rational-emotive behavioral theory (REBT),Interpersonal social rhythm (IPSRT),Behavioral modification (BMOD),"(A): Mindfulness based relaxation and stress reduction (MBSR)
(B): Rational-emotive behavioral theory (REBT)
(C): Interpersonal social rhythm (IPSRT)
(D): Behavioral modification (BMOD)",Interpersonal social rhythm (IPSRT),C,"While all approaches can be used to address the client’s concerns, interpersonal social rhythm therapy (IPSRT) would best address the client’s level of functioning and clinical symptomatology. IPSRT is a best practice for bipolar disorder and is based on the premise that psychosocial stressors influence biological rhythms. When biological systems, such as the circadian rhythm, are disrupted, symptoms can be exacerbated for individuals experiencing bipolar disorder. The goal of IPST is to restore an individual’s social rhythm by enhancing coping skills for stressful life events, regaining healthy routines, and determining how to best return to (or create) appropriate psychosocial and interpersonal rhythms. The client states that unexpected stressors have interrupted her sleep, making IPSRT the best approach for addressing the client’s concerns. Mindfulness-based stress reduction (MBSR) uses meditation and relaxation practices to improve depression, anxiety, and pain. MBSR is an appropriate intervention for bipolar disorder but does not explicitly address social, interpersonal, and biological rhythms in the way IPSRT does. Because behavioral modification is a part of IPSRT, behavioral modification alone would not address concerns to the extent that IPSRT does. Rational-emotive behavioral theory is a cognitive theory based on the assumption that maladaptive thoughts contribute to emotional and behavioral difficulties and interfere with positive life experiences. When appropriate, this approach can help with depressive symptoms, however, IPSRT is just as effective for treated bipolar disorder and can address the client’s interpersonal stressors, improve self-esteem, and enhance social support required for extended symptom abatement. Therefore, the correct answer is (B)",treatment planning
1144,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises.  Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable.    You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times.    After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What is the best demonstration of empathy in response to the client's report of leaving class after having trouble reading?,"""You are worried that you don't fit in with the other students.""","""It's important for you to be brave and try to stay in class.""","""If that happened to me, I would be upset, too.""","""Are you upset because the other kids laughed at you?""","(A): ""You are worried that you don't fit in with the other students.""
(B): ""It's important for you to be brave and try to stay in class.""
(C): ""If that happened to me, I would be upset, too.""
(D): ""Are you upset because the other kids laughed at you?""","""If that happened to me, I would be upset, too.""",C,"Using empathy to let the client know you understand what she is feeling would be beneficial. If it does not take away from the client, you can self-disclose on a similar feeling so she feels validated. Therefore, the correct answer is (D)",counseling skills and interventions
1145,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","    History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork.  The client has agreed to participate in a cognitive behavioral therapy (CBT) group for social anxiety. You co-lead the group and would like the members to experience universality, one of Irvin Yalom’s curative factors","The client has agreed to participate in a cognitive behavioral therapy (CBT) group for social anxiety. You co-lead the group and would like the members to experience universality, one of Irvin Yalom’s curative factors. Which technique would best enable you to do so?",Interpreting,Facilitating,Confronting,Linking,"(A): Interpreting
(B): Facilitating
(C): Confronting
(D): Linking",Linking,D,"Primarily used during the initial stage of group development, the leadership technique of linking best enables members to experience universality. Irvin Yalom (1985) developed the concept of curative factors, also known as therapeutic factors, to encapsulate group member experiences leading to growth. Yalom’s curative factors include “altruism, cohesion, universality, interpersonal learning input and output, guidance, catharsis, identification, family reenactment, self-understanding, instillation of hope, and existential factors” (Boon & Vermeiren, 2019). Universality occurs when group members recognize that they have shared experiences, thoughts, and feelings—and that they are not alone. Thus, universality helps validate common experiences and reduce feelings of isolation. Linking is a process used to promote and encourage member-to-member interactions, which help members recognize their similarities and common themes. Facilitating is a basic leadership skill used in the early stages of group therapy to help encourage members to talk to other members rather than the group leader. Interpreting is a leadership skill that relies on a preestablished framework for group therapy (eg, CBT). Leaders use interpreting to redirect members back to the framework when explaining the meaning of their expressed thoughts and feelings. Confronting is used when counselors find a discrepancy in an element of the client’s thoughts, feelings, and actions. Therefore, the correct answer is (C)",counseling skills and interventions
1146,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",What are you trying to do with the client when you ask him about the shirt?,To discern interest points for the client,Gather information to help diagnose the client,Establish expectations for future therapy sessions,Build trust and rapport,"(A): To discern interest points for the client
(B): Gather information to help diagnose the client
(C): Establish expectations for future therapy sessions
(D): Build trust and rapport",Build trust and rapport,D,"The client seemed disengaged and on his phone while the mother was speaking. You want to get the child to trust you. By asking the client about his shirt, you are trying to make a connection with the client and create a space where the client feels comfortable enough to open up about his feelings. Therefore, the correct answer is (D)",counseling skills and interventions
1147,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.","   rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family.  Because you do have experience counseling individuals with substance use, you decide to use a motivational interviewing approach for this client","Because you do have experience counseling individuals with substance use, you decide to use a motivational interviewing approach for this client. Which of the following statements defines the focus of motivational interviewing?",Challenging irrational thoughts and feelings in order to create more productive beliefs,Changing unhealthy behaviors in order to improve functioning,"Focusing on improving present situations and relationships, rather than examining past events",Facilitating and creating an internal desire for change,"(A): Challenging irrational thoughts and feelings in order to create more productive beliefs
(B): Changing unhealthy behaviors in order to improve functioning
(C): Focusing on improving present situations and relationships, rather than examining past events
(D): Facilitating and creating an internal desire for change",Facilitating and creating an internal desire for change,D,"Focusing on internal desire for change is the core focus of motivational interviewing because it is centered on identifying and cultivating an individual’s motivation for change and assisting the person with moving forward in therapy. Focusing on unhealthy behaviors alone is part of behavior therapy. Challenging irrational thoughts and feelings is the focus of rational emotive behavior therapy. Reality therapy focuses on improving present situations and not on the effects of past experiences on present functioning. Therefore, the correct answer is (C)",counseling skills and interventions
1148, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.",Which of the following will be most beneficial to help the client understand about panic attacks?,"Panic attacks feel like you are dying, but they will not hurt you","Once you experience panic attacks, you are likely to keep experiencing them",All of the above,Everyone experiences a panic attack at least once in their lifetime,"(A): Panic attacks feel like you are dying, but they will not hurt you
(B): Once you experience panic attacks, you are likely to keep experiencing them
(C): All of the above
(D): Everyone experiences a panic attack at least once in their lifetime","Panic attacks feel like you are dying, but they will not hurt you",A,"Many individuals have described panic attacks as feeling like they are dying because of hyperventilating, racing heart, chest pain, and feeling a loss of control. However, panic attacks are an emotional response with physical symptoms and will not cause lasting physical damage or kill an individual. It is true that some people have experienced a panic attack and have gone on to experience a panic disorder, which is recurrent panic attacks; however, this is not true for all people and many individuals experience no more panic attacks once their acute stress is relieved. Not everyone experiences panic attacks; only 11% of people in America experience them during their lifetime. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1149,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,Tony is displaying symptoms of?,Gender Dysphoria,Transvestic Disorder,Fetishistic Disorder,Frotteuristic Disorder,"(A): Gender Dysphoria
(B): Transvestic Disorder
(C): Fetishistic Disorder
(D): Frotteuristic Disorder",Transvestic Disorder,B,"Transvestic disorder is characterized by sexual arousal through cross dressing which causes serious impairment in areas of functioning. Fetishistic disorder is ruled out because of Tony's thoughts of looking like a woman is the cause of his arousal. Gender dysphoria is ruled out because Tony does not desire to be a woman. However, in some cases transvestic disorder may progress to gender dysphoria. Frotteuristic disorder is ruled out as this disorder is characterized by arousal by touching or rubbing against a non-consensual person. Therefore, the correct answer is (B)",counseling skills and interventions
1150,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","
Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",What is the most empathic approach for redirecting John back to addressing his treatment plan goals of anger management?,"""The best way for you to figure this out is to start implementing your anger management strategies before talking to your daughter.""","""Carpe Diem, John. Let's focus on practicing our deep breathing and then discuss them.""","""Why do you think Sherry left you? The same reasons your family won't speak to you?""","""I'm sorry to hear things did not work out. Let's look at what problems we identified together in our last session and see if they apply to your most important relationships.""","(A): ""The best way for you to figure this out is to start implementing your anger management strategies before talking to your daughter.""
(B): ""Carpe Diem, John. Let's focus on practicing our deep breathing and then discuss them.""
(C): ""Why do you think Sherry left you? The same reasons your family won't speak to you?""
(D): ""I'm sorry to hear things did not work out. Let's look at what problems we identified together in our last session and see if they apply to your most important relationships.""","""I'm sorry to hear things did not work out. Let's look at what problems we identified together in our last session and see if they apply to your most important relationships.""",D,"John is visibly upset when he comes to you for support with how to win his family back. Using confrontational dialogue like in answer b) in the form of interviewing questions can be harmful, not only for your therapeutic alliance but for John's fragile state of mind and emotions especially if he has not come to those conclusions himself. Telling him what you think is best to do before he has come to terms with his anger on his own is not the most effective strategy for gaining his buy-in to the counseling process. Clients may often seem as though they want a clear answer for what to do, but counseling is intended to help a person find their own answers instead of handing answers to them. Clients may also push back defensively if they feel you are telling them what to do or might respond in opposition if they are in denial. Answer d) is not coming from a person-centered approach as the counselor is insisting on teaching new coping skill while putting off the subject of interest to the client until later. Answer a) is the most empathic approach and best way to help guide John to observe his condition and build insight on his own. Therefore, the correct answer is (A)",counseling skills and interventions
1151,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","   age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement",Which screening tool assesses substance use disorder among youth between the ages of 12-17?,Delinquent Activities Scale (DAS),Brief Addiction Monitor (BAM),Screening to Brief Intervention (S2BI),Drug Abuse Screen Test (DAST-10),"(A): Delinquent Activities Scale (DAS)
(B): Brief Addiction Monitor (BAM)
(C): Screening to Brief Intervention (S2BI)
(D): Drug Abuse Screen Test (DAST-10)",Screening to Brief Intervention (S2BI),C,"In 2017, The National Institute on Drug Abuse (NIDA) released a two-minute assessment tool measuring substance use disorder risk for teens aged 12-17. The Drug Abuse Screen Test (DAST-10) is a 10-question self-screening tool for drug use in adults. The Delinquent Activities Scale (DAS) is a 36-question assessment instrument used with teens in the juvenile justice system. The Brief Addiction Monitor (BAM) is an assessment instrument for adults that assesses factors related to recovery, behavioral health, and substance use and risk. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1152,"Name: Dave Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders;Substance Use Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder; F10.99 Unspecified Alcohol-Related Disorder Age: 42 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client presents at the intake session biting his nails and cannot keep his legs from shaking. He feels anxious about his wife and work. He continually places his hands on his head and complains of headaches and nausea. He admits to drinking a bit more than he should. He denies thoughts of self-harm but sometimes wishes that he could ""disappear.""","First session You are a counseling intern at an agency that works with clients from various socioeconomic backgrounds. Your client is a 42-year-old married male massage therapist who owns two therapeutic massage practices. Over the past nine months, his business has been reduced by fifty percent. He is having great difficulty paying the bills for the business, and he has exhausted his personal savings. His wife is currently not working due to a back injury. He has difficulty concentrating during the day and is irritable around his employees, friends, and family. He states that he drinks ""too much"" in order to relax at night and admits that his hangover adds to his anxiety the next day. His wife has begun to complain, and their relationship has been strained over the past three months. The client is concerned about paying for the sessions due to financial issues. He offers to exchange massage sessions for therapy.    The client is aware that anxiety and alcohol use are impacting his work and family life negatively, but he does not know how to get a handle on them. He reports feeling overwhelmed with worry about the future of his business and whether he will be able to continue providing for his family. The client has been avoiding people lately, including old friends, and only sees his mother occasionally due to her health problems. In terms of self-care, the client acknowledges that he tends to put everyone else's needs before his own, which leads to feelings of exhaustion and anxiety. Additionally, he finds it difficult to recognize or accept compliments from others and has difficulty expressing gratitude for their help. During the intake session, you identify anxiety as one of the primary issues the client is seeking help with. You also discuss the role that alcohol is playing in his anxiety and suggest strategies for reducing anxiety without relying on it as a coping mechanism. The conversation then turns to developing a plan with the client for addressing these issues, such as scheduling regular self-care activities, limiting or eliminating alcohol use, and exploring cognitive behavioral therapy techniques for managing anxiety levels.","The client has been married for ten years. He and his wife have two children together, a son, age 10, and a daughter, age 12. The client does not speak to his father, who divorced his mother when he was four years old. The client and his mother have a good relationship. The mother lives 15 minutes away from the client and helps his wife with the children. During the past nine months, his massage therapy practice revenue has decreased by fifty percent, and it has been difficult to pay the bills. The client has exhausted all personal savings. The client is the sole income provider for his family, as his wife is not working while recovering from a back injury. ",What would provide the most relevant information pertaining to the client's presenting problem?,House Tree Person - HTP,Brief Psychiatric Rating Scale - BPRS,Beck Anxiety Inventory - BAI,Denver II,"(A): House Tree Person - HTP
(B): Brief Psychiatric Rating Scale - BPRS
(C): Beck Anxiety Inventory - BAI
(D): Denver II",Beck Anxiety Inventory - BAI,C,"The Beck Anxiety Inventory both relates to the presenting problem and is useful with measuring the client's anxiety. The BAI is appropriate for ages 17-80 years. This tool is also helpful in distinguishing between anxiety and depression. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1153,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that she and her husband have separated and she is now living with her parents. She is tearful and says that the past few days have been challenging. She reports an increase in headaches and stomachaches. The client has interviewed for a teaching position at a private school but doesn’t think she can afford a pay cut. Nevertheless, the client continues to be motivated to continue with counseling and believes that she will find a good career fit, but it may take some time. You discuss using a cognitive information processing approach with the client, and she is receptive. You explain that this approach will enable you to examine the communication, analysis, synthesis, valuing, and execution (CASVE) cycle of career decision-making skills",How would you use core counseling skills to respond to your client?,“Your marriage is in trouble. Let’s look at how this will impact your career choices.”,"“I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today.”","“I know how you feel. I also experienced difficult times with my husband. It took a while, but we are best friends now.”","“You and your husband are getting a divorce, and you believe this will negatively affect your future career choices.”","(A): “Your marriage is in trouble. Let’s look at how this will impact your career choices.”
(B): “I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today.”
(C): “I know how you feel. I also experienced difficult times with my husband. It took a while, but we are best friends now.”
(D): “You and your husband are getting a divorce, and you believe this will negatively affect your future career choices.”","“I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today.”",B,"“I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today” is the statement that best reflects core counseling skills. The counselor acknowledges the client’s underlying feelings, provides feedback grounded in the here and now, and allows space for the client to explore these feelings. Answer A is incorrect because it is an inaccurate account of what the client expressed. There was no discussion of divorce or the implication that it would affect all of her future career choices rather than the ones with lower pay. Answer B does not acknowledge the underlying feelings of sadness. Answer C is an example of a poorly timed and poorly constructed self-disclosure. When appropriately used, self-disclosures should promote client growth and leave clients with the feeling that they are understood. Therefore, the correct answer is (D)",counseling skills and interventions
1154,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.  Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior.    Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships.  Seventh session The client was a ""no show"" for his session last week. You did not hear from him and ended up reaching out to him to reschedule. He arrives at this session on time and is eager to talk about a situation that occurred with his daughter. He had reached out to her to talk about repairing the relationship, and after some convincing, she had agreed. She came to pick him up to go for lunch, and while they were in a car together, he used a term that is now considered politically incorrect to refer to one of her friends. His daughter got upset with him and would not speak with him any further. He attempted to defend himself by saying that the term he used was not derogatory.    He presents this as ""yet another example"" of his children not liking him, and ""never giving him a chance"". He does not know how to move forward. He tells you that he ""can't do anything right"" and is a failure where his children are concerned. He mentions that this episode was especially frustrating, because he has so happy at arranging this meeting. You disclose your own frustration with one of your family members and explain that sometimes that person only seems interested in connecting with you when they need help. You also incorporate a strengths-based approach to build the client's resilience.",,How might you best identify the client's strengths?,Administer a personality inventory centered around competence.,Engage the client in a conversation about his conception of success.,"Ask, ""Can you tell me about an experience in your life where you felt successful?""",Have the client list obstacles that he has faced in the past.,"(A): Administer a personality inventory centered around competence.
(B): Engage the client in a conversation about his conception of success.
(C): Ask, ""Can you tell me about an experience in your life where you felt successful?""
(D): Have the client list obstacles that he has faced in the past.","Ask, ""Can you tell me about an experience in your life where you felt successful?""",C,"Supporting the person's strengths can help address needs for support in a way which allows the person to lead and be in control of an ordinary and independent day-to-day life as much as possible. Therefore, the correct answer is (C)",counseling skills and interventions
1155,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","    History of Condition: The client’s milestones were all developmentally appropriate; he was walking at ten months, toilet trained by 24 months, and speaking in complete sentences at almost 30 months. The mother describes the client as “moody” beginning in kindergarten. His temper outbursts began to escalate in intensity and duration within the last few years. During this time, there were no known associated stressors. The mother reports that the client has always had a hard time following directions and difficulty complying with authority figures. Family History: The client has two maternal half-brothers, ages 18 and 20, and has positive relationships with both of them. His parents divorced when the client was three years old, and the mother has physical custody of the child\. Before the divorce, the client witnessed verbal and physical altercations between his parents. The client’s father visits periodically, and he has been in and out of substance abuse treatment centers for most of the client’s life. When angry with his mother, the client tells her he wishes he could live with his father. The client’s maternal grandmother is diagnosed with bipolar disorder, and the client’s mother states she struggles “off and on” with depression. Aside from the father’s substance use disorder, a paternal history of mental illness is unknown.  The child is unwilling to agree to participate in counseling",The child is unwilling to agree to participate in counseling. Which of the following best illustrates what is required for counseling services to begin?,An assent form signed by the child,A consent form signed by both parents,A consent form signed by a custodial parent and an effort to obtain assent from the child,A consent form signed by both parents and an assent form signed by the child,"(A): An assent form signed by the child
(B): A consent form signed by both parents
(C): A consent form signed by a custodial parent and an effort to obtain assent from the child
(D): A consent form signed by both parents and an assent form signed by the child",A consent form signed by a custodial parent and an effort to obtain assent from the child,C,"According to the NBCC Code of Ethics (2016), “When counseling minors, […] counselors seek the assent of clients to services and include them in decision making as appropriate” Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf. Answer D best illustrates this ethical commitment. Consent forms can be signed by either parent. Most state laws require parental consent, but it is unnecessary to obtain consent from both parents. Some states only require an assent form signed by the client but there are no states that allow this practice for children under the age of 12. Therefore, the correct answer is (D)",professional practice and ethics
1156,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.",Which of the following interventions will be most beneficial to help the client in addressing her anger at her lateness?,Explore client's perceptions of what others think about her if she is not on time,Explore client's beliefs about herself related to being on time,Explore themes related to time in the family genogram,All of the above,"(A): Explore client's perceptions of what others think about her if she is not on time
(B): Explore client's beliefs about herself related to being on time
(C): Explore themes related to time in the family genogram
(D): All of the above",All of the above,D,"Each of the responses are important for the counselor and client to explore when helping the client address her self-anger related to being late. The themes in her family of origin have helped the client formulate her beliefs about herself. Her perceptions of others' expectations for her have contributed to her negative thoughts. Therefore, the correct answer is (D)",counseling skills and interventions
1157,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","   fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend.  The client self-reported his ADHD diagnosis, and you want to confirm this diagnosis","The client self-reported his ADHD diagnosis, and you want to confirm this diagnosis. All of the following are appropriate steps to take to confirm the diagnosis, EXCEPT:",You request records from the client related to the diagnosis in order to confirm it.,You collaborate with the client’s PCP to diagnose the client.,"As a licensed therapist, you are authorized to diagnose ADHD like you would diagnose other mental health diagnoses.",You give a provisional diagnosis of ADHD in order to continue to assess for ADHD on your own.,"(A): You request records from the client related to the diagnosis in order to confirm it.
(B): You collaborate with the client’s PCP to diagnose the client.
(C): As a licensed therapist, you are authorized to diagnose ADHD like you would diagnose other mental health diagnoses.
(D): You give a provisional diagnosis of ADHD in order to continue to assess for ADHD on your own.","As a licensed therapist, you are authorized to diagnose ADHD like you would diagnose other mental health diagnoses.",C,"ADHD is a mental health diagnosis, but it is also a medical diagnosis because it is a developmental disorder. You need to receive records from the PCP and historical documentation regarding symptomology to confirm this diagnosis. Do not attempt to diagnose ADHD on your own. You can also give a provisional diagnosis while you work through narrowing down the client’s diagnosis. This is a difficult diagnosis to confirm on your own, especially through telehealth sessions, and you should collaborate with other medical/mental health professionals who have seen this client in person. Therefore, the correct answer is (A)",professional practice and ethics
1158,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.  Ninth session You have seen the client weekly, and she is progressing. She arrives at today's session on time. She appears calm, alert and focused. She states that she has been actively journaling her thoughts and feelings. This has been helpful for her in identifying themes in her faulty cognitions. She tells you that she is surprised by how much she is learning about herself, including how much her past has influenced her current beliefs.    She showed some psychomotor agitation by pulling on the strings of her blouse. The client expressed that she and her husband have been trying to implement a date night which has helped their relationship and for him to better understand what Panic Disorder is. She said that having meaningful conversations with him and having his support in times of panic has helped reduce the attack's length. However, the client did express that she cannot shake the fear of dying and leaving her children. You discuss with her the potential triggers of these panic attacks and discuss ways to manage them.    As she leaves, you see that she has bruises on her arms as she is getting ready to leave and says she was ""roughhousing"" with her husband. You are unsure if she is telling the truth, making you wonder about everything she has been saying about her husband. You discuss with her the option of attending couples therapy to help them work through any issues they may face. She says she is open to it but worried about bringing up deeper issues surrounding their relationship. You reassure her that she and her husband will have a safe space to discuss any topics and remind her about the counseling.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Immediately after telling the client that you will call the authorities regarding the bruises you see on her arms, she jumps up and aggressively moves toward you. What should you do first?","Acknowledge the outburst as part of her ongoing psychodrama, and ask the client what she should do next.",Treat the action as a potential assault and call for help.,Tell the client to return to her seat and explore the nature of the outburst.,Call for your supervisor to help you intervene in the situation.,"(A): Acknowledge the outburst as part of her ongoing psychodrama, and ask the client what she should do next.
(B): Treat the action as a potential assault and call for help.
(C): Tell the client to return to her seat and explore the nature of the outburst.
(D): Call for your supervisor to help you intervene in the situation.",Tell the client to return to her seat and explore the nature of the outburst.,C,"The client apparently acts out when confronted with intense feelings. This could be a sign of progress. It is best to try to de-escalate the situation before taking any other action. It is important to try to help the client manage her emotions constructively. Therefore, the correct answer is (B)",core counseling attributes
1159,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.  Sixth session You have been working with the client in intensive outpatient therapy and have been meeting with her two times per week. She is under medical care at the university's health center and has started taking an anti-anxiety medication that was prescribed by her physician. You have also referred her to a nutritionist for specialized guidance on developing a healthier relationship with food. You have established a strong, trusting relationship, and she has told you that she feels comfortable talking to you.    Today, the client brings up an issue that has been bothering her for a while: anxiety about eating around other people. She tells you that she usually gets her food ""to go"" from the cafeteria and eats at a bench outside or alone in her dorm room. She avoids eating in front of others when possible. However, at least once or twice a week, her teammates all go out to lunch after practice. This usually requires her to order food in front of them and she feels very anxious about it. She has been ordering the same salad with dressing ""on the side"" for several months because that is what makes her feel the most comfortable. One of her teammates commented on her ""same old salad"" and asked why she never got anything else to eat. Everyone at the table got quiet and turned to look at her. The client reports that the comment made her feel embarrassed and ashamed, like everyone was laughing at her. You ask her how she responded in the moment and she shares that she just laughed it off, but internally, she felt very embarrassed and anxious. You explore this further by asking her what emotions arise when she is around food, particularly in social settings. She reports feeling ashamed for wanting to eat ""fattening food"" because of her father's comments about her size. She skipped the last team lunch because she was so anxious about someone drawing attention to her food choices again. She closes her eyes and takes a breath. When she opens her eyes, you can see that she is struggling to hold back tears. She says, ""Everyone eats their food like it's no big deal. But it's a huge deal for me. It's all I can think about. I just want to be able to eat a meal without feeling guilty or like I'm going to get fat. I'm so tired of worrying about food all the time!""    You consider using exposure and response prevention techniques to address her fear and anxiety related to eating. You continue the session by identifying a list of foods and situations that trigger her anxiety and negative feelings about her body. You ask the client if she would like to meet with you for her next session right after practice and bring a lunch to eat in your office. She appears relieved and grateful to have a break from eating in front of her teammates.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","From a therapeutic standpoint, why are you suggesting the client eat lunch in your office?",To nurture a positive therapeutic alliance with her,To practice meal planning and portion control,"To process her thoughts, feelings, and behavior around food in a safe space",To reinforce positive behaviors through rewards and praise,"(A): To nurture a positive therapeutic alliance with her
(B): To practice meal planning and portion control
(C): To process her thoughts, feelings, and behavior around food in a safe space
(D): To reinforce positive behaviors through rewards and praise","To process her thoughts, feelings, and behavior around food in a safe space",C,"The idea is to explore her way of responding to food and what you may or may not be thinking in response to her eating while with you. You also are trying to see how that somehow gets interpreted by the client as something she is doing wrong. You intend to help change those patterns of thinking. Therefore, the correct answer is (B)",counseling skills and interventions
1160,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.",Which of the following is not a criterion for a diagnosis of Alcohol Use Disorder?,Using alcohol while knowing it exacerbates one's problems,Having a strong desire or urge to drink alcohol,Drinking the same amount with diminished effect,Using alcohol to numb or dull one's emotions,"(A): Using alcohol while knowing it exacerbates one's problems
(B): Having a strong desire or urge to drink alcohol
(C): Drinking the same amount with diminished effect
(D): Using alcohol to numb or dull one's emotions",Using alcohol to numb or dull one's emotions,D,"Using alcohol to numb one's emotions is not a criterion for alcohol use disorder. Cravings, tolerance, and withdrawal are all criteria for this diagnosis. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1161,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",What would you discuss first with the client based on his concerns and presentation during the intake?,Suicidal ideation,Method of dealing with conflict,Pain management options,Substance use history,"(A): Suicidal ideation
(B): Method of dealing with conflict
(C): Pain management options
(D): Substance use history",Suicidal ideation,A,"When discussing the client's concerns and presentation during intake, it would be best to discuss suicidal ideation first. The client has been dealing with depression for a long time. Additionally, he expresses feelings of loneliness, disconnect from family members, difficulty in maintaining relationships with others, and a reliance on alcohol to manage his emotions. These factors can increase the risk of suicidal ideation or attempts, so it is important for the clinician to assess this issue with the client first. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1162,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.  11th session As the session begins, you sit calmly in your office, virtually watching as the client pounds her fists on her desk and speaks angrily. The client informs you that she is ""not happy"" with you as a therapist. ""You therapists are all the same!"" she yells. She accuses you of being responsible for her break-up, saying that her boyfriend left her because she had been hospitalized on your recommendation.    Her facial expressions convey feelings of hurt and disappointment, and you attempt to normalize her reaction. You remain calm, opting to validate the client's feelings rather than respond defensively or deny responsibility for what has happened between the client and her partner.    As the session continues, you take a deep breath and give yourself a moment to gather your thoughts. You recognize that the client's emotional pain and distress have created a lens through which she now views your professional relationship.    Reflecting on the session and past interactions, you remember your concerns that prompted the recommendation for hospitalization. The client had exhibited signs of severe emotional distress and potential self-harm. As a therapist, you prioritized her safety and well-being. You understand her feelings of abandonment from her partner and try to determine who represents both care and potential harm in her life.    However, no matter how much empathy you try to show or how many times you attempt to normalize the client's feelings of anger, she refuses any further discussion on the topic; instead, she declares firmly that she does not want to see you again and abruptly logs out of the session.    You make a note to reach out to the client in a few days to check in on her well-being and see if she's open to discussing her feelings further. Given the intensity of her reaction, it's crucial to ensure that she has a support system during this challenging time. While she might not be receptive to your outreach initially, she needs to know that she is not alone and that help is available should she seek it.    Later, you discuss the situation with your supervisor, seeking guidance on best handling her response and processing your feelings about the matter. The supervisor reminds you that therapeutic relationships can mirror many aspects of clients' other relationships. The anger and feelings of betrayal the client is experiencing could have been elicited by any number of events in her life. The most important thing is to continue offering support while respecting her boundaries.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What would be a better approach to work with the client than the person-centered approach you have been using?,A Dialectical Behavioral approach,Narrative Therapy approach,Cognitive Behavioral Therapy (CBT) approach,An Adlerian approach,"(A): A Dialectical Behavioral approach
(B): Narrative Therapy approach
(C): Cognitive Behavioral Therapy (CBT) approach
(D): An Adlerian approach",A Dialectical Behavioral approach,A,"DBT is an evidence-based approach. Your person-centered orientation may not have given the client enough structure as she has no structure in her life and feels out of control without direction or purpose. Using a DBT approach might suggest teaching the client skills like emotional regulation, distress tolerance, and interpersonal effectiveness all that the client are lacking. Therefore, the correct answer is (B)",counseling skills and interventions
1163,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.",aged. Family History: The client reports that she is close with her parents but that they often have high expectations of her and that she worries about disappointing them. The client has an older brother who is 25 and is a lawyer. The client says some of the pressure is wanting to be as successful as her brother because she thinks her parents are really proud of him.  You provide psychoeducation on mindfulness activities to support the client in managing her morning panic attacks,"You provide psychoeducation on mindfulness activities to support the client in managing her morning panic attacks. All of the following are mindfulness strategies, EXCEPT:",Deep breathing exercises,Body scanning,Cognitive reframing,Coloring or drawing,"(A): Deep breathing exercises
(B): Body scanning
(C): Cognitive reframing
(D): Coloring or drawing",Cognitive reframing,C,"Mindfulness is the experience of focusing only on present thoughts and feelings and learning to accept the current situation. This can be helpful in simplifying a seemingly overwhelming situation by focusing on simply existing in the moment. Some techniques to use in mindfulness include coloring or drawing, deep breathing, and body scanning. Coloring or drawing focuses the client’s mind on a singular activity and helps to focus on the present. Deep breathing and body scanning focus on bodily functions and support calming the body and focusing the mind. Cognitive reframing may cause more distress because it involves working through thoughts instead of accepting a situation and focusing on the present. Cognitive reframing can be very helpful for anxiety, but when cognitive functioning is impaired by anxiety, it can be more helpful to focus the body and mind on the present. Therefore, the correct answer is (C)",counseling skills and interventions
1164,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",You feel this client would benefit from additional professional help. To whom would you refer the client for help with her depression and sleep issues?,Primary care physician,Psychiatrist,Anxiety support group,Sleep study program,"(A): Primary care physician
(B): Psychiatrist
(C): Anxiety support group
(D): Sleep study program",Psychiatrist,B,"A psychiatrist will be the most beneficial in prescribing medication for sleep and depression if necessary after evaluating and assessing the client. Therefore, the correct answer is (C)",treatment planning
1165,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice.  Following this session, the couple decides to stop meeting with you together because they plan to separate. The husband states that he would like to continue working with you","Following this session, the couple decides to stop meeting with you together because they plan to separate. The husband states that he would like to continue working with you. According to the ACA Code of Ethics, which one of the following would be the most ethical decision in this scenario?",Provide a referral to another therapist due to your past counseling relationship with his wife.,"You agree to provide individual counseling and explain that if you start to counsel him independently, you cannot provide marital counseling for him and his wife should they decide to stay together.",You agree to provide individual counseling to him and offer to provide marital counseling if they end up wanting to stay together.,You cannot continue seeing him due to having a previous counseling relationship with his wife.,"(A): Provide a referral to another therapist due to your past counseling relationship with his wife.
(B): You agree to provide individual counseling and explain that if you start to counsel him independently, you cannot provide marital counseling for him and his wife should they decide to stay together.
(C): You agree to provide individual counseling to him and offer to provide marital counseling if they end up wanting to stay together.
(D): You cannot continue seeing him due to having a previous counseling relationship with his wife.","You agree to provide individual counseling and explain that if you start to counsel him independently, you cannot provide marital counseling for him and his wife should they decide to stay together.",B,"The ACA Code of Ethics allows for the counselor to change counseling modalities, but in these cases, the counselor must explain the possible consequences of the change, which may be financial, legal, personal, or therapeutic in nature. If you begin to provide individual counseling to the husband in this case, there is a possibility of becoming biased toward him, which would create a conflict of interest should you resume marital counseling with the couple. If you think the client’s needs are out of your scope of practice, you can refer him to another counselor. Therefore, the correct answer is (D)",professional practice and ethics
1166,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.","Millie has still not addressed the death of her mother, and you feel the need to present her with this observation since it is obvious that she is distracting herself from her grief and all her subsequent anxiety and attachment issues are likely stemming from her loss. How should you approach this?",Tell her you must conduct a Complicated Grief Assessment before end of session.,Present this observation as soon as possible to make the most of the session.,"As it is only the second session, it is still appropriate for your client to lead the discussion.",You should never bring it up first.,"(A): Tell her you must conduct a Complicated Grief Assessment before end of session.
(B): Present this observation as soon as possible to make the most of the session.
(C): As it is only the second session, it is still appropriate for your client to lead the discussion.
(D): You should never bring it up first.","As it is only the second session, it is still appropriate for your client to lead the discussion.",C,"In the first session of counseling with a client who is clearly engaging and sharing on their own without prompting, it is entirely appropriate that the conversation evolves as the client leads. It is often most appropriate for all client sessions to be led by the client in content; however, to ethically address underlying reasons for presented behavior problems that could be causing the client harm, it is important to present your clinical feedback at an appropriate time. Therefore, answer d is not the right choice, as your referral of this client was entirely based upon emotional disorders developed because of this tragedy. The counselor should not pressure the client to speak on this issue when they are not ready, but to effectively address treatment it will be necessary. A Complicated Grief Assessment is an appropriate intervention to use but does not have to be done at a certain time and would more likely follow a conversation in which Millie admits to experiencing her grief. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1167,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client has attended and actively participated in all group therapy sessions. You are preparing the group for termination and discussing a “graduation” ceremony. The client has taken on a leadership role in the group, and you have asked him if he would be your “assistant” for the next group of neurodiverse men. The client approaches you, shakes your hand, and uses eye contact as he politely thanks you for the offer. You state you are pleased he has accepted. He then says, in a matter-of-fact tone, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills.”  Your client’s treatment plan goals address socio-emotional communication skills required for the diagnosis of ASD","Your client’s treatment plan goals address socio-emotional communication skills required for the diagnosis of ASD. Based your last exchange, has the client made progress on his treatment plan goals?","No, he exhibits an intrusive social approach.","Yes, he has made emotional connections with peers and is motivated to help others.","No, he did not consider your emotional welfare when responding to your offer.","Yes, he exhibited improvement in reciprocal social engagement.","(A): No, he exhibits an intrusive social approach.
(B): Yes, he has made emotional connections with peers and is motivated to help others.
(C): No, he did not consider your emotional welfare when responding to your offer.
(D): Yes, he exhibited improvement in reciprocal social engagement.","Yes, he exhibited improvement in reciprocal social engagement.",D,"When the client was offered a position as your assistant, he listened to your request and paused while awaiting a response. He also used eye contact. This illustrates social-emotional reciprocity. The client responded to the request by saying, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills” Since there is no evidence indicating that you found the comment to be derogatory, nor was there feedback provided indicating hurt feelings, answer A is incorrect. An intrusive social approach involves intrusive or inappropriate touching. Shaking someone’s hand as an agreement and acceptance of an offer does not qualify as intrusive. Motivation to help others is not a diagnostic criterion for ASD and is therefore, incorrect. Additionally, it is unclear if he has motives to help others (eg, rather than receive better refreshments or gain social prestige). Therefore, the correct answer is (B)",treatment planning
1168,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","The client talks about when he went to see his daughter at a dance recital and how, afterward when he went to say hello to her, she ignored him. He called his ex-wife later that day, and she denied knowing what was wrong, but when he talked to his son, the boy said, “Mommy told us you didn’t want to live with us anymore and that is why you left.” The client expresses frustration and anger with his ex-wife because she chose to leave him, and he thinks that it is not fair that she is telling the children a lie and also that it is affecting his relationship with them. The client states that he wanted to talk to you before he confronted his wife about this. You and the client discuss conflict resolution skills.  You are supervising a counseling intern, who thinks that he is not a good match for this client","You are supervising a counseling intern, who thinks that he is not a good match for this client. Which of the following would be an appropriate consideration for addressing this issue?","The fact that the intern has some experience with divorce, but might benefit from some education to improve his competency and therefore comfort with this client.",The impact of the client and the intern having different values on the counseling process.,"The intern does not think that he has the skills to support the client; therefore, he should be guided in attempting to provide services within the skills that he has.","The intern is not a Christian or Catholic and would not be able to support the client; therefore, a Christian counselor may be more appropriate for this client.","(A): The fact that the intern has some experience with divorce, but might benefit from some education to improve his competency and therefore comfort with this client.
(B): The impact of the client and the intern having different values on the counseling process.
(C): The intern does not think that he has the skills to support the client; therefore, he should be guided in attempting to provide services within the skills that he has.
(D): The intern is not a Christian or Catholic and would not be able to support the client; therefore, a Christian counselor may be more appropriate for this client.","The fact that the intern has some experience with divorce, but might benefit from some education to improve his competency and therefore comfort with this client.",A,"The intern would benefit from some education to improve competency because he does have some experience, which would make added education an appropriate option. Having different values or religious beliefs would not matter because the intern would not refer based on these differences because he should be focusing on supporting the client’s worldview (ACA Governing Council, 2014, p 6). The intern should not try to provide services the best that he can with the skills that he has if his skills do not meet the needs of the client. Therefore, the correct answer is (B)",counseling skills and interventions
1169,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",Which strategy effectively facilitates the client's objective of improving the expression of his feelings in more constructive ways?,Allocate time in the session for Alexei to vent his feelings,Create a list of healthy coping skills to turn to when feeling overwhelmed,Utilize the empty chair technique to address unresolved enmeshment issues with his mother,Have the client role-play activities and conversations with his wife that boost his understanding and respect,"(A): Allocate time in the session for Alexei to vent his feelings
(B): Create a list of healthy coping skills to turn to when feeling overwhelmed
(C): Utilize the empty chair technique to address unresolved enmeshment issues with his mother
(D): Have the client role-play activities and conversations with his wife that boost his understanding and respect",Create a list of healthy coping skills to turn to when feeling overwhelmed,B,"Creating a list of healthy coping skills to turn to when feeling overwhelmed is an effective strategy for helping the client express his feelings in productive ways. This strategy can help the client recognize triggers for his anxiety and develop new, more positive responses to them. Furthermore, it allows the therapist to provide guidance on how to manage negative emotions and offers practical solutions to problem-solving. Therefore, the correct answer is (A)",counseling skills and interventions
1170,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.  Fifth session This is your fifth weekly session with the client, and she states that she likes the ""structure"" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, ""I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal.""    You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, ""I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships."" You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family.    During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she ""had other stuff going on.""",,What intervention would be most appropriate to use to help the client explore her feelings for her roommate?,Normalize her feelings and help her explore her identity in a safe space.,Encourage her to talk to her family and church about her feelings,Help her to develop an action plan to cope with her feelings.,Assign her homework to research LGBTQ+ identities and their social implications.,"(A): Normalize her feelings and help her explore her identity in a safe space.
(B): Encourage her to talk to her family and church about her feelings
(C): Help her to develop an action plan to cope with her feelings.
(D): Assign her homework to research LGBTQ+ identities and their social implications.",Normalize her feelings and help her explore her identity in a safe space.,A,"This is the best intervention as it will help the client feel supported and comfortable exploring her feelings in a safe, non-judgmental environment. Normalizing feelings is recognizing, accepting, and validating a person’s emotions. It involves understanding that all emotions, whether positive or negative, are valid and important. It is important to normalize feelings to create an emotionally safe and secure environment. Exploring identity also allows clients to safely discuss and express their individuality, beliefs, and values without fear of judgment or criticism. Therefore, the correct answer is (D)",counseling skills and interventions
1171,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","   age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement.  You would like to use a screening instrument to determine the severity of your client’s depression and anxiety",You would like to use a screening instrument to determine the severity of your client’s depression and anxiety. Which one of the following screening instruments has a standardized modification for adolescents?,"Cut down, annoyed, guilty, and eye-opener (CAGE)",EQ-5D,Alcohol Use Disorders Identification Test (AUDIT),Patient Health Questionnaire (PHQ-9),"(A): Cut down, annoyed, guilty, and eye-opener (CAGE)
(B): EQ-5D
(C): Alcohol Use Disorders Identification Test (AUDIT)
(D): Patient Health Questionnaire (PHQ-9)",Patient Health Questionnaire (PHQ-9),D,"PHQ-9 is a 9-item, self-administered screening instrument used to measure depression and anxiety. PHQ-9: Modified for Teens is adapted for use with adolescents. CAGE is a four-item screening instrument measuring an individual’s problematic alcohol use related to cutting down, others’ annoyance with one’s alcohol use, personal guilt over use, and alcohol use first thing in the morning. EQ-5D measures health-related quality of life across five dimensions, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-Y can be used with children and adolescents. Although measures are included for anxiety and depression, the instrument is not designed for the sole use of determining the severity of anxiety and depression. Finally, AUDIT is used to help identify alcohol consumption, alcohol-related health problems, and drinking behaviors. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1172,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",What is the most important information to share with your client when responding to her question about therapist availability outside of sessions?,Your agency's contact information,The National Suicide Hotline number,Your cell number,Your clinical supervisor's contact information,"(A): Your agency's contact information
(B): The National Suicide Hotline number
(C): Your cell number
(D): Your clinical supervisor's contact information",The National Suicide Hotline number,B,"It is important to give the National Suicide Hotline number to all clients. Emergencies happen, and you are not on call around the clock. Even though the client claims no intent or plan to harm herself, giving her the necessary information is important. Therefore, the correct answer is (C)",professional practice and ethics
1173,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,Carlos seems disengaged currently. Which of the following statements by the counselor would be an appropriate response?,"""Do you want to tell me more about yourself?""","""Carlos, you know that you have to be involved in therapy as per court, right?""","""Tell me what you want to accomplish in our time together.""","""Wow, it sounds like things are getting worse for you.""","(A): ""Do you want to tell me more about yourself?""
(B): ""Carlos, you know that you have to be involved in therapy as per court, right?""
(C): ""Tell me what you want to accomplish in our time together.""
(D): ""Wow, it sounds like things are getting worse for you.""","""Tell me what you want to accomplish in our time together.""",C,"An open-ended question gives Carlos control as well as a sense that the counselor values his opinion. Carlos is aware that he is mandated to attend therapy. Reminding him of this may seem authoritarian or confrontational. Choice b focuses on the negative and would not add motivation for Carlos to engage. Choice c could be answered with a no. A better way to ask the question would be, ""Tell me something about yourself"". Therefore, the correct answer is (D)",treatment planning
1174,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","   ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining",What is the value in clarifying and paraphrasing the client’s presenting problem?,It enables expressions of immediacy,It assists in clarifying values.,It helps promote an egalitarian relationship.,It fosters the creation of discrepancy.,"(A): It enables expressions of immediacy
(B): It assists in clarifying values.
(C): It helps promote an egalitarian relationship.
(D): It fosters the creation of discrepancy.",It helps promote an egalitarian relationship.,C,"By clarifying and paraphrasing the client’s presenting problem, you allow the client to correct any inaccuracies and inconsistencies by rephrasing what the client has stated. A counselor’s use of these skills can help promote a sense of partnership with the client, which can serve as a foundation for conceptualizing and creating treatment plan goals. Immediacy is grounded in the here-and-now experience of the counseling process and is generally facilitated by self-disclosure. The skill of immediacy is used to reflect a parallel experience or address what is going on between the counselor and client in real-time. Immediacy is best used after the counselor establishes a therapeutic alliance with the client. Values clarification differs from the communication skill of clarification. Counselors use values clarification to help clients recognize, understand, and prioritize personal ethical and moral values. Creating discrepancy is a motivational interviewing technique used to promote change talk by pointing out the disconnect between where the client is currently and where they would like to be. Therefore, the correct answer is (A)",counseling skills and interventions
1175,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.","Given the client's situation, who needs to be on your list for the release of information, and what documentation do you need to send?",You will need to send documentation of attendance to her probation officer.,You do not need to send a release of information as she has been court-mandated to therapy.,You will need to send documentation to her probation officer and the local municipal court.,You will need to send the client's documentation of attendance to her lawyer.,"(A): You will need to send documentation of attendance to her probation officer.
(B): You do not need to send a release of information as she has been court-mandated to therapy.
(C): You will need to send documentation to her probation officer and the local municipal court.
(D): You will need to send the client's documentation of attendance to her lawyer.",You will need to send documentation of attendance to her probation officer.,A,"The client will need documentation that she is attending therapy and sent only to her probation officer. Therefore, the correct answer is (D)",professional practice and ethics
1176,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",You are documenting your session with the client. Which of the following was not part of the treatment plan discussed with the client?,Use of cognitive behavioral therapy to manage feelings more effectively,Relaxation techniques to reduce physical symptoms of distress,Medication management to address anxiety,Developing coping skills to improve overall well-being,"(A): Use of cognitive behavioral therapy to manage feelings more effectively
(B): Relaxation techniques to reduce physical symptoms of distress
(C): Medication management to address anxiety
(D): Developing coping skills to improve overall well-being",Medication management to address anxiety,C,"The client was not presented with any medication management options during the session. Therefore, the correct answer is (C)",treatment planning
1177,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss.  The client’s religious beliefs and core cultural values are inconsistent with your own worldview",The client’s religious beliefs and core cultural values are inconsistent with your own worldview. Which theoretical orientation would best provide you with a basis for sound ethical practice?,Behavior therapy,Rational-emotive behavioral therapy,Conversion therapy,Person-centered therapy,"(A): Behavior therapy
(B): Rational-emotive behavioral therapy
(C): Conversion therapy
(D): Person-centered therapy",Person-centered therapy,D,"Although all theoretical orientations can be adapted for use with culturally diverse populations, the core elements of person-centered therapy would best enable you to uphold professional ethical principles. According to the ACA Code of Ethics, “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients … and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals” The Association for Spiritual, Ethical, and Religious Values in Counseling provides a more thorough overview of ethical competencies aligned with the ACA Code of Ethics. Person-centered therapy is nondirective and uses the facilitative conditions of unconditional positive regard, empathetic understanding, and genuineness to guide the client toward self-actualization. Person-centered therapists respect diverse values, attitudes, and beliefs and refrain from taking the “expert role” in clients’ lives. In general, behavior therapy does not consider the client’s sociocultural background but instead views specific behaviors as a series of “maladaptive responses” Illegal in most states, conversion therapy is supported by conservative religious organizations that view same-sex attraction as pathological. Rational-emotive therapy is less likely to uphold ethical principles primarily because of the techniques “forcefully disputing” irrational thoughts in efforts to change “maladaptive behaviors” Unless adapted for diverse populations, rational-emotive behavior therapy (REBT) does little to consider the sociocultural and political influences on an individual’s thoughts and behaviors. Therefore, the correct answer is (B)",counseling skills and interventions
1178,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What referral would you initially consider for this case?,A social worker.,A case manager.,A psychiatrist.,A professional specialist in the community for the client and a support group for the mother.,"(A): A social worker.
(B): A case manager.
(C): A psychiatrist.
(D): A professional specialist in the community for the client and a support group for the mother.",A professional specialist in the community for the client and a support group for the mother.,D,"As a school counselor, you will likely not have the kind of time available to you that this client may need; so, having a professional in the community to follow up with the child is strongly suggested here. In addition, it is vital to be sure the mother is connected with practical resources available in the community. Therefore, the correct answer is (D)",treatment planning
1179,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","As this is the first time you are seeing a client with this particular issue and you are feeling unsure of how to proceed, what is the best action to take at this time?",Suggest the client see his physician for a full physical examination.,Consult with your supervisor,"Arrange for training in this area, to enhance your knowledge.",Seek guidance from a therapist who has expertise in this area,"(A): Suggest the client see his physician for a full physical examination.
(B): Consult with your supervisor
(C): Arrange for training in this area, to enhance your knowledge.
(D): Seek guidance from a therapist who has expertise in this area",Consult with your supervisor,B,"Since you feel unsure of how to deal with this client, your first step should be to consult with your supervisor. As an intern, it is important to seek guidance from your supervisor when addressing a clinical issue that you feel unsure of how to handle. Supervisors provide insight into potential interventions and strategies to help guide effective treatment plans, as well as offer support and guidance if needed. Therefore, the correct answer is (B)",professional practice and ethics
1180,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps.  Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, ""I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?"" You remain calm and acknowledge the client's frustration. You reply, ""You're angry with me because you feel that I'm not listening. Am I hearing you right?"" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety.    The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but ""she just doesn't get how hard it is for me."" He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, ""It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?"" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support.  Sixth session It has been one and a half months since you began seeing the client for therapy. He followed up on the referral you gave him to see a psychiatrist and he is currently taking medication for his anxiety, but he reports that ""the pills aren't really helping."" He says he loves cheerleading and gymnastics and will never give them up. He reports he is still eating and exercising to excess but refuses to stop. He continues, ""I'm aware of the dangers, but I don't care. All athletes go through pain to be successful."" You assess the client's internal and external motivation as a strategy to separate the client from his denial that he has an illness."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ","Using a cognitive-behavioral framework, which technique would you use to help this client with his anxiety?",Empty chair,Stress inoculation,Deconstructing the problem,Scaling questions,"(A): Empty chair
(B): Stress inoculation
(C): Deconstructing the problem
(D): Scaling questions",Stress inoculation,B,"Stress inoculation is used in CBT and combines relaxation skills with self-talk, role-playing, rehearsal, and/or systematic desensitization to help individuals master highly stressful events or circumstances. Therefore, the correct answer is (B)",counseling skills and interventions
1181,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ",Which assessment tool would be least relevant to use when determining a course of treatment for this client?,Children's Depression Inventory-2 (CDI-2),"Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2)",Child Attachment Interview (CAI),Child Behavioral Checklist (CBCL),"(A): Children's Depression Inventory-2 (CDI-2)
(B): Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2)
(C): Child Attachment Interview (CAI)
(D): Child Behavioral Checklist (CBCL)",Children's Depression Inventory-2 (CDI-2),A,"The client is not exhibiting signs of depression. The CDI-2 is used for ages 7 to 17 to determine the severity of depressive symptoms and to help develop a treatment plan. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1182,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What short-term goal would you prioritize with this couple during the early stage of therapy?,Establish communication guidelines to manage conflict and build trust,Address parenting challenges related to their child's autism diagnosis,Strengthen social support networks,Resolve the wife's lack of trust in her husband,"(A): Establish communication guidelines to manage conflict and build trust
(B): Address parenting challenges related to their child's autism diagnosis
(C): Strengthen social support networks
(D): Resolve the wife's lack of trust in her husband",Establish communication guidelines to manage conflict and build trust,A,"The core presenting issues are lack of trust and unhealthy communication patterns. The wife does not trust the husband due to his past alcohol abuse. When they try to discuss her concerns, it leads to conflicts and the husband withdrawing. Improving communication and rebuilding trust is foundational. If they can communicate in a healthier way and rebuild trust, it will help facilitate progress in other areas of their relationship. Therefore, the correct answer is (D)",professional practice and ethics
1183,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",Which of the following actions would be ethical and appropriate given the client's report?,Contact the client's teachers and ask for updates on her behavior to help further inform your case conceptualization,Initiate a plan to hospitalize the client due to her suicidal ideation and risk,Notify the client's parents about her suicidal ideation and strongly recommend the father change the passcode to his gun safe without informing his daughter,Notify the parents about the client's smoking without informing her,"(A): Contact the client's teachers and ask for updates on her behavior to help further inform your case conceptualization
(B): Initiate a plan to hospitalize the client due to her suicidal ideation and risk
(C): Notify the client's parents about her suicidal ideation and strongly recommend the father change the passcode to his gun safe without informing his daughter
(D): Notify the parents about the client's smoking without informing her",Notify the client's parents about her suicidal ideation and strongly recommend the father change the passcode to his gun safe without informing his daughter,C,"The client's parents should be informed of the client's suicidal ideation. While her risk is likely low, she has thought of harming herself with her father's guns. Ensuring that she is not able to act on impulse while feeling intense negative emotions is important. Therefore, the correct answer is (C)",professional practice and ethics
1184,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","You are on maternity leave, and your supervisor is covering your cases while you are out of the office. The supervisor meets with the client and daughter for the first time today and discusses the client’s progress and her treatment plan goals. The client and her daughter report measurable improvements with symptoms of depression and apathy. During today’s session, the supervisor also learns that you and the daughter went to high school together and share multiple acquaintances. There is no documentation in the client’s chart indicating that the risks and benefits of multiple relationships were reviewed with the client. At the end of the session, the supervisor asks the client for her copay. The daughter and the client state that you have “always just waived the copay,” indicating that the final bill would eventually be “written off by the agency.”  When considering the risks and benefits of multiple relationships, counselors must take appropriate professional precautions","When considering the risks and benefits of multiple relationships, counselors must take appropriate professional precautions. Which of the following is NOT a professional precaution that counselors must take when engaging in multiple relationships?",Signed waivers,Informed consent,Supervision,Documentation,"(A): Signed waivers
(B): Informed consent
(C): Supervision
(D): Documentation",Signed waivers,A,"The 2014 ACA Code of Ethics (Standard A6a) addresses multiple relationships stating, “Counselors consider the risks and benefits of accepting as clients those with whom they have had a previous relationship … When counselors accept these clients, they take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs” (ACA, 2014). Signed waivers granting permission for the counselor to proceed with the client, despite the risk involved, are not included in the professional precautions that counselors must take. Therefore, the correct answer is (B)",professional practice and ethics
1185,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.",Which of the following assessment tools would best help you determine the level of care your client needs and the treatment goals for this client?,Columbia Suicide Severity Rating Scale (C-SSRS),Beck Anxiety Inventory (BAI),Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),Beck Depression Inventory-II (BDI-II),"(A): Columbia Suicide Severity Rating Scale (C-SSRS)
(B): Beck Anxiety Inventory (BAI)
(C): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(D): Beck Depression Inventory-II (BDI-II)",Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),C,"The MMPI-2 is the best assessment tool in this situation. The other three will provide good information about different aspects of the client but will not provide a holistic view of what the client may be dealing with. The BDI-II will assist in determining if the client is experiencing depression but will not capture the anxious features, while the BAI will assess the converse. The C-SSRS will provide information about current suicidal ideation, but will not assist with possible diagnoses or capture other facets of the client's personality that may be causing him problems. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1186,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The client arrives for the session without her husband. Her affect is flat, and she presents as more subdued. The client explains that she has been in bed for the last 4 days, which has caused escalated conflict and tension with her husband. She says that her husband believes that they are at an impasse and threatened to leave during their fight last night. When processing the details of their altercation, the client states that her fear of being alone has become unbearable. She denies any suicidal plans but says she feels hopeless and void of purpose and is in significant levels of physical pain due to intractable migraines. You conduct a suicide risk assessment to determine the client’s level of safety",Which instrument would you select to provide a comprehensive suicide risk assessment with the client?,Patient Health Questionnaire-2,Columbia-Suicide Severity Rating Scale,Ask Suicide-Screening Questions Toolkit,Achenbach System of Empirically Based Assessment,"(A): Patient Health Questionnaire-2
(B): Columbia-Suicide Severity Rating Scale
(C): Ask Suicide-Screening Questions Toolkit
(D): Achenbach System of Empirically Based Assessment",Columbia-Suicide Severity Rating Scale,B,"The Columbia-Suicide Severity Rating Scale is a comprehensive suicide risk assessment appropriate for this client. It is used in multiple settings, including outpatient behavioral health, and it provides an in-depth assessment of suicidal ideation and suicidal behavior. The Patient Health Questionnaire-2 is a two-question abbreviated scale used to evaluate the frequency of depressed mood and anhedonia within the past 2 weeks. The Achenbach System of Empirically Based Assessment uses multiple informants to assess an individual’s adaptive and maladaptive behaviors. The Ask Suicide-Screening Questions toolkit consists of four screening questions and is designed for individuals ages 10 to 24. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1187,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,What is a highly effective modality of therapy for someone diagnosed with Schizophrenia?,Family systems Therapy,Cognitive Behavioral Therapy,Existential Therapy,Psychoanalysis,"(A): Family systems Therapy
(B): Cognitive Behavioral Therapy
(C): Existential Therapy
(D): Psychoanalysis",Cognitive Behavioral Therapy,B,"Cognitive behavioral therapy has been proven effective for clients diagnosed with Schizophrenia. Psychoanalysis would not be beneficial as it focuses on the subconscious process and childhood. Existential therapy is not suggested for those who are actively psychotic. Family systems therapy is not the best option as it focuses on family dynamics which is currently a trigger for Mark. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1188,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,Molly meets the diagnostic criteria for?,Panic Attacks,Agoraphobia,Generalized Anxiety Disorder,Anxiety disorder due to medical condition,"(A): Panic Attacks
(B): Agoraphobia
(C): Generalized Anxiety Disorder
(D): Anxiety disorder due to medical condition",Generalized Anxiety Disorder,C,"Molly meets the criteria for generalized anxiety disorder which include symptoms of excessive worry, difficulty controlling the worry, as well as difficulty sleeping, poor concentration and muscle tension. There is no indication that Molly has a medical condition causing symptoms of anxiety. Panic attack is not a coded mental disorder but is included in the DSM-V as a specifier used to identify one of the symptoms of Panic Disorder. Agoraphobia is the intense fear of leaving the house, which Molly does not have. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1189,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.",It would be most helpful to educate the client on which of the following topics?,The differences between ambivalence and anxiousness,The causes of Borderline Personality Disorder and the familial links,The differences in manipulating others and making suicidal threats to prevent abandonment,The research that shows Borderline Personality Disorder tends to decline with age,"(A): The differences between ambivalence and anxiousness
(B): The causes of Borderline Personality Disorder and the familial links
(C): The differences in manipulating others and making suicidal threats to prevent abandonment
(D): The research that shows Borderline Personality Disorder tends to decline with age",The differences between ambivalence and anxiousness,A,"The client presents with ambivalent affect for a second time as well as a BPD diagnosis. BPD is a personality disorder that centers around the anxiety of being rejected and abandoned, which this client appears to have experienced often. Because the client shows little insight into himself and his thoughts, emotions, and behaviors, helping him to distinguish between when he doesn't care and when he doesn't actually care and when he feels too anxious to attempt caring, will help him better understanding his feelings. Teaching the client about the causes and familial links of BPD may influence him to focus on others and how he has been harmed, rather than on his own current problems. The fact that BPD tends to decline with age may be hopeful news but may also encourage ambivalence as the client is already unmotivated to make changes in himself. Finally, the BPD client may make suicidal threats to prevent abandonment, but the threats are also indicators of the pain the individual is experiencing. It will be helpful at some point to discuss his threats and manipulative behaviors, but this would not be a priority at the beginning of treatment and may make the client feel defensive. Therefore, the correct answer is (B)",counseling skills and interventions
1190,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","Based on the information gathered in the intake, what counseling approach is likely to be most effective in addressing the client's issues?",Gestalt therapy,Motivational Interviewing,Cognitive therapy,Insight oriented therapy,"(A): Gestalt therapy
(B): Motivational Interviewing
(C): Cognitive therapy
(D): Insight oriented therapy",Motivational Interviewing,B,"Motivational interviewing (MI) is a counseling approach often used with clients who are ambivalent about change but are mandated to counseling by family or the courts. MI helps the client determine what changes can help them get what they want and what steps they could take to make those changes. It is an effective approach for substance addiction, particularly when clients do not recognize their substance issues. It is less insight oriented and focuses on resolving ambivalence and resistance. The client's past and current choices, as well as the mental status exam demonstrate poor judgement and decision-making. She uses multiple substances with negative consequences but denies any substance use problems. The other three choices are insight approaches, which are non-directive and focus more on helping the client determine the root of their problems. These approaches will not be as effective for clients who lack insight or are externally motivated to attend counseling. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1191,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","   ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years","A separate study found that the BDI-II was significantly correlated with the Patient Health Questionnaire (PHQ-9), which is evidence of which one of the following?",Test-retest reliability,Convergent validity,Predictive validity,Criterion-related validity,"(A): Test-retest reliability
(B): Convergent validity
(C): Predictive validity
(D): Criterion-related validity",Convergent validity,B,"Discovering that the BDI-II was significantly correlated with the PHQ-9 is evidence of convergent validity. Convergent validity is defined as the extent to which a test measures the hypothetical construct (eg, depression) that it intends to measure. To determine if the BDI-II accurately measures depression, the researcher correlated the measurements with those obtained with the PHQ-9. Predictive validity is when a measurement correlates with another variable that takes place in the future (eg, individuals who score high on tests measuring the onset of an illness are correlated with those who actually develop an illness). Predictive validity is a form of criterion-related validity because the specified measure accurately predicts scores on a criterion measure. Test-retest reliability occurs when participants partake in the same test twice. Reliability is obtained when a test’s stability is proven over time (ie, the scores from time one and time two are consistent and stable). Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1192,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.",,How should you respond to the client's invitation to meet with you before his session?,Clarify your role as his therapist,Discuss his request during your next session,Consider postponing his invitation until after termination,You accept his invitation since he is only a prospective client,"(A): Clarify your role as his therapist
(B): Discuss his request during your next session
(C): Consider postponing his invitation until after termination
(D): You accept his invitation since he is only a prospective client",Clarify your role as his therapist,A,"You need to clarify your role as his therapist as soon as possible to avoid miscommunication or risk damaging the therapeutic relationship. Therefore, the correct answer is (B)",professional practice and ethics
1193,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which of the following interventions would be the most effective for building communication skills at home?,Teach Jane and John how to use self-disclosure when listening to each other,Teach Jane and John basic reflecting and paraphrasing skills,"Teach Jane and John how to argue using ""I"" statements",Teach Jane and John to manage conflict more appropriately,"(A): Teach Jane and John how to use self-disclosure when listening to each other
(B): Teach Jane and John basic reflecting and paraphrasing skills
(C): Teach Jane and John how to argue using ""I"" statements
(D): Teach Jane and John to manage conflict more appropriately",Teach Jane and John basic reflecting and paraphrasing skills,B,"At this time, neither Jane or John are listening to each other's fears and concerns. Teaching them reflection and paraphrasing skills, such as ""What I hear you saying is"" allows each individual to share and be heard without judgement from their partner. This will help reduce Jane's anger and allow John to verbalize his fears as each begins to share with the other. Teaching clients to manage conflict and use ""I"" statements is an important part of communication and should be implemented once the couple has begun reestablishing trusting communication between them. Using self-disclosure when listening turns the focus from the speaker to the listener and is not a helpful communication tool while listening. Therefore, the correct answer is (A)",counseling skills and interventions
1194,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Which of the following would be most appropriate for helping the client navigate his dilemma?,Why do you think you feel sad and angry at yourself?,Your stepson didn't do it the way you wanted but you feel upset for getting angry,"The rules say your stepson was wrong, but a part of you seems to be questioning the rules",Your rules created a barrier between you and your stepson's relationship,"(A): Why do you think you feel sad and angry at yourself?
(B): Your stepson didn't do it the way you wanted but you feel upset for getting angry
(C): The rules say your stepson was wrong, but a part of you seems to be questioning the rules
(D): Your rules created a barrier between you and your stepson's relationship","The rules say your stepson was wrong, but a part of you seems to be questioning the rules",C,"Acknowledging the rules are present but that his emotions suggest a part of him is questioning them is a paraphrase of the client's dilemma without inferring judgement towards the client. Additionally, by using the term, ""the rules,"" it allows the client to focus on the rules as separate from himself instead of viewing himself as bad. This statement also provides the client an opportunity to hear that his dilemma is happening inside himself and allows him to react to the statement using the insight he appears to be developing. Asking the client ""why"" may make the client feel attacked and that he needs to defend his rules and why they are important. This is not helpful for the therapeutic relationship. Response c and d are both paraphrases of the client's dilemma but in each, the focus of the paraphrases are on the client as the problem, rather than the rules. Therefore, the correct answer is (A)",counseling
1195,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.  Fourth session You completed a risk assessment in the last session and worked on safety planning with Alexei. He arrives 15 minutes late to today's session. When you mention his tardiness, he begins yelling in German. When you appear confused, he switches over to English, saying you are harassing him just like his wife. You respond by acknowledging his feelings and gently reminding him that you are there to help him process his emotions in a safe and productive way. Once he is calm, you explore what it is about your presence that he may be perceiving as hostile or threatening. He takes a breath, apologizes to you for his outburst, and begins to talk about his wife and her disparaging comments. He explains that, when you asked why he was late, it felt like a reminder of how his wife often disregards his needs and makes him feel worthless. ""She makes some negative comment like 'you're late' or 'you never do this right'. It make me just want to give up!"" He begins talking about wanting to take a break from home and go back to Germany where he can ""start fresh"". He says that his wife's constant harassment is unbearable. Lately, he has been hoping that she will leave him. You spend the rest of the session planning with Alexei ways he can express his feelings of frustration in productive ways.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","The client voiced his interest in returning to Germany for a fresh start, which you interpret as his attempt at relieving the current stress. You believe this break can provide short-term relief but believe it is more important for him to find a way of managing these emotions, or else he will not be fully equipped with the necessary tools needed for long-term growth and development. What is the best way to respond to his statement?",Share your concerns about the potential risks to his therapeutic progress if he leaves,Reframe his comment as an opportunity to transform his current circumstances,Redirect the focus of the conversation to a discussion of healthy coping mechanisms.,Ask open-ended questions to explore the issue further.,"(A): Share your concerns about the potential risks to his therapeutic progress if he leaves
(B): Reframe his comment as an opportunity to transform his current circumstances
(C): Redirect the focus of the conversation to a discussion of healthy coping mechanisms.
(D): Ask open-ended questions to explore the issue further.",Ask open-ended questions to explore the issue further.,D,"Reflective listening allows you to understand the client's internal experience in a non-judgmental and validating way, while open-ended questions encourage them to explore their thoughts and feelings further. By responding this way, the therapist can provide support while still allowing the client autonomy over their own decision making. Additionally, it helps to maintain a positive rapport between the therapist and client. Therefore, the correct answer is (B)",counseling skills and interventions
1196,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",You decide to conduct a biopsychosocial interview to gather additional information about the client’s situation. Which areas would be addressed as part of this interview?,"Developmental history, and substance use","Difficulty in self-care, getting along with people, and getting around","Social history, mood, and behavior","The quantity and quality of relationships with peers, especially of the opposite sex","(A): Developmental history, and substance use
(B): Difficulty in self-care, getting along with people, and getting around
(C): Social history, mood, and behavior
(D): The quantity and quality of relationships with peers, especially of the opposite sex","Developmental history, and substance use",A,"Developmental history and substance use are all areas that would be addressed in a biopsychosocial interview. The purpose of a biopsychosocial interview is to examine the biological, psychological, and social factors that affect a client’s health. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1197,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that her husband’s patience continues to wear thin, so she has explored the possibility of alternate employment. She states that she applied for a position as a curriculum sales representative but did not get an interview. The client reports that the company used a personality inventory to prescreen job applicants. She says that someone in human resources told her she was not selected for an interview because the company was looking for someone who was more extraverted and a “thinker” rather than a “feeler.” The client explains that she was under the impression that they were looking for a male. She expresses an interest in using personality inventories to help identify employment that would be a good fit for her",Which one of the following theories would best address the client’s anxiety related to her professional identity and the search for purpose and meaning in her life?,Behavior modification,Psychoanalytic theory,CBT,Existential therapy,"(A): Behavior modification
(B): Psychoanalytic theory
(C): CBT
(D): Existential therapy",Existential therapy,D,"Existential therapy would best address the client’s anxiety related to her professional identity and the search for purpose and meaning in her life. Existential therapists help clients create purposeful lives, learn to exist with themselves and others peaceably, and remove the anxiety blocking them. Behavior modification uses learning techniques (eg, operant conditioning, aversive conditioning) to help clients make behavioral changes. CBT focuses on how a client’s thoughts influence how they think and feel. Psychoanalytic theory is based on the assumption that there are unconscious influences that affect how a person acts or feels. Therefore, the correct answer is (A)",counseling skills and interventions
1198,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","The client presents today with a blunted affect and an irritable mood. The daughter accompanies the client and states that the results of the client’s recent PET scan show changes in the brain that may indicate Alzheimer’s disease. You process the results with the client and her daughter and provide psychoeducation on cognitive impairment, including counseling risks, benefits, and limitations. The client would like to focus on improving psychosocial issues associated with her cognitive impairment.  You ask the client to share her previous experiences participating in her church, book club, and fitness classes","You ask the client to share her previous experiences participating in her church, book club, and fitness classes. What are you trying to accomplish?",Underscore the value of renewing and maintaining social support and exercise.,Identify any interpersonal stressors or trauma that caused her to discontinue these activities.,Assess individualized belief systems that may interfere with adherence to counseling.,Determine the client’s level of cognitive functioning before she discontinued these activities.,"(A): Underscore the value of renewing and maintaining social support and exercise.
(B): Identify any interpersonal stressors or trauma that caused her to discontinue these activities.
(C): Assess individualized belief systems that may interfere with adherence to counseling.
(D): Determine the client’s level of cognitive functioning before she discontinued these activities.",Underscore the value of renewing and maintaining social support and exercise.,A,"The primary purpose of asking the client to share her experiences of attending church, going to her book club, and taking fitness classes is to underscore the value of renewing and maintaining social support and exercise. The client is experiencing a decline in cognitive functioning but also exhibits associated behavioral and emotional disturbances. Supportive social relationships and exercise are associated with an overall increase in one’s quality of life and decreased experiences of depression and anxiety. It is unnecessary to determine the client’s cognitive functioning before discontinuing activities because we already have evidence of a modest cognitive decline from a previous level of functioning. Because the client is adhering to treatment thus far, individualized belief systems do not need to be examined. Lastly, cognitive impairments rather than interpersonal stressors or trauma are linked to the client’s discontinuation of the activities. Therefore, the correct answer is (C)",counseling skills and interventions
1199,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",What is the most effective way to build rapport with this client?,Explain the boundaries and purpose of therapy and how it will help him,"Engage in activities that involve two-way dialogue, such as role playing and problem solving",Reschedule for a different day when the client is in a better mood,Allow the client to control the sessions and follow his lead,"(A): Explain the boundaries and purpose of therapy and how it will help him
(B): Engage in activities that involve two-way dialogue, such as role playing and problem solving
(C): Reschedule for a different day when the client is in a better mood
(D): Allow the client to control the sessions and follow his lead","Engage in activities that involve two-way dialogue, such as role playing and problem solving",B,"This is the most effective way to build rapport with this client because it allows him to open up and feel heard and understood. Engaging in activities that involve two-way dialogue encourages active participation, which can help foster a more collaborative relationship between therapist and client. Therefore, the correct answer is (B)",counseling skills and interventions
1200,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","   atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together","All of the following referrals are appropriate based on the anorexia bingeing/purging type diagnosis, EXCEPT:",Inpatient treatment,Psychiatrist,Nutritionist,Dentist,"(A): Inpatient treatment
(B): Psychiatrist
(C): Nutritionist
(D): Dentist",Inpatient treatment,A,"Although anorexia is a mental health disorder, it is also a medical diagnosis, and medical considerations need to be part of the client’s treatment. The client should have regular appointments with her PCP to monitor her health. Inpatient treatment is not indicated at this time based on the information provided and because you specialize in eating disorders and are qualified to counsel this patient right now. A dentist referral should be considered because purging and poor nutrition affect tooth health. Psychiatrist-prescribed medication can be helpful in managing mood and anxiety related to anorexia. A nutritionist can be helpful for the client in identifying healthier eating habits and learning more about nutrition’s effects on the body. Therefore, the correct answer is (D)",treatment planning
1201,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.",Which of the following interventions will be most beneficial to help the clients between sessions?,Sign a behavioral contract stating each will communicate with the other daily,Have the couple put communication lower on their priorities until John feels better,Identify accountability partners for the couple to ensure they are communicating,Collaboratively develop a list of topics the couple feel safe talking about,"(A): Sign a behavioral contract stating each will communicate with the other daily
(B): Have the couple put communication lower on their priorities until John feels better
(C): Identify accountability partners for the couple to ensure they are communicating
(D): Collaboratively develop a list of topics the couple feel safe talking about",Collaboratively develop a list of topics the couple feel safe talking about,D,"Collaboratively developing a list that both John and Jane feel safe talking about provides a safe space for communication without the worry that either must talk about hard topics such as infertility or divorce while the relationship is strained. Signing a behavioral contract and identifying accountability partners are likely to put more pressure on the couple during a time when the individuals and the relationship are fragile. Encouraging them not to communicate while John is attempting to manage his depression may increase Jane's feelings of anger or sadness. It may take several weeks for John's mood to begin lifting and discouraging them from working on communicating for that time is not helpful in rebuilding their relationship. Therefore, the correct answer is (B)",treatment planning
1202,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","Based on the information gained from these three sessions, which intervention would be most effective in helping the client build insight related to her alcohol and substance use?",Have client attend a substance abuse therapy group,Complete a family genogram with information on substance use,Administer the Michigan Alcoholism Screening Test (MAST),Gently challenge the client using her past history of substance use and outcomes,"(A): Have client attend a substance abuse therapy group
(B): Complete a family genogram with information on substance use
(C): Administer the Michigan Alcoholism Screening Test (MAST)
(D): Gently challenge the client using her past history of substance use and outcomes",Have client attend a substance abuse therapy group,A,"Clients with substance addiction are prone to denying the extent that their substance abuse causes themselves or others. Family genograms and MAST assessments may provide information about patterns of use, but are not likely to facilitate insight when a client is in denial. Challenging the client with their history brings attention to incongruities, but the addict's need for deniability is strong with addiction and the counselor, particularly when working with a BPD client, must be aware of not rupturing the therapeutic relationship. Conversely, substance abuse therapy groups focus specifically on participants' addiction and the group model permits greater opportunities for participants to challenge members who minimize the effects of their addiction. A substance abuse treatment group allows the client to begin working on addiction outside of individual therapy and preserving that counselor-client relationship. Therefore, the correct answer is (C)",treatment planning
1203,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”","Based on the information provided, your client is most clearly demonstrating which of the following?",Anger at her partner for not reading her mind,"Positive coping strategies of independence, strength, and control",Effective communication skills for sharing feelings,Anger with their decreased sex life,"(A): Anger at her partner for not reading her mind
(B): Positive coping strategies of independence, strength, and control
(C): Effective communication skills for sharing feelings
(D): Anger with their decreased sex life",Anger at her partner for not reading her mind,A,"The client's change in tone and eye contact away from her partner, as well as blaming her partner for her lack of involvement and participation in her cancer treatment, strongly suggests that the client believes her partner should have known what the client needed, without being told. This passive-aggressive style of communication often leads to angry emotions. The client's eye contact with the counselor and hurriedly wiping away tears also suggests angry emotions about the loss of intimacy, though this is likely to be connected to her partner not meeting the client's unexpressed needs. The client's communication style appears to be holding in her emotions and then allowing them to come out in anger. This is not an effective style of communicating with others. The client may be using her independence, strength, and control as coping strategies, but they isolate her from her partner more than unite her, thus they are not positive in these circumstances. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1204,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.","Using the provided information, which of the following will best help you to understand the client's relationships with others?",Family Genogram,Thematic Apperception Test (TAT),Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),Beck's Anxiety Inventory-II (BAI-II),"(A): Family Genogram
(B): Thematic Apperception Test (TAT)
(C): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(D): Beck's Anxiety Inventory-II (BAI-II)",Family Genogram,A,"Completing and evaluating a family genogram will help identify unhealthy patterns and interactional dynamics. These patterns may have served the client well in childhood but have become problematic in her adult life. The MMPI-2 is used to assess personality traits and psychopathology. This may help the counselor determine a client's psychological state or a diagnosis, but it will not help explain the client's relationships with others. The BAI-II measures the client's current level of anxiety at a particular moment when the test is given. It is helpful as a pre- and post-test for monitoring anxiety levels, but will not add to the counselor's understanding of the client's relationship patterns with others. The TAT is a projective test that helps the counselor learn more about a client's emotional conflicts, themes within the client's life experience, psychological conditions, and may help the client to express their feelings in an indirect way. It does not provide specific information on the client's relationships with others. Therefore, the correct answer is (B)",counseling skills and interventions
1205,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.  Eighth session You continue to work with the client in outpatient therapy. During a previous session, the client identified a few sources of support and was able to tell her parents that she switched her major. Today, the client arrives for her appointment 20 minutes early. She appears eager to see you and excited to talk with you. When she sits down, she pulls several cookbooks out of her backpack. She tells you that she plans to go home during spring break and has collected recipes for a large meal she wants to make for her family. During this session, while exploring the client's relationship with food, you discover that she spends many hours in the library reading through cookbooks and watching baking shows on her computer. She says that she has an apple for breakfast, picks up a small salad ""to go"" from the campus cafeteria every day at exactly 12:00 p.m., and bakes a sweet potato for dinner in the microwave in her room at 6:00 p.m. She looks forward to her meals and plans her day around them. She says she is envious of other people who ""can eat anything whenever they want."" She tells you she is worried that if she eats extra food, she will become obese overnight and never stop eating.  You continue to explore the client's relationship with food by asking, ""What do you think would happen if you ate whatever you wanted?"" She replies, ""I'm afraid that if I eat extra food, I'll gain weight and never be able to stop eating. I'll keep getting bigger and bigger and turn into a severely obese person."" After taking a moment to think, the client shares, ""I'm scared that if I gain weight, no one will love me or care about me. Then I'll be completely alone, and it will be all my fault because I couldn't control my eating!"" You listen compassionately as the client shares her fear. You also emphasize that this is an extreme outcome and unlikely to occur. You encourage her to think realistically about the potential consequences of eating additional food and acknowledge that there may be some negative outcomes, but they are not guaranteed or irreversible.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","After acknowledging the client's feelings regarding her weight, what cognitive distortion could you identify in her statement that might be hindering progress?",Discounting the Positive,Catastrophizing,Magnification,Mind reading,"(A): Discounting the Positive
(B): Catastrophizing
(C): Magnification
(D): Mind reading",Catastrophizing,B,"Catastrophizing is a cognitive distortion in which someone imagines the worst possible outcome will happen. In this case, it appears the client has convinced herself that if she eats extra food, she will suddenly become obese and never be able to stop eating. Then she'll be completely alone and it will be all her fault because she couldn't control her eating. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1206,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”",Which of the following should be a priority during this first meeting with this client?,Assuming a non-judgmental stance,Demonstrating empathic attunement,Using redirection to help decrease negative thoughts,Acknowledging the client's diversity and intersectionality,"(A): Assuming a non-judgmental stance
(B): Demonstrating empathic attunement
(C): Using redirection to help decrease negative thoughts
(D): Acknowledging the client's diversity and intersectionality",Demonstrating empathic attunement,B,"Empathic attunement is a counselor's awareness of the client's emotional, somatic, and behavioral rhythms through tracking moment-to-moment changes and building a therapeutic connection demonstrating congruence and understanding. Attunement requires the counselor to emotionally engage with the client and their story and is the foundation of the therapeutic relationship. Acknowledging diversity and intersectionality and assuming a non-judgmental stance are both important parts of developing a therapeutic working relationship that allows the client to feel safe and understood during counseling. These are appropriate tasks but may be received as insincere if empathic attunement is not already present. Redirection to decrease negative thoughts may be helpful when using cognitive behavioral theory but should not be used when building the therapeutic relationship as the client may feel censured while telling their story. Therefore, the correct answer is (B)",professional practice and ethics
1207,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.  Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a ""new chance at living."" She further discloses that she recently met a ""wonderful man."" They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that ""he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me."" She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different.    From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. ""He's always around when I need him,"" she explains, ""And he listens to me and takes what I say seriously."" The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, ""If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared.""    You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",How could dialectical behavior therapy be used in this session to help the client navigate her newfound relationship?,Provide an empathetic and non-judgmental space for the client to explore her feelings about the relationship at her own pace,Encourage the client to practice mindful awareness of her feelings,Evaluate her early attachment experiences and discuss how this affects her interpersonal relationships,Explore feelings about unresolved past issues that may be impacting this relationship,"(A): Provide an empathetic and non-judgmental space for the client to explore her feelings about the relationship at her own pace
(B): Encourage the client to practice mindful awareness of her feelings
(C): Evaluate her early attachment experiences and discuss how this affects her interpersonal relationships
(D): Explore feelings about unresolved past issues that may be impacting this relationship",Encourage the client to practice mindful awareness of her feelings,B,"DBT emphasizes the importance of recognizing and acknowledging one's emotions, rather than suppressing them. In this session, DBT could be used to help the client navigate her newfound relationship by encouraging her to practice mindful awareness of her feelings. This would involve helping the client recognize and accept any positive or negative thoughts or emotions that arise as a result of her relationship. By doing so, the client will gain insight into what works for and against her in this relationship, allowing her to make more informed decisions about it going forward. Therefore, the correct answer is (C)",counseling skills and interventions
1208,Initial Intake: Age: 31 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.","You are a counselor in a private practice setting.  Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car.  She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.","Family History:
The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school.  She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.","Based on the information provided, which of the following diagnoses should the counselor suspect for this client?",Obsessive Compulsive Personality Disorder (OCPD),Major Depressive Disorder (MDD),General Anxiety Disorder (GAD),Adjustment Disorder (AD),"(A): Obsessive Compulsive Personality Disorder (OCPD)
(B): Major Depressive Disorder (MDD)
(C): General Anxiety Disorder (GAD)
(D): Adjustment Disorder (AD)",Obsessive Compulsive Personality Disorder (OCPD),A,"The client is not only angry and irritated with her friend, who asserts control in their relationship, but she is also easily angered when her children don't put toys away in the right places or when her sister-in-law does not meet her moral expectations. Additionally, she described her husband, who was her opposite, as messy and not always on time, which led to problems and arguments. These factors suggest the client meets criteria for OCPD, which are: preoccupations with rules, order, and organization such that the point of the activity is lost; perfectionism that interferes with activities; scrupulous about matters of morality; and miserly toward others as evidenced by anger at being asked to borrow money. The client may be experiencing an adjustment due to the death of her husband, but the characteristics she relates were present before his death. The client relates some symptoms of depression and anxiety, but does not meet criteria for either. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1209,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","   sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time.  You suspect that the client has post-traumatic stress disorder (PTSD)",You suspect that the client has post-traumatic stress disorder (PTSD). Which of the following does not meet the criteria for PTSD?,Difficulty with memory surrounding the traumatic event,Symptoms occur after at least 3 days following the traumatic event,Irritability,Poor concentration,"(A): Difficulty with memory surrounding the traumatic event
(B): Symptoms occur after at least 3 days following the traumatic event
(C): Irritability
(D): Poor concentration",Symptoms occur after at least 3 days following the traumatic event,B,"Within PTSD, the criteria for trauma symptoms requires that they must last longer than 1 month following the traumatic event. Acute stress disorder has similar criteria to PTSD, but it occurs only 3 days to 1 month following the traumatic event. Poor concentration, difficulty remembering the events of the traumatic event, and irritability are all symptoms of PTSD. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1210,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","   vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week.  When considering cultural concepts of stress, ataque de nervios is a condition commonly described by clients of Latino descent","When considering cultural concepts of stress, ataque de nervios is a condition commonly described by clients of Latino descent. Which one of the following symptoms is NOT typical of ataque de nervios?",Nausea,Sadness,Irritability,Vertigo,"(A): Nausea
(B): Sadness
(C): Irritability
(D): Vertigo",Sadness,B,"Ataque de nervios, although not an official diagnosis, is a commonly used idiom in the Latin culture that describes certain symptoms. Translated directly into an “attack of nerves,” sadness is not a common symptom of ataque de nervios because symptoms are more often based in anxiety. Irritability, nausea, and vertigo are symptoms commonly described by individuals complaining of these attacks. Therefore, the correct answer is (D)",counseling skills and interventions
1211,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.",,What is the most important element to take into consideration when initially establishing your group?,Setting of the group,Issues at termination,Maintaining confidentiality outside the group,Having a psychiatrist on site,"(A): Setting of the group
(B): Issues at termination
(C): Maintaining confidentiality outside the group
(D): Having a psychiatrist on site",Setting of the group,A,"The group setting is the most important consideration because the group environment needs to be safe, private, consistently available. It should also be comfortable and contain adequate furniture. Therefore, the correct answer is (C)",professional practice and ethics
1212,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","   Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication","According to Jean Piaget, the client’s thinking can be characterized by which one of the following?",Can think about what-if or hypothetical situations,The ability to understand abstract ideas,Uses deductive reasoning and logic,Thinks concretely and begins to perform logical operations,"(A): Can think about what-if or hypothetical situations
(B): The ability to understand abstract ideas
(C): Uses deductive reasoning and logic
(D): Thinks concretely and begins to perform logical operations",Thinks concretely and begins to perform logical operations,D,"At age 7, the client thinks concretely and begins to perform logical operations. Piaget’s concrete operational stage of development occurs between the ages of 7 and 11. During this stage, children form mental operations or rules as evidenced by understanding concepts of conservation and reversibility. Piaget’s next stage of development (occurring at ages of 12+), is the formal operational stage, in which children and adults can use deductive reasoning and logic and think abstractly. Individuals in the formal operational stage of development also have the ability to think about what-if, or hypothetical, situations. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1213,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ",What is the rationale for providing educational materials to the client's parents as a way to help them begin to understand their child's situation?,This is the least confrontative way to begin the psychoeducational process and provides the highest probability of a successful outcome.,"This provides more information in a shorter time, leaving more sessions for feedback and processing.","This will give information to the mother, to help her be more convincing in her discussions with the father.",This allows the parents to share the educational materials with the extended family,"(A): This is the least confrontative way to begin the psychoeducational process and provides the highest probability of a successful outcome.
(B): This provides more information in a shorter time, leaving more sessions for feedback and processing.
(C): This will give information to the mother, to help her be more convincing in her discussions with the father.
(D): This allows the parents to share the educational materials with the extended family",This is the least confrontative way to begin the psychoeducational process and provides the highest probability of a successful outcome.,A,"Gender Dysphoria is a sensitive subject in some families. Giving them resources is the best way to educate them and to support your client. Therefore, the correct answer is (C)",counseling skills and interventions
1214,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","You meet with the client 2 weeks after the initial intake because she refused to come for the session scheduled the past week. Because of the cancellation, you decide to change the focus of your session to meet the client’s needs for comfort and security over the foster parents’ need for guidance and skills. The client engages a little more in interacting with you, and you praise her for her involvement. At one point in the session, the client hits you and goes and sits down to continue playing. At the end of the session, you provide the foster parents with ways that they can increase attachment and positive interactions with your client. You empathize with the foster parents regarding their desire to help the client feel loved and cared for",All of the following can be beneficial in improving attachment between the foster parents and the client EXCEPT:,Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family.,Encourage the parents to provide family activities focused on family cohesion.,Engage in one-on-one play daily with the client.,Provide physical affection and verbal reinforcement daily to the client.,"(A): Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family.
(B): Encourage the parents to provide family activities focused on family cohesion.
(C): Engage in one-on-one play daily with the client.
(D): Provide physical affection and verbal reinforcement daily to the client.",Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family.,A,"Encouragement to visit the client’s birth parents should be a highly planned out event, should be coordinated with the foster care case manager, and should follow court recommendations. This kind of visit has the potential to cause harm to the client and also to the client’s relationship with her caregivers. One-on-one play, physical affection, verbal reinforcement, and family cohesion activities can all foster a more appropriate attachment between the client and the foster parents. Therefore, the correct answer is (D)",counseling skills and interventions
1215,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises.  Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable.    You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times.    After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",How will the client most likely compensate for the errors she makes during oral reading?,By excelling at physical activities,Through using memory and inference,By reading slowly,Through deflection,"(A): By excelling at physical activities
(B): Through using memory and inference
(C): By reading slowly
(D): Through deflection",Through using memory and inference,B,"Compensating using memory and inference is a technique that individuals with a reading disorder use because recognizing and memory help aid in the process. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1216,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest","Given the client’s ability to describe what happens when he feels angry, how would you proceed?",Refer the client for a psychiatric medication evaluation.,Have the client keep a journal and record the relationship between behavioral symptoms and negative self-talk.,Teach the client relaxation techniques to use when experiencing associated physiological symptoms.,Request that the client’s teacher move the client’s desk back with the other students.,"(A): Refer the client for a psychiatric medication evaluation.
(B): Have the client keep a journal and record the relationship between behavioral symptoms and negative self-talk.
(C): Teach the client relaxation techniques to use when experiencing associated physiological symptoms.
(D): Request that the client’s teacher move the client’s desk back with the other students.",Teach the client relaxation techniques to use when experiencing associated physiological symptoms.,C,"Evidence-based practices for DMDD include cognitive-behavioral therapy and mindfulness-based interventions. Relaxation skills training is a mindfulness-based intervention. Since the client can identify physiological symptoms associated with feeling angry (eg, heart races, teeth clench, chest tightness), the next step would be to teach relaxation and other emotional regulation skills. Although medication can be prescribed to children with acute symptoms, this is generally initiated if therapy alone proves ineffective. Asking the client to keep a journal would not be appropriate for this client as there is currently no demonstration of insight or motivation. At present, requesting that the teacher move the client’s desk back with his peers is not in the client’s or the other students’ best interest. Therefore, the correct answer is (B)",counseling skills and interventions
1217,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.  11th session The group as a whole has made progress, and members have found healthy outlets for expressing their thoughts and feelings. Rick has become more open with the women in the group and seems more receptive to what they have to say. Rick says that his grades have improved, his mother is proud, and he is encouraged by other group members who nod their heads and smile. The group has met its goals. The members have learned strategies to take with them as they prepare for termination. You remind the group that there are only a few more weeks left to meet. You begin to discuss the group members' feelings regarding the end of therapy. Rick starts to cry and says, ""Why does every woman in my life cause problems for me?""    The other group members offer Rick reassurance and empathy, but he continues expressing his frustration and sadness. You encourage the group to reflect on each person's progress and to be mindful of the emotions that this ending brings out. You explain to the group that endings can be difficult and that giving them permission to feel the emotions that arise during this transition is important.    Rick is still struggling with the idea of ending the therapy and expresses his fear of being left alone. He continues to express his feeling that every woman in his life has caused him pain and suffering, and this group's ending has triggered his worst fears. You recognize his fear and attempt to validate his experience by emphasizing his progress in the group and the positive changes he has seen in himself. You explain that the group can support him through the transition and the other members offer encouraging words of encouragement.    Rick is still anxious and overwhelmed. He talks about the difficulty of coping with the loss of the group and how he worries that he won't be able to manage his feelings without the support of the group. You explain to the group that it is natural to feel sadness and loss as well as gratefulness and pride in the progress they have all made. You encourage the group to identify the strategies they have learned in the group that they can use to manage their emotions. Finally, you assure Rick that he can use the skills he has learned in the group to cope with the emotions associated with the end of therapy.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ",What is the major contributing factor responsible for Rick's current feelings toward women from a gestalt point of view?,Cultural and familial expectations,Displaced anger being unable to express his feelings to his family,The trauma of his parent's separation,His sister's dominance over him from being oldest and most favored.,"(A): Cultural and familial expectations
(B): Displaced anger being unable to express his feelings to his family
(C): The trauma of his parent's separation
(D): His sister's dominance over him from being oldest and most favored.",The trauma of his parent's separation,C,"From a gestalt point of view, it is likely that Rick's feelings towards women stem from unresolved issues in his past. The major contributing factor to Rick's problems with women is the trauma of his parent's separation resulting from his mother's affair and his father leaving the family. This event caused significant disruption to the family and left Rick feeling abandoned by his father and betrayed by his mother. This resulted in Rick developing feelings of resentment and anger towards his mother, as well as other women in his life. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1218, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.",Leah has been sharing without pause for 30 straight minutes. It has been difficult to keep up with her changing topics and introducing new information. How do you help her to slow down?,"Calmly interject, encourage her to take a deep breath, and refocus the dialogue",Interrupt with the observation and tell her to slow down,"When she takes her next pause, ask her to stop and review only the highlights",Allow her to share however she needs to until she comes to a natural stop,"(A): Calmly interject, encourage her to take a deep breath, and refocus the dialogue
(B): Interrupt with the observation and tell her to slow down
(C): When she takes her next pause, ask her to stop and review only the highlights
(D): Allow her to share however she needs to until she comes to a natural stop","Calmly interject, encourage her to take a deep breath, and refocus the dialogue",A,"Modeling how to take a deep breath while she is sharing and helping her to refocus is the best choice for an intake and assessment session as you are specifically trying to organize your counseling strategies with her moving forward. This is a gentle and non-invasive intervention for helping Leah improve her session's quality. As her counselor, you are trying to get to know her and help her feel heard and understood at the same time; silently listening to her vent without being able to reflect, summarize, or ask questions to get to know her better is not necessarily more helpful for Leah. You are also responsible for completing this intake within a specific amount of time while honoring her VA benefit authorizations; while this does not take precedence over Leah's need for therapeutic engagement, it is an administrative aspect of professional counseling that is necessary for order and maintenance of boundaries. Answer a) projects a critical demeanor and may cause Leah to feel offended or stifled in her sharing, and answer d) is unnecessary as you are having her stop and repeat herself. Answer b) is not realistic if she has not taken a breath for 30 minutes and your intake is only scheduled to be 55 minutes. Therefore, the correct answer is (C)",counseling skills and interventions
1219, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.",Which of the following assessments would be least helpful in diagnosing the client's academic issues?,Wide Range Achievement Test - 5 (WRAT-5),Kaufman Assessment Battery for Children II (KABC-II),Wechsler Intelligence Scale for Children V (WISC-V),Wechsler Adult Intelligence Scale IV (WAIS-IV),"(A): Wide Range Achievement Test - 5 (WRAT-5)
(B): Kaufman Assessment Battery for Children II (KABC-II)
(C): Wechsler Intelligence Scale for Children V (WISC-V)
(D): Wechsler Adult Intelligence Scale IV (WAIS-IV)",Wide Range Achievement Test - 5 (WRAT-5),A,"The WRAT-5 is an achievement test and can be used to determine how the individual is currently functioning in reading, math, spelling, and comprehension. It is used to screen individuals to identify those who need a more comprehensive evaluation. The WAIS-IV and WISC-V are both intelligence assessments that will identify if the client has a deficit in some area of intellectual functioning. The WAIS-IV tests from age 16 to adult and the WISC-V tests children up to and including age 16, so either of these may be helpful. The KABC-II tests for both achievement and intelligence and also can help in identifying learning disabilities so this will be a helpful test with this client. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1220,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","The client no-showed for her last session without calling to cancel. She arrives today, appearing disheveled and irritable. The client states that she has not been sleeping well. She explains that she was talking to someone on an online dating site and had planned a face-to-face meeting this past weekend. She says she waited at the bar for more than an hour and finally realized that her date had stood her up. She explained that she was in so much shame after the incident that she engaged in self-harm. The client reveals superficial razor cuts on her thigh and upper arm. She says she feels like she is a failure and undeserving of love.  You ask the client to relax into the present moment and acknowledge thoughts and feelings that may arise without categorizing them as good or bad",You ask the client to relax into the present moment and acknowledge thoughts and feelings that may arise without categorizing them as good or bad. Why are you engaging the client in this exercise?,To teach conflict resolution skills,To encourage a nonjudgmental stance,To identify core beliefs,To assess the client’s capacity for transference,"(A): To teach conflict resolution skills
(B): To encourage a nonjudgmental stance
(C): To identify core beliefs
(D): To assess the client’s capacity for transference",To encourage a nonjudgmental stance,B,"The purpose of this activity is to encourage the client to take a nonjudgmental stance. You are using a component of dialectical behavior therapy, which is an empirically validated approach for BPD. This approach targets black-and-white or all-or-nothing dialects that characterize common thinking patterns among individuals with BPD. Mindfulness-based exercises are used to help the client stay fully aware of the present (ie, here-and-now) moment. In this state of awareness, clients learn to accept and regulate intense emotions in a nonjudgmental fashion. Identifying core beliefs, teaching conflict resolution skills, and exploring transference and countertransference are also interventions for BPD; however, a nonjudgmental stance allows the client to have experiences that are “both-and” rather than “either-or”. Therefore, the correct answer is (D)",counseling skills and interventions
1221,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.",,What do you identify as a major stressor for this client?,Social isolation,English language barrier,High parental expectations,Financial obligations,"(A): Social isolation
(B): English language barrier
(C): High parental expectations
(D): Financial obligations",Social isolation,A,"The client stated that she has no friends and states that there is no possibility of meeting people at work because she is on a student visa and is not allowed to hold a job. She currently lives in dorm housing with a female roommate but feels homesick and isolated. Stressors like social isolation, loneliness, and the lack of a support network can lead to depression, anxiety, and suicidal ideation. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1222,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.  10th session During the last few counseling sessions, you and the client explored ways that she and her husband could better collaborate and communicate in order to manage their respective responsibilities. You worked with the client to develop coping skills to manage her anxiety, including deep breathing exercises and visualization techniques. You also engaged the client in a discussion about how her beliefs and values were influencing her reactions to her family's needs and strategized how to set boundaries and make decisions that honor her values without feeling guilty or overwhelmed. She has been actively using these coping strategies to better manage her emotions and has been more successful in communicating her needs to her husband.    When you meet for today's session, the client appears to be in a positive mood. After a long discussion with her husband and her brothers, everyone finally agreed it would be best to move her mother into an assisted living facility. She says, ""I had the most trouble convincing my youngest brother that assisted living was the best option. I think my sister-in-law was the one who finally helped him to understand why making the switch would give my mother the best chance for a better quality of life."" She goes on to describe it as ""one of the most difficult decisions I've ever made."" You ask her how she is feeling now that the decision has been made, and she tells you, ""a little bit guilty, but mostly relieved."" You affirm her courage and ability to handle such a challenging situation. She tells you that she ""can finally breathe again."" She also believes that she might be able to have a better relationship with her mother with her being in an assisted living facility. The client does not want to resent her mother every day and expresses a desire to try to make the most of the time they have left together. She tells you that she has been going through some old family photo albums and came across a picture of her mother when she was newly married. She says, ""She and my dad looked so happy together. There was a time when she wasn't so critical and demanding."" The client tells you that she has been reflecting on her own experiences as a mother lately and thinking about ""the courage my mother must have had to leave everything that was familiar to her and move to a new country with four kids in tow."" She remarks that this newfound awareness has helped her understand why her mother was so demanding and strong-willed; she now sees that all of these qualities stem from a desire to provide for their family and give them the best possible life.    Toward the end of the session, the client says, “I’m so grateful for everything you have done. You have been a great listener and given me the tools to cope with everything in a healthier way."" You acknowledge her progress and remind her that she has come a long way since the beginning of your counseling sessions.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ","You are researching the effectiveness of the communication skills which you have applied with your cross-cultural couple. As you analyze the results of your study, which of the following coefficients of correlation would indicate the strongest relationship?",1.1,-0.98,0,0.8,"(A): 1.1
(B): -0.98
(C): 0
(D): 0.8",-0.98,B,"- 098 indicates a negative relationship between the effectiveness of the treatment and the communication skill techniques you are using. Of the answer options, this is the strongest relationship, even though it is a negative relationship. Therefore, the correct answer is (D)",professional practice and ethics
1223,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations.”  How would a client-centered therapist view this remark by the client?“My husband’s patients with me is growing thin. I don’t think I can ever live up to his expectations",How would a client-centered therapist view this remark by the client?“My husband’s patients with me is growing thin. I don’t think I can ever live up to his expectations.”,"As sadness resulting from the “I’m not OK,” “You’re OK” life position",As a mistaken style of life resulting from inferiority feelings,As a failure identity resulting from irresponsibly meeting the need for love,As incongruence stemming from a discrepancy between self-image and one’s ideal self,"(A): As sadness resulting from the “I’m not OK,” “You’re OK” life position
(B): As a mistaken style of life resulting from inferiority feelings
(C): As a failure identity resulting from irresponsibly meeting the need for love
(D): As incongruence stemming from a discrepancy between self-image and one’s ideal self",As incongruence stemming from a discrepancy between self-image and one’s ideal self,D,"Developed by Carl Rogers, client-centered therapy is based on the assumption that incongruence results from a discrepancy between one’s self-image and ideal self. Conditions of worth are created when an individual takes on a significant other’s condition of regard to the extent that self-experience is circumvented (or pursued). Alfred Adler adopted the belief that feelings of inferiority contribute to a mistaken style of life. According to William Glasser, credited with developing reality therapy, a failure identity occurs when the need for love is met in an irresponsible manner. Reality therapy, also known as control theory, emphasizes the importance of one’s need for love and the need to feel worthwhile. Eric Berne, credited with developing transactional analysis, viewed depression and sadness as the result of adopting the “I’m not OK; you’re OK” life position. Therefore, the correct answer is (B)",counseling skills and interventions
1224,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.  10th session During the last few counseling sessions, you and the client explored ways that she and her husband could better collaborate and communicate in order to manage their respective responsibilities. You worked with the client to develop coping skills to manage her anxiety, including deep breathing exercises and visualization techniques. You also engaged the client in a discussion about how her beliefs and values were influencing her reactions to her family's needs and strategized how to set boundaries and make decisions that honor her values without feeling guilty or overwhelmed. She has been actively using these coping strategies to better manage her emotions and has been more successful in communicating her needs to her husband.    When you meet for today's session, the client appears to be in a positive mood. After a long discussion with her husband and her brothers, everyone finally agreed it would be best to move her mother into an assisted living facility. She says, ""I had the most trouble convincing my youngest brother that assisted living was the best option. I think my sister-in-law was the one who finally helped him to understand why making the switch would give my mother the best chance for a better quality of life."" She goes on to describe it as ""one of the most difficult decisions I've ever made."" You ask her how she is feeling now that the decision has been made, and she tells you, ""a little bit guilty, but mostly relieved."" You affirm her courage and ability to handle such a challenging situation. She tells you that she ""can finally breathe again."" She also believes that she might be able to have a better relationship with her mother with her being in an assisted living facility. The client does not want to resent her mother every day and expresses a desire to try to make the most of the time they have left together. She tells you that she has been going through some old family photo albums and came across a picture of her mother when she was newly married. She says, ""She and my dad looked so happy together. There was a time when she wasn't so critical and demanding."" The client tells you that she has been reflecting on her own experiences as a mother lately and thinking about ""the courage my mother must have had to leave everything that was familiar to her and move to a new country with four kids in tow."" She remarks that this newfound awareness has helped her understand why her mother was so demanding and strong-willed; she now sees that all of these qualities stem from a desire to provide for their family and give them the best possible life.    Toward the end of the session, the client says, “I’m so grateful for everything you have done. You have been a great listener and given me the tools to cope with everything in a healthier way."" You acknowledge her progress and remind her that she has come a long way since the beginning of your counseling sessions.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",Which strategy would be inappropriate during the termination phase with the client?,Clearly assessing the client's growth and development in therapy and the ways in which the client plans to sustain her progress,Thoroughly exploring the client's unresolved emotional feelings from childhood and making suggestions that will help her resolve these feelings,Helping the client to examine and process her feelings regarding the end of regular therapy sessions,Strategically evaluating the therapeutic process and examining what was effective and what needed to be improved from the client's standpoint,"(A): Clearly assessing the client's growth and development in therapy and the ways in which the client plans to sustain her progress
(B): Thoroughly exploring the client's unresolved emotional feelings from childhood and making suggestions that will help her resolve these feelings
(C): Helping the client to examine and process her feelings regarding the end of regular therapy sessions
(D): Strategically evaluating the therapeutic process and examining what was effective and what needed to be improved from the client's standpoint",Thoroughly exploring the client's unresolved emotional feelings from childhood and making suggestions that will help her resolve these feelings,B,"Exploring the unresolved emotional feelings the client may carry with her throughout life is not an appropriate strategy during the termination phase with the client. Instead, this should have been implemented during the active phase of therapy. Therefore, the correct answer is (C)",counseling skills and interventions
1225,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.  Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered.",,"In this group, you will be working with clients that have Generalized Anxiety Disorder. According to the DSM-5-TR, what is considered a differential for Generalized Anxiety Disorder?",Panic Disorder,Agoraphobia,Schizoid Personality Disorder,Anorexia Nervosa,"(A): Panic Disorder
(B): Agoraphobia
(C): Schizoid Personality Disorder
(D): Anorexia Nervosa",Panic Disorder,A,"Panic Disorder is a differential for Generalized Anxiety Disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1226,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","   ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation.  You are devoutly religious, and homosexuality goes against your personal beliefs","You are devoutly religious, and homosexuality goes against your personal beliefs. How should you handle personal values that conflict with those belonging to the client?",Seek training to help you avoid imposing your beliefs onto clients.,Refer the client to another provider whose values are more aligned with the client’s.,Ask the client to call your attention to any unintentional microaggressions that may occur during your clinical encounters.,Continue to work with the client as long your values are not openly discriminatory.,"(A): Seek training to help you avoid imposing your beliefs onto clients.
(B): Refer the client to another provider whose values are more aligned with the client’s.
(C): Ask the client to call your attention to any unintentional microaggressions that may occur during your clinical encounters.
(D): Continue to work with the client as long your values are not openly discriminatory.",Seek training to help you avoid imposing your beliefs onto clients.,A,"According to the ACA Code of Ethics (2014), “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature” Answer C is the only answer option that reflects this ethical standard. Therefore, the correct answer is (C)",professional practice and ethics
1227,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","   ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.”  The client relies on her son when she is too anxious to leave the house, and she describes her parents as overbearing","The client relies on her son when she is too anxious to leave the house, and she describes her parents as overbearing. How might a structural family therapist define the boundaries in the client’s family?",Clear,Disengaged,Diffuse,Flexible,"(A): Clear
(B): Disengaged
(C): Diffuse
(D): Flexible",Diffuse,C,"The client’s family boundaries can be described as diffuse. Structural family therapists focus on boundaries among family members. Boundaries are rules or barriers within a family system that dictate the amount of contact that members have with each other and the larger community. Families with diffuse boundaries are also described as enmeshed, which is observed in families who have become overly dependent on one another. Flexible boundaries occur when the boundaries are neither too closed and isolated nor too open and rigid. Flexible boundaries and clear boundaries are synonymous. Structural family therapists view healthy boundaries as those with the flexibility to adapt to stressors, communicate, and adjust limits when needed. Disengaged boundaries are rigid, and family members are isolated from one another. Therefore, the correct answer is (D)",counseling skills and interventions
1228,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice.  The husband left the session",The husband left the session. What would be the most beneficial intervention for the couple?,Encourage the husband to return to the session.,Cancel the session in order to reconvene when the couple is willing to meet together because you are providing couples counseling.,Encourage both individuals to take responsibility for their contribution to the conflict.,Meet individually with both partners in order to process thoughts and feelings regarding the relationship.,"(A): Encourage the husband to return to the session.
(B): Cancel the session in order to reconvene when the couple is willing to meet together because you are providing couples counseling.
(C): Encourage both individuals to take responsibility for their contribution to the conflict.
(D): Meet individually with both partners in order to process thoughts and feelings regarding the relationship.",Meet individually with both partners in order to process thoughts and feelings regarding the relationship.,D,"The most beneficial intervention at this point would be to separate the partners and meet with them individually. This may be helpful in creating a more comfortable environment for expression for both partners. You will gain insight into each person’s perspective in a manner that is safer than the couples setting. It might be helpful to encourage the husband to return, but the couple is having trouble communicating, and getting each individual’s unbiased perspectives could be very helpful. It is also helpful to get individuals to take responsibility for their own actions, but the couple is not capable of this at this point in therapy because they are just starting to explore their emotions regarding the wife’s affair. Therefore, the correct answer is (C)",treatment planning
1229,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","   e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family",Which cardinal feature differentiates generalized anxiety disorder (GAD) from other anxiety-related disorders?,The presence of an acute stressor,Chronic apprehensive expectation,Intrusive thoughts or images,Separation from attachment figures,"(A): The presence of an acute stressor
(B): Chronic apprehensive expectation
(C): Intrusive thoughts or images
(D): Separation from attachment figures",Chronic apprehensive expectation,B,"The DSM-5-TR criteria for GAD includes excessive anxiety and worry (chronic apprehensive expectation). When the clinical presentation includes an acute stressor, the distress may be better explained by diagnoses such as post-traumatic stress disorder or acute stress disorder. Separation anxiety is considered when the distress is explained by separation from attachment figures. Lastly, obsessive-compulsive disorder is characterized by intrusive and unwanted thoughts or images. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1230, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,Which of the following screening tools for substance use would not be appropriate for Sandy?,CRAFFT 2.0,TAPS,DAST-10,ANA,"(A): CRAFFT 2.0
(B): TAPS
(C): DAST-10
(D): ANA",CRAFFT 2.0,A,"The CRAFFT 20 is for children 12-18 and would not be appropriate of Sandy. The tobacco, alcohol, prescription medication and other substance use- brief screening tool (TAPS) is only useful for screening of a forementioned drugs. The Drug abuse screening test- self screen (DAST) takes 5 minutes to yield quick results. The Addictions Neuroclinical Assessment (ANA) measures behavior, brain imaging and genetics for a comprehensive measure the levels and origins of addiction. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1231,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.  Sixth session The client has been making progress and has joined the track team at school. He is the fastest runner on the team and has already broken some school records. He says that the team is becoming like his family. The coach has become his mentor and provides stability for the client. According to the client, he does not have the support for his new activity from his parents. His mother is tired of picking him up from track practice, and his father is not very enthusiastic about his son's involvement on the track team either. The client expresses feeling sad about his parents' reaction. He says, ""I feel like my parents don't care about me."" You contact both parents and suggest a session with all the adults responsible for the client's care. The mother immediately agrees, but the father expresses reluctance to participate in therapy. The client's father expresses his concerns about his involvement in therapy sessions, saying that he does not see how that will help his son. He is also worried that you will ""side with"" the client's mother and that he will end up getting blamed for the problems in the family. Despite his reservations, he agrees to attend the session, along with his ex-wife.    You facilitate a session with the client's parents, focusing on helping them understand their child's point of view in order to develop more effective communication between them. You emphasize the importance of expressing love and support for the child, even if they are not able to provide a unified front when it comes to rules and expectations. You explain that having different rule systems is not uncommon among divorced couples but also encourages both parents to work together to come up with consistent boundaries that can be enforced by both households. The mother expresses understanding while the father remains skeptical.    In response to the father's skepticism, you explain that working together towards a common goal is essential in developing successful communication and strengthening the parent-child relationship. You encourage both parents to discuss their expectations with each other and come up with a plan of action that works for them as well as their son. You also suggest that they attend family counseling sessions if needed, as this can help them better understand one another's point of view and work through any unresolved issues that could be causing distress in their relationships. You remain hopeful that by taking these steps, the client will feel more secure in his environment and ultimately benefit from the unified support of both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",What is the best method for you to evaluate your counseling effectiveness with this client?,Ask the parents to provide feedback on your performance as a counselor,Evaluate the client's progress based on your observations of him during sessions,Evaluate the client's progress through regular check-ins and conversations with the parents,Rely on feedback from the client alone to measure success,"(A): Ask the parents to provide feedback on your performance as a counselor
(B): Evaluate the client's progress based on your observations of him during sessions
(C): Evaluate the client's progress through regular check-ins and conversations with the parents
(D): Rely on feedback from the client alone to measure success",Evaluate the client's progress through regular check-ins and conversations with the parents,C,"Evaluating the client's progress through regular check-ins and conversations with the parents, as well as any changes that they have seen in their son since attending family counseling sessions, is the best way to measure effectiveness as a counselor. This allows you to make sure that progress is being made and that any issues brought up during therapy sessions are being addressed. Therefore, the correct answer is (A)",treatment planning
1232,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",Which reflects the duration and frequency of symptoms needed for the client's diagnosis?,Four symptoms for at least six months,Two symptoms within the last six months,One symptom for at least three months,Six symptoms within the last 12 months,"(A): Four symptoms for at least six months
(B): Two symptoms within the last six months
(C): One symptom for at least three months
(D): Six symptoms within the last 12 months",Four symptoms for at least six months,A,"This answer has a sufficient length of time and number of symptoms to begin treatment for ODD. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1233, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.","Based on the information provided, why should the client be taught grounding and relaxation skills prior to working on deeper issues?",The client's support system members sometimes irritate her so she may not feel supported.,The client has likely experienced a significant trauma that could cause some disassociation.,The client's issues began in childhood and developmental regression is likely during processing.,Processing the client's issues may lead to increased negative thoughts and emotions.,"(A): The client's support system members sometimes irritate her so she may not feel supported.
(B): The client has likely experienced a significant trauma that could cause some disassociation.
(C): The client's issues began in childhood and developmental regression is likely during processing.
(D): Processing the client's issues may lead to increased negative thoughts and emotions.",Processing the client's issues may lead to increased negative thoughts and emotions.,D,"Clients in counseling often feel worse before they feel better as they face uncomfortable emotions, thoughts, and behaviors. The client has a history of criminal activity and an eating disorder that are often associated with a desire or need to control things and events in her life. It will be important to prepare the client for any increase in negative thoughts and feelings with coping strategies so the negative thoughts and emotions do not lead to negative behaviors. The counselor will support the client during therapy and the client may or may not choose to share her background and therapeutic work with her support system. There is no evidence that the client has previously regressed to a childlike state, that she has suffered trauma other than what has been explained to the counselor, or experienced disassociation. Coping strategies, which are helpful for all clients, are important for this client due to her history of coping through negative behaviors. Therefore, the correct answer is (B)",counseling skills and interventions
1234,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","   tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her","All of the following are appropriate assessment tools to explore differential diagnoses for major depressive disorder and PTSD, EXCEPT:",Adult ADHD Self-Report Scale,Generalized Anxiety Disorder-7 (GAD-7),Adjustment Disorder-New Module 20,Acute Stress Disorder Scale,"(A): Adult ADHD Self-Report Scale
(B): Generalized Anxiety Disorder-7 (GAD-7)
(C): Adjustment Disorder-New Module 20
(D): Acute Stress Disorder Scale",Acute Stress Disorder Scale,D,"Acute stress disorder would not be an indicated differential diagnosis; therefore, the Acute Stress Disorder Scale is not indicated here. Although it may be considered upon initial diagnosis, the client has experienced trauma symptoms over her lifetime. Acute stress disorder would not be diagnosed outside the timeframe of 3 to 30 days following the trauma exposure. Adjustment disorder would be appropriate to assess for because the client recently had some major life changes; however, the disturbances are likely a result of continuous exposure to trauma. Anxiety disorders should also be considered because PTSD has some symptoms that involve anxiety and panic. ADHD, though unlikely, could explain concentration issues and other symptoms that may appear in depression and PTSD. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1235,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",Which of the following screening tools for alcohol use would not be applicable to John?,Rapid Alcohol Problems Screen (RAPS),Adult Substance Use Survey (ASUS),Brief Michigan Alcoholism Screening Test (BMAST),"Brief Screener for Alcohol, Tobacco, and other Drugs (BSTAD)","(A): Rapid Alcohol Problems Screen (RAPS)
(B): Adult Substance Use Survey (ASUS)
(C): Brief Michigan Alcoholism Screening Test (BMAST)
(D): Brief Screener for Alcohol, Tobacco, and other Drugs (BSTAD)","Brief Screener for Alcohol, Tobacco, and other Drugs (BSTAD)",D,"The BSTAD is helpful for identifying risky substance use by adolescents age 12-17. The RAPS and BMAST instruments have both been proven effective in quickly screening adults for severity of alcohol use. The Rapid Alcohol Problems Screen was specifically noted in clinical trials to have increased sensitivity for and best performance results with the African American population. The ASUS is a 64-item self-report survey designed to assess an individual's perceived alcohol and other drug use and can be useful to gauge additional information that might indicate problems of emotional or mood adjustment. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1236,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services","All of the following are primary focuses of the termination session, EXCEPT:",Signaling an end to the therapeutic relationship,Identifying that growth has occurred,Evaluating the effectiveness of therapy,Encouraging ongoing therapeutic changes,"(A): Signaling an end to the therapeutic relationship
(B): Identifying that growth has occurred
(C): Evaluating the effectiveness of therapy
(D): Encouraging ongoing therapeutic changes",Evaluating the effectiveness of therapy,C,"Evaluating the effectiveness of therapy should have occurred throughout the entirety of the counseling services; therefore, it is not a primary focus of termination. At the end of services, you want to focus on what the client has achieved and not on what you have done as a counselor. The termination session focuses on ending the relationship, encouraging the client to continue to use the learned skills without you, and helping the client to realize what has been accomplished. Therefore, the correct answer is (D)",professional practice and ethics
1237,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","   ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake",Which instrument would you use to assess this client for both problematic alcohol use and related psychological and emotional adjustment?,The Drug Abuse Screening Test (DAST),The Alcohol Use Disorders Identification Test (AUDIT),"Cut Down, Annoyed, Guilty, and Eye-Opener (CAGE)",The Adult Substance Use Survey (ASUS),"(A): The Drug Abuse Screening Test (DAST)
(B): The Alcohol Use Disorders Identification Test (AUDIT)
(C): Cut Down, Annoyed, Guilty, and Eye-Opener (CAGE)
(D): The Adult Substance Use Survey (ASUS)",The Adult Substance Use Survey (ASUS),D,"The Adult Substance Use Survey (ASUS) is a 64-item questionnaire that assesses an individual’s perceived alcohol or substance use. There are additional questions designed to evaluate emotional difficulties and other mood-related issues. The Alcohol Use Disorders Identification Test (AUDIT) is used to help identify alcohol consumption, alcohol-related health problems, and drinking behaviors. The CAGE is a four-item screening instrument measuring an individual’s problematic alcohol use related to cutting down, others’ annoyance with one’s alcohol use, personal guilt over use, and alcohol use first thing in the morning. The Drug Abuse Screening Test (DAST) detects drug abuse and dependence and is not used to assess alcohol use or mood-related issues. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1238,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.",ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report,Which of the following symptoms would be needed to make a diagnosis of reactive attachment disorder?,Frequent tantrums.,The disturbance is evident before the age of 10.,Minimal response to comfort when distressed.,Difficulty making friends.,"(A): Frequent tantrums.
(B): The disturbance is evident before the age of 10.
(C): Minimal response to comfort when distressed.
(D): Difficulty making friends.",Minimal response to comfort when distressed.,C,"The only symptom required to make the diagnosis of reactive attachment disorder would be noted minimal or rare response to comfort when the client is experiencing strong emotions. Frequent tantrums may be evident in reactive attachment disorder; however, it is can also be an indication of other disorders. Difficulty making friends is not a criterion for reactive attachment disorder. The age range for reactive attachment disorder is 9 months to 5 years old. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1239,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","The client has shared a certain disaffection with her parents, and seemed reluctant to confide in the teacher who referred her to you. This could suggest a tendency in the client to have generational trust issues. How would you most effectively build a therapeutic alliance with this client?",Explore resources that are available to her.,Use self-disclosure of a difficult time in your past.,Remain neutral and validate her experience.,Examine why she is afraid to talk to her parents.,"(A): Explore resources that are available to her.
(B): Use self-disclosure of a difficult time in your past.
(C): Remain neutral and validate her experience.
(D): Examine why she is afraid to talk to her parents.",Remain neutral and validate her experience.,C,"This client is in a particularly vulnerable state right now. She has just found out that she is pregnant. She is scared to tell her parents and unsure of what to do next. You must create a safe space for her to process her situation. Remain neutral, regardless of your values and opinions, and validate her experience. Therefore, the correct answer is (A)",counseling skills and interventions
1240,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",Which best describes the value of an Individualized Education Plan?,Engages the child in Autism group settings so that he can be exposed to other individuals with similar situations,"Uses family/interdisciplinary team to address academic, social, emotional, and intellectual issues as well as the student's ability to function successfully in a school setting","Provides planned, intensive interventions to address the student's academic concerns","Enlists the care of an in-home specialist, school teachers, counselors, and other supports in the community","(A): Engages the child in Autism group settings so that he can be exposed to other individuals with similar situations
(B): Uses family/interdisciplinary team to address academic, social, emotional, and intellectual issues as well as the student's ability to function successfully in a school setting
(C): Provides planned, intensive interventions to address the student's academic concerns
(D): Enlists the care of an in-home specialist, school teachers, counselors, and other supports in the community","Uses family/interdisciplinary team to address academic, social, emotional, and intellectual issues as well as the student's ability to function successfully in a school setting",B,"This is the value of an Individualized Education Plan. Therefore, the correct answer is (D)",treatment planning
1241,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students.  Seventh session Almost two months have passed since you first met with the client. She has been meeting you for weekly therapy sessions. During previous sessions, you continued to work on developing a sense of trust with the client which has allowed her to open up to you about the myriad of feelings that she has regarding her injury. You explored and processed feelings of grief and sadness, as well as feelings of anger and resentment. Several sessions have been dedicated to identifying automatic thoughts that have been contributing to the client's negative attitude and replacing negative self-talk like ""I'm broken"" with more positive and realistic statements. You have also been using solution-focused techniques to help her to focus on what is within her power to change and take active steps toward making those changes.    During today's session, the client agrees with you when you state that you believe she has achieved many of her goals in therapy. The client has worked through her ambivalence towards teaching the younger ballet classes and is now actively pursuing this opportunity. She reports that she finds a sense of purpose in helping the students learn and appreciate dance, as well as feel accomplished for their achievements. She says, ""It's still strange not being the student anymore, but I'm glad that I decided to try it. The kids had a performance last week, and one of the girls gave me this really sweet clay ballet shoe that she made in her art class. She told me that I'm the reason she felt 'brave enough' to keep dancing even though she was scared. That meant a lot to me.""    You then ask her about her relationship with her parents. She reports that it has improved since they had the discussion about trust. They are now more willing to listen to her opinions and have loosened some of the restrictions, though there are still some limits in place. Although they still have expectations of her and restrict certain activities, they now talk to her more openly and engage with her in a positive manner. She tells you that she would like to get all A's this semester to make her parents proud. She is getting better grades in history but states that her other classes are ""boring."" She also mentions wanting to put some limits on the amount of time she spends with her friends and ""get away from smoking as much."" She says that she is trying to be a better role model for her ballet students. You acknowledge how hard she has worked to reach this point and congratulate her on taking initiative in improving her academic performance and setting new boundaries with her friends."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.","Using a solution-focused approach, how would you provide positive reinforcement for the client's progress and encourage her to continue working on her goals?","""I'm impressed with the changes you have been making in your life by deciding to take on teaching ballet and setting boundaries with your friends. What do you think has been helping you make these changes?""","""What do you think would be the most helpful strategies for improving your grades in your other classes and setting healthy boundaries with your friends?""","""It's great that you want to make your parents proud by getting all A's this semester, but it's also important to remember that it's okay if you don't get perfect grades.""","""It sounds like you have many goals that you want to accomplish, such as getting better grades, setting boundaries with your friends, and being a better role model for your students. What can you do right now to start working towards these goals?""","(A): ""I'm impressed with the changes you have been making in your life by deciding to take on teaching ballet and setting boundaries with your friends. What do you think has been helping you make these changes?""
(B): ""What do you think would be the most helpful strategies for improving your grades in your other classes and setting healthy boundaries with your friends?""
(C): ""It's great that you want to make your parents proud by getting all A's this semester, but it's also important to remember that it's okay if you don't get perfect grades.""
(D): ""It sounds like you have many goals that you want to accomplish, such as getting better grades, setting boundaries with your friends, and being a better role model for your students. What can you do right now to start working towards these goals?""","""I'm impressed with the changes you have been making in your life by deciding to take on teaching ballet and setting boundaries with your friends. What do you think has been helping you make these changes?""",A,"With this response, you are giving the client a compliment. A compliment as a technique in solution focused therapy is a way of acknowledging a person's strengths and successes in order to promote positive emotional states and to help focus on solutions rather than problems. Therefore, the correct answer is (A)",counseling skills and interventions
1242,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","This session is occurring in the client’s home in order to observe behaviors in his natural environment. The client’s parents and 8-year-old brother are present. You are observing during this session in order to gather information and then to provide psychoeducation at the end of the session to the parents. The client and his brother are sitting on the floor playing with a building toy, which the client’s parents report is often a toy that causes him frustration because he plays very specifically with it and his brother does not want to play how he does. After about 5 minutes, the client becomes visibly frustrated as he is telling his brother to put a brick in a certain place because it is the same color and his brother says he is not going to and goes to build on his own. The client continues to build and asks for the piece repeatedly over a few minutes. The client then picks up what he is building and throws it against the wall and leaves the room","Based on the client’s diagnosis of autism and his presentation throughout these sessions, which of the following areas of the mental status exam may be outside of normal limits?","Orientation to person, place, time, and situation",Hygiene,Memory,Eye contact,"(A): Orientation to person, place, time, and situation
(B): Hygiene
(C): Memory
(D): Eye contact",Eye contact,D,"The client struggles with social skills; therefore, eye contact would likely not always be present or appropriate. The client does not appear to struggle with orientation or hygiene, although these may be factors for other individuals who have autism. Memory is not affected because the client does not have intellectual impairment. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1243,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",What are you attempting to do by summarizing what the client tells you?,Facilitating steps that might assist the client in resolving her concerns,Determining the client's main issues as discussed during the session,Paraphrasing what the client is saying,Creating interventions to help the client better manage her concerns,"(A): Facilitating steps that might assist the client in resolving her concerns
(B): Determining the client's main issues as discussed during the session
(C): Paraphrasing what the client is saying
(D): Creating interventions to help the client better manage her concerns",Determining the client's main issues as discussed during the session,B,"During the initial intake it is always critical to be sure the therapist is clear about what is going on; otherwise, the tendency is to miss primary issues vital to stabilizing the client. Therefore, it is always helpful to carefully process what a client is saying, how they are saying it, and to what extent those concerns may be impacting them. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1244,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.  Eighth session You continue to work with the client in outpatient therapy. During a previous session, the client identified a few sources of support and was able to tell her parents that she switched her major. Today, the client arrives for her appointment 20 minutes early. She appears eager to see you and excited to talk with you. When she sits down, she pulls several cookbooks out of her backpack. She tells you that she plans to go home during spring break and has collected recipes for a large meal she wants to make for her family. During this session, while exploring the client's relationship with food, you discover that she spends many hours in the library reading through cookbooks and watching baking shows on her computer. She says that she has an apple for breakfast, picks up a small salad ""to go"" from the campus cafeteria every day at exactly 12:00 p.m., and bakes a sweet potato for dinner in the microwave in her room at 6:00 p.m. She looks forward to her meals and plans her day around them. She says she is envious of other people who ""can eat anything whenever they want."" She tells you she is worried that if she eats extra food, she will become obese overnight and never stop eating.  You continue to explore the client's relationship with food by asking, ""What do you think would happen if you ate whatever you wanted?"" She replies, ""I'm afraid that if I eat extra food, I'll gain weight and never be able to stop eating. I'll keep getting bigger and bigger and turn into a severely obese person."" After taking a moment to think, the client shares, ""I'm scared that if I gain weight, no one will love me or care about me. Then I'll be completely alone, and it will be all my fault because I couldn't control my eating!"" You listen compassionately as the client shares her fear. You also emphasize that this is an extreme outcome and unlikely to occur. You encourage her to think realistically about the potential consequences of eating additional food and acknowledge that there may be some negative outcomes, but they are not guaranteed or irreversible.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","Given the client’s level of treatment and diagnosis, which of the following options would be the most appropriate combination to consult with regarding this client’s care?","PCP, nutritionist, and psychiatric nurse","PCP, nutritionist, and psychiatrist","Physician, academic advisor, and social worker","Case manager, psychiatric nurse, and nutritionist","(A): PCP, nutritionist, and psychiatric nurse
(B): PCP, nutritionist, and psychiatrist
(C): Physician, academic advisor, and social worker
(D): Case manager, psychiatric nurse, and nutritionist","PCP, nutritionist, and psychiatrist",B,"A collaborative treatment plan would likely involve the client's Primary Care Physician, nutritionist, and psychiatrist for a client diagnosed with an eating disorder who is being treated in an outpatient setting. Therefore, the correct answer is (D)",treatment planning
1245,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.  Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience.    You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",What indicator provides the most comprehensive measure of the client's therapeutic progress up to this point?,Reduced frequency of nightmares,Utilizing calming techniques more effectively,Regaining meaning and purpose in life,Improved relationships with family and friends,"(A): Reduced frequency of nightmares
(B): Utilizing calming techniques more effectively
(C): Regaining meaning and purpose in life
(D): Improved relationships with family and friends",Regaining meaning and purpose in life,C,"By regaining a sense of purpose and direction, the client is able to move forward in her therapeutic journey even when faced with difficult emotions or memories associated with the traumatic event. This indicates that the client is making progress in terms of understanding and managing her symptoms, as well as developing coping strategies to help her manage distress. Therefore, the correct answer is (B)",treatment planning
1246,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors.  Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor.    You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings.  Seventh session Today, you meet with Becky and both of her parents. Her father demands to be included in the treatment process. He is adamantly opposed to his daughter being placed in special classes, but the mother expresses her belief that placement in a special class is the best solution. The parents continue to disagree. Finally, Becky screamed out her support for her father's side of the argument.    Becky's reaction in support of her father's position only further escalated the disagreement between her parents. Her mother seemed to be taken aback by Becky's outburst and tried to explain calmly why she believed special classes would be the best solution for their daughter. At this point, the conversation became more heated. Her mother expressed her frustration with her husband, saying he always seemed to take Becky's side regardless of the situation. This further agitated the father, and he began to raise his voice in protest. Sensing the tension in the room, Becky suddenly crossed the room and sat on her father's lap. The parents' discussion escalated into an argument, with Becky's mother finally walking out of the office."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",The client's teacher has requested an update regarding the counseling process and the timeframe for referring the client to special education classes. What is the most appropriate response?,The therapist should refer to the agreed-upon timeframe adopted during the intake process and assure the teacher that the recommendation will be forwarded by then.,"The therapist should invite her to all sessions regarding the student. As a part of the IEP team, the teacher should have been part of the therapy process.","The therapist should forward all therapy notes to her. Since the teacher is part of the IEP team, she is privileged to all therapy sessions.",The therapist needs to take no action. The teacher no longer has a relevant part in the process.,"(A): The therapist should refer to the agreed-upon timeframe adopted during the intake process and assure the teacher that the recommendation will be forwarded by then.
(B): The therapist should invite her to all sessions regarding the student. As a part of the IEP team, the teacher should have been part of the therapy process.
(C): The therapist should forward all therapy notes to her. Since the teacher is part of the IEP team, she is privileged to all therapy sessions.
(D): The therapist needs to take no action. The teacher no longer has a relevant part in the process.",The therapist should refer to the agreed-upon timeframe adopted during the intake process and assure the teacher that the recommendation will be forwarded by then.,A,"As part of the IEP team, the teacher is privy to the outcomes of therapy related to recommendations for special education classes. The therapy notes themselves are private. Therefore, the correct answer is (A)",professional practice and ethics
1247,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.",rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives,"All of the following are criteria for borderline personality disorder, EXCEPT:",Recurrent suicidal behavior,Binge eating,"Inappropriate, intense anger or difficulty controlling anger",Recurrent depressive episodes,"(A): Recurrent suicidal behavior
(B): Binge eating
(C): Inappropriate, intense anger or difficulty controlling anger
(D): Recurrent depressive episodes",Recurrent depressive episodes,D,"Depressive episodes are not a symptom of borderline personality disorder. There is a long list of diagnostic criteria for borderline personality disorder, five of which must be present for diagnosis. One category of criteria for borderline personality disorder, according to the DSM-5-TR, is impulsive behavior, which includes binge eating in addition to excessive spending, inappropriate sexual relations, substance abuse, and dangerous driving. Intense anger and suicidal ideation are additional elements in the list of diagnostic criteria for borderline personality disorder. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1248,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","   tion. Family History: The client has been married for 25 years. The client has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together",The Age Discrimination in Employment Act of 1967 and its amendments include all of the following EXCEPT:,Preferences based on age are prohibited.,Mandatory retirement of individuals in executive positions over age 65 years of age is permitted.,An employer should ensure that at least 20% of their workforce is older than 50 years of age.,Employers may reduce benefits based on age only if the cost of reduced benefits is the same as the cost of providing full benefits to younger workers.,"(A): Preferences based on age are prohibited.
(B): Mandatory retirement of individuals in executive positions over age 65 years of age is permitted.
(C): An employer should ensure that at least 20% of their workforce is older than 50 years of age.
(D): Employers may reduce benefits based on age only if the cost of reduced benefits is the same as the cost of providing full benefits to younger workers.",An employer should ensure that at least 20% of their workforce is older than 50 years of age.,C,"The employer is not required to have a specific percentage of the workforce that must be above a certain age according to the Age Discrimination in Employment Act of 1967 and its amendments. However, employers do have guidelines about mandatory retirement for individuals in executive positions and reductions in benefits. It is also prohibited to have preferences based on age for a position. Therefore, the correct answer is (A)",professional practice and ethics
1249,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”","Considering the information provided, which question should the counselor ask at this time?",Why did her parent's divorce make the client feel anxious?,How has the client handled problems over her lifetime?,Would the client be open to attending a support group for cancer patients?,What makes the client feel most upset today?,"(A): Why did her parent's divorce make the client feel anxious?
(B): How has the client handled problems over her lifetime?
(C): Would the client be open to attending a support group for cancer patients?
(D): What makes the client feel most upset today?",How has the client handled problems over her lifetime?,B,"Regardless of counseling theory used, understanding the client's coping skills, including how they have changed over time provides the counselor with information on whether the client needs to be taught new coping skills or may already possess skills that can be used in therapy. The counseling profession is a strengths-based model and solidifying past strengths or installing new ones is a primary goal in counseling. Support groups for cancer patients are specifically focused on the needs that these individuals face with their disease. It may be an effective concurrent therapy for this client at a later date, but the client's current expectation is individual therapy as evidenced by coming to counseling. Asking the client about today's feelings only does not demonstrate that the counselor heard the client's story as many of the past and current concerns of the client were already stated. Exploring the client's emotions related to her parent's divorce may be a good intervention but asking ""why"" questions is not good counseling practice as it may make clients feel defensive. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1250,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.  Sixth session The client has not been following through with her mood journal. She says that she ""got bored and didn't feel like writing in it anymore."" During this session, a month and a half into therapy, she relays an incident that happened with the friend she went to visit out-of-state. They argued due to political differences and are currently not talking to each other. The client now considers her friend ""a drunk who doesn't know what she's talking about."" You suggest that the client's anger and judgment may be a defense that she uses to avoid feeling rejected as she did with her father. You state, ""It seems that in an attempt to avoid feeling hurt and rejected, you use anger and alcohol to push people away."" The client responds with reflective silence and begins to tear up.    You guide the client to examine her defensive behavior and understand why she relies on it when faced with difficult emotions. You emphasize that her feelings of hurt, rejection, and anger are valid, however, they can be managed in healthier ways. You suggest that part of processing these feelings is to recognize them and make attempts at reconnecting with her friend. Additionally, you recommend cultivating self-care practices. The client acknowledges the importance of looking after herself during this difficult time, understanding that if she is able to take care of herself first she will be in a better position to address her relationships.    You remind the client that it is important to take steps to move forward, even if those steps are small. You highlight her willingness to talk through her emotions and gain insight into her reactions as an opportunity to grow in self-awareness. You explain that having knowledge of one’s own feelings helps them to make better decisions and boundaries, which can lead to healthier relationships with others and ultimately, more peace within oneself. With this understanding, you create a plan of action together for how she will move forward between now and your next session. You close the session by telling the client that she has made progress today by having gained insight into her feelings, and that will lead to exploration of how to respond to them more productively. You conclude by encouraging her to keep exploring new methods of self-care and to bring up any additional topics she wants to discuss in the next session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",Which of the following is most indicative of your effectiveness in treating this client?,She has gained insight into her feelings.,She is beginning to address her unresolved relationship issues with her father.,She is becoming more expressive of her feelings.,She is exploring her struggles more openly.,"(A): She has gained insight into her feelings.
(B): She is beginning to address her unresolved relationship issues with her father.
(C): She is becoming more expressive of her feelings.
(D): She is exploring her struggles more openly.",She has gained insight into her feelings.,A,"The primary issue is her mood dysregulation. The fact that she has a deeper, more appreciative understanding of her feelings indicates a greater level of effectiveness in her treatment outcome. These breakthroughs allow the client to feel empowered and look at a situation more realistically, leading to improved understanding and self-awareness. She is then able to move forward and change behaviors due to this understanding. Therefore, the correct answer is (A)",treatment planning
1251,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ","Based on the mother's disclosures in today's session, what will you focus on during the next counseling session with the client?",Work on establishing trust and rapport with the client,Assess the client's needs and develop a treatment plan,Determine the details of the client's relationship with her father,Explore the client's relationship with her parents,"(A): Work on establishing trust and rapport with the client
(B): Assess the client's needs and develop a treatment plan
(C): Determine the details of the client's relationship with her father
(D): Explore the client's relationship with her parents",Assess the client's needs and develop a treatment plan,B,"The goal of the next counseling session should be to assess the client's needs and develop an appropriate treatment plan. This will involve exploring the client's relationship with her mother and her father, along with understanding the issues that are leading to her lying and theft. Only after a comprehensive assessment can a treatment plan be developed that is tailored to the client's individual needs. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1252, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,"The counselor recently lost her father, so she feels sad to hear about Theodore's loss. She has a sudden urge to buy Theodore some groceries, so he has food at home. This is an example of?",Countertransference,Empathy,Case management,Transference,"(A): Countertransference
(B): Empathy
(C): Case management
(D): Transference",Countertransference,A,"Countertransference occurs when something in the therapeutic relationship brings up feelings for the counselor due to unresolved needs or personal conflicts. If the counselor recently lost her father and has a need to do something outside of her role, this is an example of countertransference. It is important for the counselor to recognize this and bring this to a colleague or supervisor. It would not be appropriate to work this out in the client's session. Transference occurs when the client projects their feelings, desires and drives onto the counselor. Case management is a service in which a client is set up with resources. An example of Case Management would be referring Theodore to a pantry or helping him to apply for food stamps. Empathy is an important skill to have as a counselor. It allows the counselor to put themselves in the shoes of their clients. Although the counselor may be feeling empathy, this is an example of the counselor's urge to attend to her own needs, not the needs of the client. Therefore, the correct answer is (B)",counseling skills and interventions
1253,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.",Which of the following interventions will be most beneficial to help the client in addressing his relationships within the context of his narcissistic traits?,Learning to engage in recreational activities that his wife finds important,Learning to recognize and respect boundaries,Learning to organize himself so he is not easily distracted,Learning to internalize the compliments he receives from his supervisor,"(A): Learning to engage in recreational activities that his wife finds important
(B): Learning to recognize and respect boundaries
(C): Learning to organize himself so he is not easily distracted
(D): Learning to internalize the compliments he receives from his supervisor",Learning to recognize and respect boundaries,B,"Learning to recognize and respect boundaries is the most important intervention to focus on because people with NPD and narcissistic traits often do not see or will ignore others' boundaries to meet their own needs. Understanding where the self ends and another person begins is an important feature of boundaries and is critical for the client to attend to in relationships. Engaging in recreational activities that require more physical activity and thrill-seeking is more related to his attention deficit, hyperactivity type, rather than his narcissistic traits. Organizing himself to decrease distraction is also more related to his ADHD, attention/distraction type. Learning to internalize compliments will help the client improve self-esteem and will, over time, help him reduce the instances of self-esteem injury, but this is a long-term goal and will not be an intervention at this time in therapy. Therefore, the correct answer is (D)",counseling skills and interventions
1254,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.  Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is ""officially sleeping in the spare bedroom"" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, ""We don't talk anymore. He just berates me all the time, and that hurts a lot."" As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, ""She's a mess. I don't know what to say.""    You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed.    Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship.  Seventh session You met previously with each partner separately. They shared their perspectives with you about their relationship. The husband told you that he was reluctant to stay with his wife. The wife described feelings of worthlessness and loneliness. Today, the husband arrives for their couples session ten minutes after the wife, as they are driving in separate cars. The husband states that he is bored at home and is tired of his wife ""nagging"" him. The wife rolls her eyes and expresses that she will never be a priority, and the husband blames her for everything that goes wrong. The wife is now staying at her friend's house, and the husband is relieved that she is gone. You talk to the couple about their perceived outcomes in therapy and what they hope to accomplish going forward.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ","The husband tells his wife that he feels pressured by her focus on sex. The wife responds back to him calmly, stating how she feels. You want to encourage them to continue speaking with one another. What would be most helpful for you to do at this point?",Agree with the husband,Agree with the wife,Use listening skills,Interrupt them,"(A): Agree with the husband
(B): Agree with the wife
(C): Use listening skills
(D): Interrupt them",Use listening skills,C,"If they are communicating calmly with each other, it is important for you to listen and reflect with them. Therefore, the correct answer is (C)",core counseling attributes
1255,Initial Intake: Age: 28 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Couple,"The couple appear to be their stated ages with positive signs of self-care related to hygiene and dress. Both individuals appear overweight for height, and John appears to visually be categorizable as obese. Both individuals presented with congruent affect to their stated moods. Neither demonstrated retardation, spasticity, or hyperactivity of motor activity. The couple present as cooperative, open, and forthcoming, though each frequently looks at the other and confirms that the information they are presenting individually is accurate. Jane is noted to be caregiving of and highly empathetic to John. John is noted to respond appropriately to Jane’s statements. Neither presents with reports of suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a private practice setting.  Your client, Jane, is 28 years old and presents with her spouse, John, a 24 year-old Hispanic male for “problems communicating.” The couple report that they have been married for one year after cohabitating for one year prior to marriage. Immediately after their marriage they began trying to become pregnant. They state they sought help from a specialist after several months and on learning that some degree of infertility existed, Jane began hormone therapy. Jane notes that it was soon after this time that the communication problems between them began. She tells you that it was at this point that she and John realized that they may not be able to have a biological child together. John acknowledges that Jane has tried many times over the last year to bring up this topic for discussion, but he chooses not to engage her.  He tells you that he tends to believe that “if I don’t think about it, it will probably go away.” Jane agrees with John and reports that over time, the couple have talked less and spend much less time together. John agrees and says that sometimes “I may not say more than five words to Jane in a day.”  Jane reports that they have not been intimate in over two months. When completing the intake paperwork, John endorsed no problems on any symptom criteria. Jane reported “serious” problems with “feeling sad, loss of interest in things she previously enjoyed, crying spells, and stress. She reported “moderate” problems with “feelings of worthlessness, anxiety, loss of appetite, and sleep disturbance. The couple states they were to sign divorce papers last week but made the decision to try counseling first. Neither has participated in counseling previously.","Family History:
The couple currently live with Jane’s 10 year-old son from her previous marriage and Jane’s 75 year-old grandfather, for whom the couple provide care. Jane owns and operates a small shop, is completing her bachelor’s degree, cares for her grandfather, and parents her son, who is heavily involved in baseball. She describes a history of hypothyroid disease though is no longer taking medication as her disease is now controlled with diet and exercise. She reports taking an antidepressant for two years, approximately seven years ago. She currently is taking Provera and Clomid for infertility and states these have had a noticeable effect on her mood. John reports this is his first marriage and he has no children from prior relationships. He was laid off two years ago and has been working in his uncle’s business, but the family has no insurance. He is actively involved in caring for Jane’s son and grandfather. He reports a history of high blood pressure. Prior to their wedding, John states he experienced irritability, agitation, difficulty sleeping due to “thinking about things” and worry. He was prescribed an SSRI and took this for six months. He tells you it seemed to help but he discontinued it 8 to 9 months ago. He reports that his doctor said his anxiety might have been because of his high blood pressure.","Based on the information provided, which of the following diagnoses is most appropriate for the couple's situation at this time?",Post Traumatic Stress Disorder (PTSD),Adjustment Disorder (AD),Major Depressive Disorder (MDD),General Anxiety Disorder (GAD),"(A): Post Traumatic Stress Disorder (PTSD)
(B): Adjustment Disorder (AD)
(C): Major Depressive Disorder (MDD)
(D): General Anxiety Disorder (GAD)",Adjustment Disorder (AD),B,"The couple as a whole and individually are exhibiting signs of an Adjustment Disorder. The stated problems occurred within three months of the infertility issues (Criterion A), the significant decrease in communication (ie, less than five words a day) and intimacy are out of proportion to the severity of the stressor (Criterion B. 1), and does not appear to meet conditions for another disorder, does not represent bereavement (death of a loved one), though may represent grief, related to loss of dreams or goals. The couple do not provide evidence of a traumatic event suitable for a diagnosis of PTSD. Jane presents some symptoms of a MDD, though she does not meet full criteria at this time, though the counselor would continue to monitor her. John presents some symptoms of anxiety but does not qualify for a diagnosis of GAD. Adjustment disorders may include specifiers of anxiety and depressed mood, which encompass the symptoms that the individuals as a couple are currently exhibiting. A counselor would monitor each individual closely in case the Adjustment Disorder develops into a more severe diagnosis (Criterion C - the stress-related disturbance does not meet the criteria for another mental disorder). Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1256,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","   eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin",Which one of the following is NOT a criterion for adjustment disorder?,"Significant stress that impairs social, occupational, or other areas of functioning",Symptoms that are not based on a normative stress reaction,Emotional and behavioral symptoms that start within 3 months of a stressor,The presence of psychotic features,"(A): Significant stress that impairs social, occupational, or other areas of functioning
(B): Symptoms that are not based on a normative stress reaction
(C): Emotional and behavioral symptoms that start within 3 months of a stressor
(D): The presence of psychotic features",The presence of psychotic features,D,"The presence of psychotic features is not a specifier for adjustment disorder, but the following specifiers might apply: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions or conduct, or unspecified. The specifier used for this couple is “with anxiety” because there is anxiety present about the future of their relationship. All of the other listed criteria (symptoms occurring within 3 months of the stressor, impaired functioning, and symptoms that are not based on a normative stress reaction) apply to adjustment disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1257,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.",Which of the following interventions would not be included in psychodynamic therapy aimed at increasing the client's level of insight and awareness?,Transference,Identifying core beliefs,Content vs. process,Free association,"(A): Transference
(B): Identifying core beliefs
(C): Content vs. process
(D): Free association",Identifying core beliefs,B,"Identifying core beliefs is a useful intervention in cognitive behavioral therapy, not psychodynamic therapy. Psychodynamic therapy is unstructured and makes use of the relationship between the client and counselor (transference and countertransference), free association to help the client and counselor explore how the conscious and unconscious are influencing the client, and content vs process in which the counselor helps the client explore their communication at both conscious and unconscious levels and what is meant by their verbal or behavioral communication. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1258,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy.  You suspect that client 1 is actually experiencing symptoms consistent with antisocial personality disorder",You suspect that client 1 is actually experiencing symptoms consistent with antisocial personality disorder. Which one of the following statements best characterizes antisocial personality disorder?,Severe introversion that keeps the individual from participating in daily activities,Disregarding or violating the rights of others,Argumentative/irritable/defiant behavior,"Grandiosity, lack of empathy, and a need for admiration","(A): Severe introversion that keeps the individual from participating in daily activities
(B): Disregarding or violating the rights of others
(C): Argumentative/irritable/defiant behavior
(D): Grandiosity, lack of empathy, and a need for admiration",Disregarding or violating the rights of others,B,"Antisocial personality disorder is defined by behavior that violates or disregards the rights of others. Argumentative, defiant, and irritable behaviors characterize oppositional defiance disorder, which is defined by persistent opposition to authority figures. Grandiosity, a need for admiration, and lack of empathy characterize narcissistic personality disorder. Severe introversion is not specific to antisocial personality disorder and would likely need further assessment to determine its cause. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1259,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Given that the client went to the emergency room with severe dyspnea and fear of dying from myocardial infarction and seems to be decompensating, what therapy would you now consider?",Selective serotonin reuptake inhibitors (SSRIs),Exposure therapy,Group therapy,Cognitive-behavioral therapy (CBT),"(A): Selective serotonin reuptake inhibitors (SSRIs)
(B): Exposure therapy
(C): Group therapy
(D): Cognitive-behavioral therapy (CBT)",Cognitive-behavioral therapy (CBT),D,"CBT is the most effective treatment for panic disorder, focusing on changing negative thought patterns and behaviors associated with panic attacks. It is an evidence-based approach that helps patients to identify and challenge unhelpful or inaccurate thoughts associated with the disorder. It also teaches relaxation techniques, such as breathing exercises and progressive muscle relaxation, to help manage physical symptoms of anxiety. Additionally, CBT encourages individuals to gradually face their fears in order to desensitize them from panic attack triggers. Therefore, the correct answer is (B)",treatment planning
1260,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Considering the information provided, which question will be most effective to ask when setting treatment goals for the client?",All of the above,"Which is most important to work on: your depression, narcissistic traits, or ADHD?",What have you tried in the past to make changes that haven't worked?,What do you hope to gain from working together in counseling?,"(A): All of the above
(B): Which is most important to work on: your depression, narcissistic traits, or ADHD?
(C): What have you tried in the past to make changes that haven't worked?
(D): What do you hope to gain from working together in counseling?",What do you hope to gain from working together in counseling?,D,"When setting goals, it is important for the client to want to make changes in counseling so having the client identify what they would like to gain from your work together will be an important first step in developing appropriate goals. Presenting the client with multiple and/or potential diagnoses can be disheartening and shaming to the client who is asking for help and looking for hope through counseling. Using behavioral terms to set goals would be a more appropriate, encouraging, and collaborative way of developing goals with a client. Asking the client what has not been helpful in the past may be a part of setting up interventions, but goal setting should be framed positively and focus on client's strengths and resilience as these are foundational to the counseling profession. All of the above is not correct as responses b and c are not appropriate for setting goals. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1261, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.",Which of the following would be the counselor's next step in working with this client?,Explain to the client's school that she is experiencing hallucinations and delusions,Express your concerns to client's mother and have her choose the next step,Enroll the client in a social skills group for adolescents to build social skills,Refer to psychiatry for medication evaluation,"(A): Explain to the client's school that she is experiencing hallucinations and delusions
(B): Express your concerns to client's mother and have her choose the next step
(C): Enroll the client in a social skills group for adolescents to build social skills
(D): Refer to psychiatry for medication evaluation",Refer to psychiatry for medication evaluation,D,"The client should be referred to psychiatry for medication evaluation to treat her schizophrenia and depressive symptoms. Schizophrenia does not resolve on its own and the client will likely require medication throughout her lifetime. Once she has been evaluated and medication is prescribed, the counselor and parent will notify the school of any concerns regarding the client. Enrolling the client in a social skills group may be helpful after medication has been instituted as she will need to learn skills in communicating appropriately with others while feeling limited by her medication. Medications for schizophrenia have side effects that make it difficult for individuals to engage with others. It is appropriate for the counselor to express concerns to the client's mother, but this should be done while providing the treatment options rather than asking the mother how to handle the situation as she does not have the expertise about the disorder and treatment that the counselor possesses. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1262, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.",What is a common premorbid condition that often precedes Conduct Disorder?,Reactive Attachment Disorder,Oppositional Defiant Disorder,Intermittent Explosive Disorder,Premature Conduct Disorder,"(A): Reactive Attachment Disorder
(B): Oppositional Defiant Disorder
(C): Intermittent Explosive Disorder
(D): Premature Conduct Disorder",Oppositional Defiant Disorder,B,"ODD is the condition that often develops into Conduct if untreated or unresolved. RAD is a condition found in children who don't form healthy emotional attachments with their primary caregivers before the age of 5, often due to neglect. IED is marked by episodes of unwarranted anger with behavioral outbursts that are out of proportion to the situation. Premature Conduct Disorder is not a real term. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1263,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","   vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week.  The client requests to have a session with his children to support their continued transition to being children of divorced parents. The client’s children live across state lines","The client requests to have a session with his children to support their continued transition to being children of divorced parents. The client’s children live across state lines. Considering the location of the children, which of the following is the most ethical clinical decision?","Your main client, the father, is in your state; therefore, it is okay to have a family session.",You consult with the state boards of both states and follow their recommendations.,"You cannot provide counseling to the children while also counseling their father, so you provide referrals to a counselor licensed in both states.",You cannot provide a therapy session to the client’s children because they are in a state in which you are not licensed.,"(A): Your main client, the father, is in your state; therefore, it is okay to have a family session.
(B): You consult with the state boards of both states and follow their recommendations.
(C): You cannot provide counseling to the children while also counseling their father, so you provide referrals to a counselor licensed in both states.
(D): You cannot provide a therapy session to the client’s children because they are in a state in which you are not licensed.",You consult with the state boards of both states and follow their recommendations.,B,"Different states have varying rules for providing across-state counseling services. It is always important to consider state regulations regarding cross-border counseling services prior to providing counseling. Simply providing referrals may meet the family’s needs; however, it would be more helpful to the client to find out more about the states’ regulations. You cannot move forward with providing a session just because the father lives in the state you are licensed in. Therefore, the correct answer is (D)",professional practice and ethics
1264,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,Which referral would be most beneficial to Carlos?,Narcotics anonymous,Military school,Big Brother/Big Sisters,Alcoholics anonymous,"(A): Narcotics anonymous
(B): Military school
(C): Big Brother/Big Sisters
(D): Alcoholics anonymous",Big Brother/Big Sisters,C,"Big Brothers/Big Sisters may be a beneficial program which would provide Carlos with a positive role model. Additionally, Carlos is lacking a positive male role model. There is no indication that Narcotics or Alcoholics anonymous are warranted at this time. Military school would not address the underlying psychopathology. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1265, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.","You decide not to share his mother's inattention in the second session with Raul. By doing this, you are avoiding all except which of the following outcomes?",Harming Raul's relationship with mom,Increasing Raul's perception or feelings of neglect,Inadvertent backlash onto your therapeutic alliance,Derailing the session's planned interventions,"(A): Harming Raul's relationship with mom
(B): Increasing Raul's perception or feelings of neglect
(C): Inadvertent backlash onto your therapeutic alliance
(D): Derailing the session's planned interventions",Derailing the session's planned interventions,D,"Sessions with your client should be viewed as taking the time to address what is needed to achieve treatment plan goals. This may often include many derailments from your planned interventions so that greater objectives can be reached. Flexibility is significant when providing care that involves volatile emotional content and processes. Therefore, the correct answer is (D)",counseling skills and interventions
1266, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.","Based on the information provided, which intervention should be completed in this first meeting?",Provide educational materials on academic disabilities,Develop a safety plan for the client and the family,Schedule client for psychological and academic testing,Teach client a relaxation method to help her contain emotions,"(A): Provide educational materials on academic disabilities
(B): Develop a safety plan for the client and the family
(C): Schedule client for psychological and academic testing
(D): Teach client a relaxation method to help her contain emotions",Develop a safety plan for the client and the family,B,"The client denies any suicidal or homicidal ideations but at least one occurrence has been reported where the client threatened her sister with a knife. Safety of the client and others is the first level of Maslow's hierarchy and is the priority needed for this family before leaving the intake meeting. Scheduling the client for any testing will be an important piece of treatment and while it may be efficient, it is not necessary that testing is scheduled prior to leaving this meeting. The client has not been tested so providing education on academic disabilities would be inappropriate. Teaching the client relaxation methods may be helpful at some point but given the client's current presentation, she may not understand the strategies or be able to implement them at this time. Therefore, the correct answer is (A)",treatment planning
1267,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What would be potential risk factors necessary to consider in the creation of a safety plan for this client?,The client's recent changes in medication.,"The client's disorder, self-harm, use of substances, previous hospitalization, and family history.",The client's current economic status.,"Recent perceived loss, alcohol use, previous hospitalization, history of self-harm, and family history.","(A): The client's recent changes in medication.
(B): The client's disorder, self-harm, use of substances, previous hospitalization, and family history.
(C): The client's current economic status.
(D): Recent perceived loss, alcohol use, previous hospitalization, history of self-harm, and family history.","Recent perceived loss, alcohol use, previous hospitalization, history of self-harm, and family history.",D,"The client has several risk factors. This answer captures most of the client's current risk factors. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1268,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",,Reiterate that the practice of using coping skills is a long-term learning process.,"Provide feedback that because he is still struggling, he should continue practicing.",Include them anyway because it is not up to the client.,"Explain that coping skills go in everyone's chart, and he shouldn't feel bad.","(A): Reiterate that the practice of using coping skills is a long-term learning process.
(B): Provide feedback that because he is still struggling, he should continue practicing.
(C): Include them anyway because it is not up to the client.
(D): Explain that coping skills go in everyone's chart, and he shouldn't feel bad.",Reiterate that the practice of using coping skills is a long-term learning process.,A,"Providing our clients with education on the pervasive, life-long challenge of learning and applying coping skills is a great way to validate and encourage them to keep practicing. Reframing their goals in the form of ongoing efforts can be motivational in nature, without leaving them feeling ashamed they have not mastered a previously attempted goal like in answer d). It is not best practice to write treatment plan goals the client is refusing to work on, like in answer a), and saying “coping skills go in everyone's chart” in answer b) is minimizing your clinical feedback that he specifically needs to work on them. Therefore, the correct answer is (C)",
1269,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","   . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation","Of the following, which one is NOT an accurate depiction of the use of motivational interviewing (MI)?",Counselors take a direct approach during the initial phases of MI.,Counselors support the client’s self-efficacy.,Counselors leave the decision up to the client to change.,Counselors use strategies to elicit change talk.,"(A): Counselors take a direct approach during the initial phases of MI.
(B): Counselors support the client’s self-efficacy.
(C): Counselors leave the decision up to the client to change.
(D): Counselors use strategies to elicit change talk.",Counselors take a direct approach during the initial phases of MI.,A,"Counselors do NOT take a direct approach during the initial phases of MI. MI is a person-centered, strengths-based approach used to reduce ambivalence and evoke lasting behavioral change. The counselor functions as a facilitator rather than an expert and guides the patient toward change. At no time is MI direct in nature, even in the initial phases. Counselors using MI emphasize autonomy, self-efficacy, and the use of evocation to elicit change talk. Therefore, the correct answer is (B)",counseling skills and interventions
1270,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","As you begin the intake, the client appears anxious and states that he has many things he wants to share with you and says he ""needs to get all these things off his chest."" What discussion should you have with him before you begin?",Discuss the non-judgmental nature of the counseling process,Review limits of confidentiality,Remind him that he will set the pace for what he needs to share with you,Give permission for him to share slowly so he doesn't later regret his vulnerability,"(A): Discuss the non-judgmental nature of the counseling process
(B): Review limits of confidentiality
(C): Remind him that he will set the pace for what he needs to share with you
(D): Give permission for him to share slowly so he doesn't later regret his vulnerability",Review limits of confidentiality,B,"Counselors are required to discuss the limits of confidentiality with all clients prior to counseling. This client has a history of suicidal ideation and intent so the counselor must review the circumstances that would require breaking confidentiality to protect the client from self-harm. Discussing the nature of counseling is important as is allowing the client to set the pace for self-disclosure based on the growing therapeutic relationship. Research has shown that clients who overshare too early in the counseling relationship often regret their vulnerability and may discontinue counseling due to embarrassment or shame. Therefore, the correct answer is (C)",professional practice and ethics
1271,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.","Using the provided information, for which diagnoses should the counselor assess?",Bipolar I Disorder and Rumination Disorder,Obsessive Compulsive Personality Disorder and Attention Deficit/Hyperactivity Disorder,Obsessive Compulsive Personality Disorder and Intellectual Disability,Bipolar I Disorder and Obsessive Compulsive Disorder,"(A): Bipolar I Disorder and Rumination Disorder
(B): Obsessive Compulsive Personality Disorder and Attention Deficit/Hyperactivity Disorder
(C): Obsessive Compulsive Personality Disorder and Intellectual Disability
(D): Bipolar I Disorder and Obsessive Compulsive Disorder",Obsessive Compulsive Personality Disorder and Attention Deficit/Hyperactivity Disorder,B,"The counselor should assess for symptoms of OCPD and Attention Deficit/Activity Disorder (ADHD) as the client demonstrates symptoms that meet criteria for OCPD (preoccupation with details, rules, order, and organization; perfectionism; excessive devotion to work to the exclusion of leisure activity) and symptoms that meet criteria for ADHD (fidgets or squirms in seat; difficulty remaining seated when expected to; talks excessively; blurts out answers before questions are completed). Research shows that ADHD shows a high comorbidity for some personality disorders such as OCPD. Response a is incorrect because the client has not demonstrated any symptoms related to bipolar I disorder such as being more talkative ""than usual,"" inflated self-esteem or grandiosity, racing thoughts and decreased need for sleep, or involvement in high-risk activities. Response b is incorrect as there are no symptoms presented that are congruent with an intellectual disability. The client has completed college and owns his own business. Response c is incorrect because rumination disorder is a disorder of eating, not cognitive thought or personality. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1272,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","   mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic","Due to the client’s reported suicidal ideation, which of the following would be an appropriate intervention regarding management of suicide risk?",Create a safety plan.,Encourage the client to stay with his girlfriend so he is not alone.,Coordinate for placement in a psychiatric hospital to safely address the crisis.,Provide psychoeducation on cognitive reframing in order to manage depressive symptoms.,"(A): Create a safety plan.
(B): Encourage the client to stay with his girlfriend so he is not alone.
(C): Coordinate for placement in a psychiatric hospital to safely address the crisis.
(D): Provide psychoeducation on cognitive reframing in order to manage depressive symptoms.",Create a safety plan.,A,"A safety plan would be the best first intervention because suicidal ideation is present, but without an intent or plan. A safety plan provides options for coping with negative thoughts and lists the people that the client can contact for support. Cognitive reframing will be beneficial in treating depression and at times suicidal thoughts, but this would not be taught quickly and effectively enough to assist the client in the first session. Encouragement to stay with his girlfriend may provide safety and/or be part of the safety plan, but it will not guide the client on how to manage his thoughts in the way that the safety plan would. Placement in a psychiatric hospital is not always necessary when someone has suicidal thoughts, and this may enhance the client’s anxiety. Further questioning and assessments can be used to ensure that someone is at low risk for suicide and if they are lower risk, they can likely be stabilized in the community with a safety plan. Therefore, the correct answer is (B)",treatment planning
1273,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""  Fourth session The client has been ""looking forward to working with you"" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is ""hard on her.""    She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father.","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ","During the subsequent joint session, the client's father states, ""All these problems he has are because he wants to be a girl."" Which of the following psychoeducation statements addresses this statement?","""I agree, but do you really think we can force your child to act a certain way?""","""We are working to treat the client for gender dysphoria, not gender nonconformity.""","""It would be best if you started using the client's preferred pronouns.""","""Often, the problem is not a child's gender expression but how those around them react to that expression.""","(A): ""I agree, but do you really think we can force your child to act a certain way?""
(B): ""We are working to treat the client for gender dysphoria, not gender nonconformity.""
(C): ""It would be best if you started using the client's preferred pronouns.""
(D): ""Often, the problem is not a child's gender expression but how those around them react to that expression.""","""Often, the problem is not a child's gender expression but how those around them react to that expression.""",D,"This statement places the context of the problem in the sociocultural response to the client's gender expression without placing blame. Therefore, the correct answer is (C)",counseling skills and interventions
1274,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”",Which of the following goals would be the most appropriate overarching goal in working with this client?,Develop sense of empathy for others,Reduce use of alcohol and other substances,Implement mindfulness practices to reduce risk-seeking behaviors,"Learn to manage emotions, tolerate distress, and improve relationships","(A): Develop sense of empathy for others
(B): Reduce use of alcohol and other substances
(C): Implement mindfulness practices to reduce risk-seeking behaviors
(D): Learn to manage emotions, tolerate distress, and improve relationships","Learn to manage emotions, tolerate distress, and improve relationships",D,"Clients with BPD must learn to manage and tolerate distress as these situations and emotions push them towards frantic, inappropriate behaviors geared to relieving the immediate distress without insight into the consequences of their actions on self and relationships with others. Reducing alcohol and substance use and implementing mindfulness are part of the skills that may be learned through dialectical behavioral therapy (DBT), an evidence-based model for working with BPD. Individuals with BPD do not by nature lack empathy for others, as in the case of the person with a narcissistic personality disorder so this goal would not be typically appropriate for the client with BPD. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1275,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.",What provisional diagnosis would you add to Melanie's chart?,Cannabis Use Disorder,"Cannabis Use Disorder, in early remission",Substance Use Disorder,Cannabis Induced Anxiety Disorder,"(A): Cannabis Use Disorder
(B): Cannabis Use Disorder, in early remission
(C): Substance Use Disorder
(D): Cannabis Induced Anxiety Disorder",Cannabis Use Disorder,A,"Cannabis Use Disorder is the most appropriate and general diagnosis currently, as Melanie meets criteria for this diagnosis to stand alone and separate from her other diagnoses. It has not been determined that Melanie's anxiety was initially caused by use of marijuana; comments in her family history indicate the possibility of anxiety was present before her onset of drug use. The specifier ""in early remission"" only applies if criteria has not been met within the last three months, and Melanie has only been in treatment for six weeks. The DSM-5 categorizes a variety of substance use disorders separately. If you know the substance being used, it is best to diagnose to that category. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1276,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ","Given the client's presenting issues, what would you focus on assessing first?",Family dynamics,Colombian culture,Possibly severe depression,Suicidal/homicidal ideation,"(A): Family dynamics
(B): Colombian culture
(C): Possibly severe depression
(D): Suicidal/homicidal ideation",Suicidal/homicidal ideation,D,"During the MSE, you noted that the client made homicidal and suicidal statements. In addition, her appearance, affect speech and thought process indicates that she is experiencing significant distress. You must assess this further to determine her risk of homicide and/or suicide. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1277,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Based on the information provided, which of the following should the counselor suspect for this client?","Major Depressive Disorder (MDD), Attention Deficit Disorder (ADHD) - Inattentive Type","Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic Personality Disorder (NPD)","Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic traits","Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type","(A): Major Depressive Disorder (MDD), Attention Deficit Disorder (ADHD) - Inattentive Type
(B): Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic Personality Disorder (NPD)
(C): Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic traits
(D): Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type","Persistent Depressive Disorder (PDD), Attention Deficit Disorder (ADHD) - Combined Type, Narcissistic traits",C,"The client meets criteria for PDD with a depressed mood most days than not for at least two years (Criterion A). His low self-esteem and feelings of hopelessness meet Criterion B and these have been present for over two years, meeting Criterion C These suggest the client meets criteria for PDD. Additionally, the client meets criteria for ADHD, combined types which is expressed through his forgetfulness, inattention and distraction, and his ""need"" for active recreation that includes high physical activity and thrill-seeking. The client meets several criteria for NPD, but does not meet the required five or more criteria. He is noted to have a sense of self-importance, though this is observed and not felt by him; he possesses a sense of entitlement that he should have what he wants or desires, even at the expense of others' feelings; he is envious of others, and he has difficulty accessing empathy. These criteria do not meet the full criteria for NPD and because the client possesses insight to understand that these feelings and behaviors are not appropriate, loving, or who he wishes to be, he possesses NPD Traits, not the full personality disorder diagnosis. While he does not meet the full disorder, the trait would be listed in his documentation and be a part of a treatment plan. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1278,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",How might you use a summarization during this session?,"""I see you brought your medical file to session. Let's see if we can find what may be related to your anxiety symptoms.""","""We are a week behind in your therapy since you missed your last session. Instead of going over your medical file this week, we need to continue to work on reducing the anxiety you say you are having.""","""I see that you are anxious today. Some deep breathing may help you relax and it will be a good way to end this session.""","""We have talked about your anxiety and how it's been affecting you. I'd like to offer you homework and recommendations of some relaxation methods I think may help.""","(A): ""I see you brought your medical file to session. Let's see if we can find what may be related to your anxiety symptoms.""
(B): ""We are a week behind in your therapy since you missed your last session. Instead of going over your medical file this week, we need to continue to work on reducing the anxiety you say you are having.""
(C): ""I see that you are anxious today. Some deep breathing may help you relax and it will be a good way to end this session.""
(D): ""We have talked about your anxiety and how it's been affecting you. I'd like to offer you homework and recommendations of some relaxation methods I think may help.""","""We have talked about your anxiety and how it's been affecting you. I'd like to offer you homework and recommendations of some relaxation methods I think may help.""",D,"Summarizing a session entails briefly discussing how the session started, what issues were brought up, and reminder of any resolution to a problem or homework assigned. This helps you and the client to agree on the general topic of the session and how to proceed in the time between this session and the next one. Therefore, the correct answer is (C)",counseling skills and interventions
1279,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.  Fourth session Last week you misjudged the client, and she ended up in the hospital for mood stabilization. She was released after 7 days and arrives to today's session with an older gentleman who remains seated in the waiting room. You notice her mood is elevated, and she exhibits childlike behaviors in the session. The client is giggling and fidgeting in her chair. You ask her about her feelings and her goals for therapy. She describes feeling happy and having a ""new chance at living."" She further discloses that she recently met a ""wonderful man."" They have had dinner together every night since she was released from the hospital. The client continues to describe her newfound relationship with this man and explains that they met on a dating app. She shares that ""he is the answer to all of my prayers to be in a healthy relationship with someone who truly loves and understands me."" She also shares that her soon-to-be ex-husband never truly loved her and that this new relationship feels different.    From her description, this new relationship appears to provide her with a sense of safety and security, but you remain cautious. You explore the client's thoughts and feelings about this newfound relationship in more detail. You ask the client to describe how the relationship has changed her outlook on life. The client explains that she now feels hopeful and optimistic about the future, as this new partner makes her feel loved and accepted for who she is. She also reports feeling more confident in herself and her decisions. You ask the client how she knows that this man cares about her. The client discloses that he has been very supportive and understanding, even when she was hospitalized for her mood stabilization. She explains that he has gone out of his way to make sure she feels safe and secure in their relationship. ""He's always around when I need him,"" she explains, ""And he listens to me and takes what I say seriously."" The client acknowledges that the man is older, and they come from different cultural backgrounds. She shares that she does not know much about his past relationships, but he has been very honest with her about his intentions for their relationship. She tells you, ""If I'm honest, I'm a little bit anxious about the future, but I'm more excited than scared.""    You recognize that the client is in an emotionally vulnerable state, and you want to ensure she is making healthy decisions. You proceed by exploring the potential risks of this relationship in more detail. You ask the client questions about her comfort level with entering into a relationship with someone from a different cultural background, and how she believes these differences may affect their relationship. You also explore the potential benefits and risks of entering into a new romantic relationship. You remind her that healthy relationships are built on trust, communication, and respect - all components that take time to develop. You further explain the importance of setting boundaries and expectations early in a relationship in order to ensure that both parties’ needs are met. Finally, you encourage the client to take any necessary steps to ensure her safety, such as getting to know her partner better and introducing him to friends or family members she trusts.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ","When working with a client who has been diagnosed with Borderline Personality Disorder, which of the following is most likely to be achievable as a short-term goal?",Achieve and maintain healthy boundaries between self and others,"Reduce stress, anxiety, and depression","Eliminating self-harming behaviors, rages, and violent outbursts",Significantly improve social functioning and reduce oppositional behavior,"(A): Achieve and maintain healthy boundaries between self and others
(B): Reduce stress, anxiety, and depression
(C): Eliminating self-harming behaviors, rages, and violent outbursts
(D): Significantly improve social functioning and reduce oppositional behavior","Reduce stress, anxiety, and depression",B,"Reducing stress, anxiety, and depression is typically achievable in the short term. This would involve creating a healthy support network, practicing mindfulness and self-awareness, and identifying emotions driving certain behaviors. Therefore, the correct answer is (A)",treatment planning
1280, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.","You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.","Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.","Based on the information provided, which of the following tests will best help determine the client's diagnosis?",Personality Assessment Inventory (PAI),Beck's Depression Inventory-II (BDI-II),Minnesota Multiphasic Personality Inventory-2 (MMPI-2),Rorschach Inkblot Test,"(A): Personality Assessment Inventory (PAI)
(B): Beck's Depression Inventory-II (BDI-II)
(C): Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
(D): Rorschach Inkblot Test",Rorschach Inkblot Test,D,"The Rorschach Inkblot Test is used to examine personality characteristics and emotional functioning using a complex interpretation and algorithm that is required for accurate analysis of the client's responses. This test would be most helpful in determining the client's diagnosis because it does not require extensive reading or reading comprehension as is needed in long, self-report tests such as the MMPI-2 and the PAI, both of which have over 500 questions. The BDI-II will determine if the client is currently experiencing depression, but will not assess other characteristics or functioning. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1281,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps.  Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, ""I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?"" You remain calm and acknowledge the client's frustration. You reply, ""You're angry with me because you feel that I'm not listening. Am I hearing you right?"" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety.    The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but ""she just doesn't get how hard it is for me."" He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, ""It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?"" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support.  Sixth session It has been one and a half months since you began seeing the client for therapy. He followed up on the referral you gave him to see a psychiatrist and he is currently taking medication for his anxiety, but he reports that ""the pills aren't really helping."" He says he loves cheerleading and gymnastics and will never give them up. He reports he is still eating and exercising to excess but refuses to stop. He continues, ""I'm aware of the dangers, but I don't care. All athletes go through pain to be successful."" You assess the client's internal and external motivation as a strategy to separate the client from his denial that he has an illness."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ","You state, ""I hear you saying all athletes go through this to be successful. What does it feel like for you to compare yourself to others?"" What skill are you utilizing?",Engaging in constructive confrontation,Providing an encourager,Asking an open-ended question,Asking a close-ended question,"(A): Engaging in constructive confrontation
(B): Providing an encourager
(C): Asking an open-ended question
(D): Asking a close-ended question",Asking an open-ended question,C,"You are asking the client an open-ended question that elicits how the client feels about others who do this and what this feels like for him. Therefore, the correct answer is (C)",counseling skills and interventions
1282,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ",You note some issues in the way the father and son interact with one another. Which would be the least effective way to improve the client's interactional patterns?,Addressing the client's thought patterns and maladaptations contributing to the behavior,Exploring the client's interpersonal behaviors,Showing the client logical consequences,Examining specific relationships,"(A): Addressing the client's thought patterns and maladaptations contributing to the behavior
(B): Exploring the client's interpersonal behaviors
(C): Showing the client logical consequences
(D): Examining specific relationships",Showing the client logical consequences,C,"In therapy, showing the client logical consequences involves the therapist engaging the client in a conversation geared toward predicting consequences of thoughts, actions, and feelings. The therapist may share his/her view in a non-judgmental manner regarding the pros and cons of a certain situation. This is an influencing skill designed to help clients consider possible consequences of their actions. This will not directly help you improve the client's interactional patterns. Therefore, the correct answer is (D)",counseling skills and interventions
1283,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,Kathleen states at the end of the session that they cannot come in because she has a doctor's appointment. Tony states that he could come anyway by himself. How should the counselor respond?,"Yes, we can do that",Couples in Marital Counseling can only be seen as a unit,Let me ask my supervisor,Let's talk about if that would be beneficial,"(A): Yes, we can do that
(B): Couples in Marital Counseling can only be seen as a unit
(C): Let me ask my supervisor
(D): Let's talk about if that would be beneficial",Let's talk about if that would be beneficial,D,"There is no definitive rule that a client can only be seen as a couple in marital counseling. Individuals in the marriage may be seen as well. Counselors should be aware of this and have the appropriate clinical knowledge before seeing part of the couple separately. In determining whether one member of the couple can be seen individually, the counselor should consider the impact it may have on the therapeutic process. Additionally, it is important that ground rules are set prior to the individual session, such as: whatever is said in session will be shared in the next session when both members can attend. Therefore, the correct answer is (C)",counseling skills and interventions
1284,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","In the therapeutic context of the session, the client conveyed a palpable sense of apprehension and unease regarding the disclosure of her pregnancy to her parents, especially given the intricacies of their relationship dynamics. Considering the emotional weight and potential ramifications of her disclosure, what is the best strategy to employ in order to assist her in navigating her fears and anticipations about her parents' possible responses?",Use a guided imagery technique to help the client visualize her and her parents' reactions to her situation,Discuss confidentiality with the client in relationship to her parents' right to know about the pregnancy,"Inform the client that as a mandated reporter, you must disclose the pregnancy to her parents",Role play to help the client determine what she might like say to her parents if she decides to tell them,"(A): Use a guided imagery technique to help the client visualize her and her parents' reactions to her situation
(B): Discuss confidentiality with the client in relationship to her parents' right to know about the pregnancy
(C): Inform the client that as a mandated reporter, you must disclose the pregnancy to her parents
(D): Role play to help the client determine what she might like say to her parents if she decides to tell them",Role play to help the client determine what she might like say to her parents if she decides to tell them,D,"There are various options to consider in terms of involving the client's parents in this case. The least intrusive way may be to role play to help the client figure out what to say to her parents if she decides to tell them about her pregnancy. Therefore, the correct answer is (A)",counseling skills and interventions
1285,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment.  The client states he is tired of the obstacles he faces due to his sexual orientation. He no longer wants to be attracted to men and believes being gay is a sin. He has heard of conversion/reparative therapy and would like to pursue this treatment option",The client states he is tired of the obstacles he faces due to his sexual orientation. He no longer wants to be attracted to men and believes being gay is a sin. He has heard of conversion/reparative therapy and would like to pursue this treatment option. How do you respond?,Discuss the benefits and harms and refer the client to a therapist who provides this treatment.,Encourage the client to seek religious guidance and continue to treat the client.,Discuss the harms of this treatment and continue to treat the client.,Consult a therapist who provides this treatment prior to determining whether a referral is appropriate.,"(A): Discuss the benefits and harms and refer the client to a therapist who provides this treatment.
(B): Encourage the client to seek religious guidance and continue to treat the client.
(C): Discuss the harms of this treatment and continue to treat the client.
(D): Consult a therapist who provides this treatment prior to determining whether a referral is appropriate.",Discuss the harms of this treatment and continue to treat the client.,C,"The American Counseling Association (ACA) and several other professional organizations have determined that conversion therapy causes harm to patients, and since counselors have an ethical obligation to “do no harm,” they should actively advise clients against it. Despite this, conversion therapy is still legal in most states. The ACA Code of Ethics (2014) requires that “counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others” Referring the client to someone who provides this treatment would be considered unethical in all circumstances, and therefore consulting that therapist to determine referral opportunities would also be inappropriate. Since conversion therapy is a religious-based practice the ACA would hold that encouraging the client to seek religious guidance is a vague suggestion and includes an element of risk. The best option is therefore answer choice D. Therefore, the correct answer is (D)",treatment planning
1286,"Name: Luna Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F81.0 Specific Learning Disorder, with Impairment in Reading Age: 13 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Hispanic Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is an average-built individual who is alert. The client is casually dressed and adequately groomed. Speech volume is quiet, and speech flow is slow. She has difficulty maintaining eye contact for extended periods and often looks down at her feet. She demonstrates irritability at times during the interview and sighs several times. Her thought process is logical. Her estimated level of intelligence is in the low average range, with limited abstract thinking. Concentration is intact. The client shows no problems with memory impairment.","First session As the mental health therapist working in a school setting, you welcomed your new client and her parents into your office. They explained their daughter's struggle with reading and how it caused her to freeze when faced with a spelling or math test. After listening to them closely, you asked the client why she did not enjoy reading. She said that words confused her and made no sense, so she found it difficult to remember what she read.    You consider possible solutions for your client, who was having difficulty with schooling due to a lack of literacy skills. You proposed an idea: ""Let's try incorporating creative activities as part of our therapy sessions."" Doing so, we can develop strategies for improving written language comprehension and expression while making learning fun for your daughter.""    The parents were hesitant but agreed to try it after seeing their daughter's enthusiasm about trying something different than traditional methods like instruction books or worksheets, as those have not been effective in the past. During the session, you brainstormed ideas around stories, role-playing games, and drawing activities focusing on using everyday experiences as inspiration for creating unique narratives within each session – not only reinforcing literacy skills but also providing an opportunity for emotional growth through storytelling exercises.  Fourth session The client came to her weekly session with you feeling discouraged and embarrassed about what happened in school earlier that day. She had been called on to read a paragraph from the science textbook in front of the whole class, and she could not get through it. Her classmates, who she usually gets along with, began to laugh at her, and she quickly excused herself to the clinic, saying she had a stomachache. It was the worst experience she had ever encountered, making her feel even more vulnerable.    You offered comfort as you discussed strategies for the client's reading struggles. You also encourage the client not to give up and assure her that no matter what happens tomorrow, next week, or next month, she can reframe the fear and embarrassment she felt with being surrounded by support and people that will help her through these challenging times.    After the client leaves, you talk with her parents over the phone. You suggest they meet at school with everyone involved with their daughter to discuss how best to implement an Individualized Education Plan (IEP). Your objective with this meeting is to review the areas where improvements and support could be given and determine if any changes need to occur for your client."," The client says she is only poor at reading and ""good at everything else."" She says that she feels stressed when she has to read. The client's IQ is 89. A reading specialist assessed her, and her reading skills are abnormally low. Throughout elementary school, teachers noted the client has difficulty reading and that, in turn, it has adversely affected the client's academic achievement. As a result, special needs are implemented in the client's school setting. The client has an active Individualized Education Plan (IEP). Pre-existing Conditions: The client has also been diagnosed with epilepsy and is on medication for seizures. The client had frequent seizures for many years until a medication that lessened the occurrence of her symptoms was prescribed. The client fell when she was eight, hit her head, and fractured her skull. She was not diagnosed with any traumatic brain injury, but she did need stitches. Additional Characteristics: The client portrays positive interactions with both staff and peers at school. The client does state she feels she is ""stupid"" when it comes to reading and wishes she could get better. The client's family is supportive and values education. They are hands-on in supporting the client in any way they can. ",What assessment tool would help you confirm a diagnosis of Specific Learning Disorder with Impairment in Reading?,Wechsler Preschool and Primary Scale of Intelligence (WPPSI),Behavior Assessment System for Children (BASC-3),KeyMath-3 Diagnostic Assessment (KeyMath-3 DA),Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R),"(A): Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
(B): Behavior Assessment System for Children (BASC-3)
(C): KeyMath-3 Diagnostic Assessment (KeyMath-3 DA)
(D): Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R)",Woodcock-Johnson Psychoeducational Battery-Revised (WJ-R),D,"The WJ-R is used to test cognitive abilities, scholastic aptitude, and achievement in areas such as reading, math, and written language. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1287, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,An immediate objective for Theodore should be?,to find housing,to find another way to make meals for himself,to tell his son he doesn't want to live with him,to determine his own goals,"(A): to find housing
(B): to find another way to make meals for himself
(C): to tell his son he doesn't want to live with him
(D): to determine his own goals",to determine his own goals,D,"Although there are several areas of concern, it is important for the client to make choices for themselves and establish their own goals. By establishing their own goals, this also increases the likelihood of attainability and success. Housing is a priority for Theodore, but it was not stated that this is an emergency. Theodore was able to care for his wife, so he is likely able to care for himself. It is also not an emergency for Theodore to tell his son he doesn't want to live with him. If that is something that Theodore would like to set as a goal, then it can be made a priority. Making meals is a more pressing matter in terms of overall health. However, it is a goal that Theodore should be making for himself. Therefore, the correct answer is (B)",treatment planning
1288,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ","Using a cognitive-behavioral therapy approach, what would be most useful as you begin to teach the couple constructive communication skills?",Psychoeducation on respectful listening,Staying with the feeling,Modeling active listening,Cognitive reframing,"(A): Psychoeducation on respectful listening
(B): Staying with the feeling
(C): Modeling active listening
(D): Cognitive reframing",Modeling active listening,C,"By demonstrating healthy, productive communication skills and providing the couple with specific examples of what it looks like to actively listen to one another, they can learn how to better communicate and understand each other’s feelings. This will help them build trust in their relationship and work together more effectively when making decisions about managing family responsibilities. Therefore, the correct answer is (D)",counseling skills and interventions
1289,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.  11th session As the session begins, you sit calmly in your office, virtually watching as the client pounds her fists on her desk and speaks angrily. The client informs you that she is ""not happy"" with you as a therapist. ""You therapists are all the same!"" she yells. She accuses you of being responsible for her break-up, saying that her boyfriend left her because she had been hospitalized on your recommendation.    Her facial expressions convey feelings of hurt and disappointment, and you attempt to normalize her reaction. You remain calm, opting to validate the client's feelings rather than respond defensively or deny responsibility for what has happened between the client and her partner.    As the session continues, you take a deep breath and give yourself a moment to gather your thoughts. You recognize that the client's emotional pain and distress have created a lens through which she now views your professional relationship.    Reflecting on the session and past interactions, you remember your concerns that prompted the recommendation for hospitalization. The client had exhibited signs of severe emotional distress and potential self-harm. As a therapist, you prioritized her safety and well-being. You understand her feelings of abandonment from her partner and try to determine who represents both care and potential harm in her life.    However, no matter how much empathy you try to show or how many times you attempt to normalize the client's feelings of anger, she refuses any further discussion on the topic; instead, she declares firmly that she does not want to see you again and abruptly logs out of the session.    You make a note to reach out to the client in a few days to check in on her well-being and see if she's open to discussing her feelings further. Given the intensity of her reaction, it's crucial to ensure that she has a support system during this challenging time. While she might not be receptive to your outreach initially, she needs to know that she is not alone and that help is available should she seek it.    Later, you discuss the situation with your supervisor, seeking guidance on best handling her response and processing your feelings about the matter. The supervisor reminds you that therapeutic relationships can mirror many aspects of clients' other relationships. The anger and feelings of betrayal the client is experiencing could have been elicited by any number of events in her life. The most important thing is to continue offering support while respecting her boundaries.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What should you challenge and need to resolve if the client comes back to therapy?,The client's lack of responsibility for her behavior.,The client's feelings of anger and fear.,The client's concept that you are responsible for the break-up.,Exploring her feeling towards therapy and therapists.,"(A): The client's lack of responsibility for her behavior.
(B): The client's feelings of anger and fear.
(C): The client's concept that you are responsible for the break-up.
(D): Exploring her feeling towards therapy and therapists.",The client's concept that you are responsible for the break-up.,C,"This is important and central to the current conflict. Calmly challenging the client on this point in future sessions will likely be essential in helping to repair the therapeutic rupture. Therefore, the correct answer is (D)",counseling skills and interventions
1290,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Not feeling pain or having an out of body experience is called?,Disassociation,Displacement,Projection,Hallucination,"(A): Disassociation
(B): Displacement
(C): Projection
(D): Hallucination",Disassociation,A,"Disassociation is the feeling that you are separated from yourself, which often happens when someone experiences a very painful or traumatic event. Displacement is a defense mechanism in which a negative emotion is redirected to a less threatening object. Projection is a defense mechanism in which feelings are placed onto another object or person. Hallucinations are experiences that are not real and are created by your mind. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1291,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What steps can you take to address the client's continued discouragement despite therapy?,Show support and use active listening skills.,"Remember that discouragement is part of the process, allowing him to work through his feelings and find his own way.",Meet with the client more frequently.,Assign homework exercises to practice the coping skills you are teaching.,"(A): Show support and use active listening skills.
(B): Remember that discouragement is part of the process, allowing him to work through his feelings and find his own way.
(C): Meet with the client more frequently.
(D): Assign homework exercises to practice the coping skills you are teaching.",Show support and use active listening skills.,A,"Even though you might be delivering helping the client, it appears as though he is still struggling with his emotions and what he should do. Don't overlook the importance of being where the client is in the process. Don't get ahead of them if they need more time to process what they feel. Therefore, the correct answer is (B)",counseling skills and interventions
1292, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",What elements are generally included in a CBT Thought Record?,"event, automatic thoughts, underlying core beliefs, new core beliefs","trigger, thought, feeling, reason, desired thought, desired feeling","trigger, feelings, underlying core beliefs, desired core beliefs, new feelings","event, emotion rating, thought, challenging thoughts, new thought, new emotion rating","(A): event, automatic thoughts, underlying core beliefs, new core beliefs
(B): trigger, thought, feeling, reason, desired thought, desired feeling
(C): trigger, feelings, underlying core beliefs, desired core beliefs, new feelings
(D): event, emotion rating, thought, challenging thoughts, new thought, new emotion rating","event, emotion rating, thought, challenging thoughts, new thought, new emotion rating",D,"Cognitive Behavioral therapy ""thought records"" walk clients through what event occurred that caused negative emotional states and negative automatic thoughts. Through examining these connections and after a client gives a rating to each emotion, you then help them reality test and challenge the thoughts they had - attempting to get them to provide evidence in support of or against their original thoughts. This processing technique is intended to train their minds to automatically challenge ""negative automatic thoughts"" in effort at reducing negative emotional states. Any of the above elements would be helpful as part of an exercise or follow-up activity looking at underlying core beliefs, but the goal of a thought record is to address here and now automatic responses. Therefore, the correct answer is (B)",counseling skills and interventions
1293,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ",What is most important when assembling a team to help the client?,Educating the client in managing her eating patterns,Communicating with members of the client's treatment team,Ensuring necessary medical care while preventing self-harm,Ensuring that the treatment team follows through with their care,"(A): Educating the client in managing her eating patterns
(B): Communicating with members of the client's treatment team
(C): Ensuring necessary medical care while preventing self-harm
(D): Ensuring that the treatment team follows through with their care",Ensuring necessary medical care while preventing self-harm,C,"Medical care while preventing self-harm include imposed treatment, enforced feeding, the duty to protect minors and adults, the determination of competence and capacity among medically comprised clients, and the effectiveness of coercive treatment for clients with eating disorders. Therefore, the correct answer is (B)",professional practice and ethics
1294,Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined,"Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with","You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.",The client reports that a worker from the local child protective services office met with her and that she is worried about what the coach will do in response when he finds out that she reported him. The client says that she has not returned to school but that the school has provided the classwork and homework needed to keep up; she feels like the school is supporting her well enough to not fall behind. The client confirms that all of the symptoms that she described during her last session are still present,Which of the following is LEAST likely to be a long-term effect of this client’s trauma if left untreated?,Difficulty with trust,Adjustment disorder,Clinical depression or anxiety,Difficulty with intimacy,"(A): Difficulty with trust
(B): Adjustment disorder
(C): Clinical depression or anxiety
(D): Difficulty with intimacy",Adjustment disorder,B,"Adjustment disorders arise in reaction to major events or life changes that disrupt an individual’s prior way of life. These events may be positive or negative in nature. Common causes include the divorce of parents, moving to a new home/state/school, marriage, having children, loss of a job, loss of a loved one, or retirement. Although an adjustment disorder may be peripherally linked to stress from trauma or retraumatization, it is the least likely of all of the options to result from sexual trauma (post-traumatic stress disorder would be more likely). Intimacy and trust might be difficult for the client in the future because they are directly related to the sexual assault. Depression and anxiety symptoms are already present and may progress to clinical levels if untreated. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1295,Initial Intake: Age: 9 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Lottie presents as excited, over-stimulated and hyperactive, unable to sit still and does not take breaks from talking. Her appearance is highly disheveled with stained clothes and unbrushed hair. Lottie nervously walks around your office touching and commenting on everything. You ask her nicely to ask you before she touches your things, but she refuses and continues to do so. Lottie deflects from every question posed in your assessment. She denies SI/HI, hallucination, or delusion, which you were surprisingly able to find out from her.","
Diagnosis: Attention Deficit Hyperactivity Disorder, predominantly hyperactive type (F90.1), Oppositional defiant disorder (F91.3), Reaction to severe stress (F43.9)
 

Lottie is a 9-year-old girl in the fourth grade who has been referred to you by officials in her elementary school. You are a counseling intern of a private practice that specializes in adult personality disorders, but your supervisor accepted Lottie as a new client because Lottie’s mother is a former client of her agency, and she requested her daughter be seen by your practice as opposed to a school-based counselor. Lottie’s mother does not want Lottie’s peers to know she is in therapy. Lottie has been doing well in school academically but has not been able to behave appropriately for years, according to the referral report. Lottie bounces up and down in her chair constantly, makes impulsive noises throughout the day, and engages in inappropriate behaviors daily. Some of the behaviors listed include invading the personal space of her peers, licking and eating school supplies to garner reactions from fellow classmates, hiding on the playground and refusing to emerge, and many other behaviors. Lottie follows basic classroom directions but needs constant reminding or guiding that the teacher does not have time for. Lottie breaks down into hysterical emotional fits when she does not get her way and her behaviors have been spreading the school staff too thin to be capable of managing without intervention. This session is conducted with only Lottie in the room; her mother insists on waiting in the car outside so she can make some phone calls. She mentions her Medicaid has just been reactivated to pay for sessions.","Family History:
Lottie lives at home with her mother and mother’s boyfriend, as well as their 1-year-old son Davie who is her half-brother. You learned from speaking with her mother beforehand that Lottie’s biological father was a drug addict and homeless, and he was recently shot and killed, about four months ago. Lottie knows and understands what happened. During the intake session you ask her to draw a picture of something important to her. She likes this assignment and draws you a picture of her father’s homeless camp where she last saw him. She explains to you the details surrounding his murder and mature, intimate details of her mother’s broken relationship with him. “How do you know all of this, Lottie?” you ask her, concerned. “Oh, my mother told me. She tells me everything.”","You ask Lottie if she feels safe at home. She replies, ""I'm not answering that, I could get in trouble."" How should you proceed?",Ask her why she would get in trouble.,Call department of family services and file a report.,Conduct the Child Safety Self-Report Checklist.,Use motivational interviewing.,"(A): Ask her why she would get in trouble.
(B): Call department of family services and file a report.
(C): Conduct the Child Safety Self-Report Checklist.
(D): Use motivational interviewing.",Ask her why she would get in trouble.,A,"Furthering this conversation to obtain as much information as possible from Lottie can better inform your next step decisions. You cannot file a report without more information about alleged abuse or neglect. There is no official document called the ""Child safety self-report checklist"" although you can run through checklist items with her if she is willing to answer them. This can be accomplished through one-at-a-time questions in casual conversation, which seem to be most effective with Lottie. Motivational interviewing does not yet apply here but may be useful soon depending on the rest of the conversation. Therefore, the correct answer is (D)",counseling skills and interventions
1296,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ","As part of your continuing education, you have elected to use this case as an exemplar. What is your next step?",Remove the personal information from the record to obviate consent,Set aside a therapy session to explore the legalities of record use in depth,Explain to the clients why their case can serve as an exemplar,Obtain informed consent from both clients concerning their records,"(A): Remove the personal information from the record to obviate consent
(B): Set aside a therapy session to explore the legalities of record use in depth
(C): Explain to the clients why their case can serve as an exemplar
(D): Obtain informed consent from both clients concerning their records",Obtain informed consent from both clients concerning their records,D,"The clients must be asked to consent before their data can be shared. Therefore, the correct answer is (D)",professional practice and ethics
1297,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.  10th session You have been seeing Gregory for therapy every week for the past three months. You have worked to improve the parent-child relationship and incorporated parent-management training into his treatment plan. You have taught Gregory's mother techniques to improve his behavior and support his emotional functioning. Also included in Gregory's treatment plan is improving impulse control, learning problem-solving skills, and improving social skills. You have used CBT interventions, structured activities, games, and role-playing exercises with Gregory to achieve these goals.    Today, Gregory begins the session by taking a paper from his backpack and handing it to you. You see that he received a high grade on his mid-term in Global Studies. You praise him for his hard work. Then, you ask him how it felt to get his grades back up. There is a long silence. Gregory is fidgeting with the string on his backpack. He turns, looks out the window, and whispers, ""Good, I guess."" You notice the client has tears in his eyes. You draw his attention to his behavior and affect and ask, ""Why are you upset after being successful with your exam?"" He shrugs his shoulders, looks at you, says, ""Would you stop asking me so many questions?"" and walks out of the office. You follow him into the waiting room and hear him tell his mom, ""I'll be in the car."" His mom looks confused. You say to her, ""Is something going on or did something happen with Gregory that I should know about? He seemed upset after showing me his good exam grades."" She thinks for a moment and tells you that he found a box of old family pictures and has been going through them. She wonders if this is related to his reaction today.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",Gregory needs to use telehealth for the next week. What would be your priority regarding the use of this technology?,Determine if the client is in danger of harming themselves or someone else,Instruct the client regarding technology protocols,Maintain client confidentiality,Provide age an appropriate means of telecommunication for the client,"(A): Determine if the client is in danger of harming themselves or someone else
(B): Instruct the client regarding technology protocols
(C): Maintain client confidentiality
(D): Provide age an appropriate means of telecommunication for the client",Maintain client confidentiality,C,"Confidentiality would be the most important consideration regarding distance therapeutic services. Trust is the cornerstone of the therapeutic relationship and is critical regarding any therapy delivery methodology you use. The therapist must ensure that the telehealth sessions mimic an in-person session regarding client confidentiality. Therefore, the correct answer is (A)",professional practice and ethics
1298,Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual,"Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.
","Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.",,The counselor should gather information on?,How long Michael will be suspended,How Michael's teacher reacted,What triggered the fight,What punishment the other student received,"(A): How long Michael will be suspended
(B): How Michael's teacher reacted
(C): What triggered the fight
(D): What punishment the other student received",What triggered the fight,C,"It is important for the counselor to understand what triggered the fight, especially since it is out of character for Michael. The length of time that Michael will be suspended as well and the ramifications that the other student had are not relevant to understanding Michael's symptoms. Knowing how Michael's teacher reacted may be important if she was not supportive of him, but there is no indication of that currently. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1299,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","Based on the client's current presentation in this session and the information he shared, which of the following goals would be most effective to focus on for this session?",Client will obtain employment to meet his needs for independence,Client will develop a support system to meet his needs for community and support,Client will experience reduction in depression and anxiety,Client will experience no suicidal ideation or thoughts of self-harm,"(A): Client will obtain employment to meet his needs for independence
(B): Client will develop a support system to meet his needs for community and support
(C): Client will experience reduction in depression and anxiety
(D): Client will experience no suicidal ideation or thoughts of self-harm",Client will develop a support system to meet his needs for community and support,B,"As the client has presented with improvement in his emotional well-being and employment circumstances, and is focused on a lack of friendships, it will be most effective to focus on the goal of developing a support system to meet his needs for a social community. The client, with the help of medication, has begun reducing his depression, though he presents as anxious about meeting new people. Focusing on developing a support system will help reduce this anxiety, while providing a support community. The client has met his goal for employment and the counselor should continue to monitor this with the client to ensure that he is progressing towards independence. The client reported no thoughts of suicide or self-harm at this time and the counselor and client will just continue to monitor this goal. Therefore, the correct answer is (D)",counseling skills and interventions
1300,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ",Which of the following statements taken by themselves is most indicative of a diagnosis of Separation Anxiety Disorder?,The client is exhibiting symptoms of repetitive behaviors.,The client has experienced a major life change.,The client is more talkative than usual and is easily distracted.,The client is resistant to going to the store or to school.,"(A): The client is exhibiting symptoms of repetitive behaviors.
(B): The client has experienced a major life change.
(C): The client is more talkative than usual and is easily distracted.
(D): The client is resistant to going to the store or to school.",The client has experienced a major life change.,B,"Separation Anxiety Disorder is often precipitated by a significant life change such as moving, the death of a loved one, divorce, or becoming a parent. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1301,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences",Which of the following is the most accurate definition of mindfulness?,Meditation focused on being aware of thoughts and feelings and interpreting what those thoughts and feelings mean to you,Being aware of how you feel in the moment and then engaging that awareness through the use of cognitive reframing,"Using deep breathing, progressive muscle relaxation, and radical acceptance of how you feel and what you are thinking","Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing","(A): Meditation focused on being aware of thoughts and feelings and interpreting what those thoughts and feelings mean to you
(B): Being aware of how you feel in the moment and then engaging that awareness through the use of cognitive reframing
(C): Using deep breathing, progressive muscle relaxation, and radical acceptance of how you feel and what you are thinking
(D): Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing","Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing",D,"The best definition of mindfulness includes meditation that involves being aware of thoughts and feelings with no judgment or interpretation and that involves grounding techniques. The goal of mindfulness is to be completely present in your body and to be aware of thoughts and feelings but not to engage in them. Interpretation or radical acceptance of thoughts and feelings would likely escalate thoughts and feelings because they were already distressing for the client. Just controlling cognitions or just controlling the body’s response to a situation does not completely support the definition of mindfulness. Therefore, the correct answer is (C)",counseling skills and interventions
1302,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Given the information presented, which of the following interventions will be most beneficial to help the client understand her hoarding?",Ask client to choose one item a day to discard,"Utilize the ""empty chair"" to explore relationships that have been replaced by possessions",Have the client bring a small box of her possessions to session for therapeutic exploration,Have the client choose an item in her home at random and journal about its value to her,"(A): Ask client to choose one item a day to discard
(B): Utilize the ""empty chair"" to explore relationships that have been replaced by possessions
(C): Have the client bring a small box of her possessions to session for therapeutic exploration
(D): Have the client choose an item in her home at random and journal about its value to her",Have the client bring a small box of her possessions to session for therapeutic exploration,C,"Common features in hoarding disorders include difficulty making decisions, trouble organizing, procrastination, avoidance, and using objects as replacements for relationships. Having the client bring a small collection of items to session so that the client and counselor can explore the client's emotions and thought processes surrounding items that have little value but take up space in her home. The empty chair exercise is a helpful intervention to help clients explore relationships. This client has demonstrated limited insight about her hoarding, making an empty chair exercise difficult. Given the client's limited insight into her hoarding, she is not likely to follow through with journaling or find it helpful. Asking the client to discard one item a day is not an effective treatment for hoarding disorder as the difficulty in making decisions about what should go or stay is part of the disorder. Therefore, the correct answer is (A)",treatment planning
1303,"Name: Alex Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, Severe Age: 65 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Multiracial Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","Appearance: The client is dressed in a manner that can be described as casual, suggesting that they might not have made any special effort to dress up for the session. Additionally, he is unshaven, which you note might indicate either personal preference, a decline in grooming habits, or possibly, decreased motivation and energy.    Behavior: The client's overall behavior is withdrawn.    Mood and Affect: His stated mood is depressed, implying feelings of sadness, hopelessness, or desolation. His affect, the observable manifestation of his feelings, is flat.    Speech: His speech is both slowed and measured.    Thought Process and Content: The client's thought process is tangential. He tends to veer off-topic and does not consistently answer questions directly or stay on point. The content of his thoughts is notably negative and self-defeating.    Perceptual Disturbances: No delusions or hallucinations have been reported, indicating that the client has no gross misinterpretations of reality or perceptual disturbances.    Orientation: The client is oriented to person, place, and time.    Insight: It appears that the client has poor insight into his condition.    Attitude: His attitude towards the evaluator is compliant and cooperative.","First session You are a licensed mental health therapist. Today you are seeing a 65-year-old male via distance counseling. You introduce yourself and ask him what prompted him to schedule an appointment to see you. He reports that he has felt ""down in the dumps"" for several years, and as he gets older, he feels more depressed and is in constant pain. As he is talking, he shifts around in his seat, appearing to have difficulty staying in a comfortable position. He continues by saying he feels depressed most of the time, has lost interest in activities that he once found enjoyable, feels hopeless, and is fatigued all the time. He also says he has lost his appetite and has difficulty sleeping. He states that ""no one wants me around."" Then he looks down and says, ""I don't really blame them. I wouldn't want to be around me either."" At work, he has difficulty concentrating and making decisions and is distressed that his co-workers see him negatively. When you ask him about his relationship with his wife, he says that while they live together, they have ""not been close for a long time now."" They both sleep in separate bedrooms and they lead separate lives. He explains, ""We just kind of grew apart. We still love each other and would never get divorced, but now we're more like roommates. She's very social and involved in the community. I'm more of a homebody.""    After the client has shared why he is seeking counseling, you state, ""I can hear that you are feeling very discouraged. It sounds like you have been going through a difficult time for quite some time now and it's taking a toll on your life. Let's explore what might be contributing to these feelings and how we can work together to help find solutions or ways to cope with the challenges you're facing."" You use a solution-focused brief therapy technique and ask him visualize what successful treatment would look like. He contemplates it for some moments and says, ""I'd feel better, I guess."" You encourage the client to think more deeply about what successful treatment would look like and explain how this visualization process can help him gain clarity on his desired outcomes. He says, ""Hmm, I'm not really sure. Can you give me some examples? This is my first time in therapy and I'm not really sure what to expect."" You provide some examples of tangible goals that he might set for himself, such as improving sleep patterns, having better communication with family members and co-workers, and finding meaningful activities to engage in. The client is able to identify some areas that could be improved and formulates realistic, achievable goals. Together, you create an action plan for successful treatment, which includes specific steps he can take to reduce symptoms and increase positive outcomes. You schedule a follow-up appointment to meet with him next week.  Fourth session It has been three weeks since your initial session with the client, and he has been keeping his weekly appointments. Last week you suggested he see a psychiatrist, and you begin today's session by discussing the results of his psychiatric referral. The client reports that he was prescribed antidepressant medication. He is not feeling much relief from his depressive symptoms now, but his psychiatrist told him that it could take a few months for the medication to reach maximum efficacy. Next, you discuss treatment options and the use of cognitive-behavioral therapy combined with his medication regimen. He is willing to try the combined approach, and together you create a treatment plan with both short-term and long-term goals. He mentions his job being a source of frustration. You spend some time discussing the client's job and his feelings about it. He expresses his desire to retire, but he worries about the financial burden it may place on his wife. He says, ""My retirement benefits are not that great, and I lost a lot of money in the stock market last year. I just don't know how I can make this work. I'm not sure if retiring now is the right decision."" You discuss other possibilities for him to consider for retirement, such as part-time work or freelancing in a field he enjoys. You also brainstorm with him about ways for him to transition out of his current job in a way that reduces conflict with his co-workers, such as taking scheduled breaks and speaking with his supervisor about his workload. You provide support and suggest that he speak with his wife about their financial situation before making any decisions about his retirement. He agrees and states he will bring it up with her this upcoming week.    Toward the end of the session, the client reveals that he has been contemplating cutting back on his drinking, but he is worried that he will not have any friends if he stops drinking. He says, ""I already feel like a failure at work and as a husband. If I lose the few friends that I still have, I'll be alone and will never be happy again."" You utilize motivational interviewing strategies and suggest that if he stops drinking, it will not mean that he has to give up all of his friends, but rather that he may need to find new friends who do not drink alcohol or who can meet with him in an alcohol-free context. He nods his head and says, """"I hear what you're saying, but who is the world would want to be friends with someone like me? The only reason I've got any friends left is because I like to drink with them."" You empathize with his feelings of self-doubt, but remind him that it is possible to find meaningful friendships without drinking. You give him a homework assignment to find at least one activity or group that seems interesting to him and create a plan to start building positive relationships with others. You reassure him that you will be there to support him through this process and set a date for his next appointment.","The client reports that his relationships with family members were strained growing up, with his father often away for work and his mother struggling with her own mental health. He reports that his mother drank a lot, which the client defends saying, ""I guess I'd drink a lot if I had 5 kids by the time I was 22 years old. The client grew up feeling unsupported and unimportant, which led to a disconnect from the rest of his family. Of his four siblings, the client keeps in touch with one brother, but ""my other two brothers and sister live in different states and have different lives. I think they've struggled with depression, too. We don't talk much."" Despite this difficulty in connecting, the client has an adult daughter whom he ""loves very much and tries to stay in contact with. He wishes he could have done better for her during his parenting years, and despite their rocky past, has a deep desire to maintain a healthy relationship. He says, ""I don't want her to think the same way I do about family and relationships. I want her to have good ones."" The client is currently employed as a corrections officer and feels his job has no potential for advancement. He has been working there for 20 years and is ready to retire in less than a year. He expresses that it has been challenging and physically and mentally exhausting. In addition, he is tired of ""dealing with both the inmates and the administration."" He tells you his co-workers consider him a ""slacker"" because he is always tired and takes as many breaks as he can get away with. He is also worried about ""word getting back to his co-workers"" that he is in therapy. The client expresses that he has some drinks, especially after work, to calm down. He reports that he will drink in social settings as well. He states that his preferred drink of choice is whiskey.",You have been asked to publicly comment on a bill pending in your state legislature that would make clinical depression eligible for medical leave. What is your ethical responsibility?,Your ethical responsibility is to publicly remain neutral in order to not influence future clients.,You have no ethical responsibility to weigh in on a matter of public debate.,Your ethical responsibility is to not participate in contentious public debates.,Your ethical responsibility is to advocate for this as an advancement of client care.,"(A): Your ethical responsibility is to publicly remain neutral in order to not influence future clients.
(B): You have no ethical responsibility to weigh in on a matter of public debate.
(C): Your ethical responsibility is to not participate in contentious public debates.
(D): Your ethical responsibility is to advocate for this as an advancement of client care.",Your ethical responsibility is to advocate for this as an advancement of client care.,D,"One of the ethical responsibilities as a therapist is to advocate for client issues. Therefore, the correct answer is (A)",professional practice and ethics
1304,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment.  To help the client identify treatment plan goals, you ask him to envision what it would be like if he woke up one day and a miracle had occurred—a miracle that caused his problem to cease to exist","To help the client identify treatment plan goals, you ask him to envision what it would be like if he woke up one day and a miracle had occurred—a miracle that caused his problem to cease to exist. Which therapy approach does this reflect?",Gestalt therapy,Motivational enhancement therapy,Client-centered therapy,Solution-focused brief therapy,"(A): Gestalt therapy
(B): Motivational enhancement therapy
(C): Client-centered therapy
(D): Solution-focused brief therapy",Solution-focused brief therapy,D,"Solution-Focused Brief Therapy (SFBT) is a short-term, solution-oriented best practice used to help clients establish and reach goals by improving motivation and creating measurable behavioral change. The Miracle Question is an SFBT technique that encourages the client to envision a future without the problem. The client is then asked to provide details of what is pictured, enabling you to partner with the client to form manageable and attainable treatment planning goals. Gestalt therapy is based on developing a here-and-now awareness. Client-centered therapy emphasizes attaining congruence between one’s ideal self and actual self. Motivational Enhancement Therapy emphasizes increasing change talk to reduce ambivalence. Therefore, the correct answer is (C)",counseling skills and interventions
1305,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client receives psychoeducation on various treatment interventions for agoraphobia. She understands the risks and benefits, and you review informed consent each session. The client would like to work on her fear of stairs first, which is less anxiety-provoking than elevators. She expresses an understanding of exposure exercises and is willing to give them a try. You and the client use a Subjective Units of Distress Scale (SUDs) to measure the intensity of each anxiety-provoking situation, which can range from 0 units (no distress) to 100 units (extreme distress).  Capnometry-assisted respiratory training (CART) is an approach for agoraphobia that targets underlying biological factors",Capnometry-assisted respiratory training (CART) is an approach for agoraphobia that targets underlying biological factors. The theoretical framework for CART is based on which of the following assumptions?,Muscle tension resulting from anxiety and panic can be treated with progressive relaxation and deep breathing.,Drops in body temperature resulting from anxiety and panic can serve as an alert to start using coping strategies and deep breathing.,Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control.,Increased heart rate resulting from anxiety and panic can be altered with autogenic relaxation and mindfulness meditation.,"(A): Muscle tension resulting from anxiety and panic can be treated with progressive relaxation and deep breathing.
(B): Drops in body temperature resulting from anxiety and panic can serve as an alert to start using coping strategies and deep breathing.
(C): Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control.
(D): Increased heart rate resulting from anxiety and panic can be altered with autogenic relaxation and mindfulness meditation.",Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control.,C,"The framework for CART assumes that low levels of carbon dioxide resulting from symptoms of anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control. The CART approach measures PaCO2and respiration rates believed to be the primary or secondary causes of anxiety and panic. Individuals are instructed to breathe in ways that prevent hyperventilation. This is achieved by taking slow, shallow breaths. CART is based on the theory that deep breaths, such as those used in relaxation training, can induce hyperventilation, leading to increased fear and panic. Progressive relaxation, thermal biofeedback, and mindfulness meditation are also effective in reducing anxiety but do not attribute therapeutic change to increased levels of PaCO2. Therefore, the correct answer is (D)",counseling skills and interventions
1306,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.","Based on the information provided, which assessment would be most helpful at this time?",An attachment style assessment,A genogram,A family session for observation,Yale-Brown Obsessive Compulsive Symptoms Inventory (Y-BOCS),"(A): An attachment style assessment
(B): A genogram
(C): A family session for observation
(D): Yale-Brown Obsessive Compulsive Symptoms Inventory (Y-BOCS)",A genogram,B,"A genogram will provide a pictorial map of the client's nuclear and extended family and the patterns and relationships between them. Often genograms can include significant others with whom the client frequently interacts so these relationships can also be examined. The genogram will help the client and counselor examine how the client interacts with others and patterns that may be helpful or unhelpful for him. A history of OCPD behaviors will show up in a genogram as the counselor and client explore patterns of interacting with others. An attachment style assessment will help the counselor understand the client's experience with early primary caregivers and how that relationship may be replicated in his romantic relationship with his wife. This is helpful information but does not provide the breadth of material that a genogram will provide based on the client's difficulties relating to others including his wife, stepchildren, employees, and friends. The Y-BOCS is an assessment for OCD, while this client shows more affinity towards traits of OCPD (preoccupation with details, rules, order, and organization; perfectionism; excessive devotion to work to the exclusion of leisure activity). A family session for observation would not be helpful in building therapeutic rapport as the family focus would likely be on describing how the client's behaviors make the family feel that they cannot meet his expectations. A family or couple session may be more helpful once treatment has begun to help provide a supportive environment for the client while he attempts to make changes. Therefore, the correct answer is (B)",counseling skills and interventions
1307, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.",Which counseling strategy is the best for addressing the client's family issues and relationship with her mother?,FFT,MI and DBT techniques to help her gain insight,"Provide active listening, validate of her feelings, and introduce her to REBT",Recommending a 12 Step program for codependency and providing resources in her area,"(A): FFT
(B): MI and DBT techniques to help her gain insight
(C): Provide active listening, validate of her feelings, and introduce her to REBT
(D): Recommending a 12 Step program for codependency and providing resources in her area","Provide active listening, validate of her feelings, and introduce her to REBT",C,"In this early phase of getting to know your client, you are still working to gain rapport and trust. Lacking history of counseling with this client and without further clarification of her issues, MI (motivational interviewing) and DBT (dialectical behavioral therapy) are too confrontational. Validation of feeling has been regarded as one of the best ways to illicit a positive response from your client and gain their engagement, and REBT (rational emotive behavioral therapy) is an excellent choice within Cognitive Behavioral Therapy interventions to begin to help the client address her beliefs that are affecting her emotions rather than focusing on other people or events that have occurred. REBT's key tenets involve acceptance of self and others while learning how to challenge cognitive distortions affecting moods and behaviors. Regarding answer a), the scenario does not identify codependency as an issue despite the potential a counselor may consider it exists. Answer a) further involves recommending treatment for character deficits that she has not yet self-identified with you in counseling, nor has she yet requested for any outside support. Support groups are also an unrealistic option to consider since she is evidently already struggling with one online session let alone a long-term, in-person commitment. FFT (family functional therapy) is an intensive, short-term program providing in-home family counseling to address juvenile delinquency and is therefore not appropriate. Therefore, the correct answer is (B)",counseling skills and interventions
1308,"Name: Christopher Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ","The client presents partially as her preferred gender, wearing makeup and a semi-long hairstyle while still dressed as a cis-gendered 12-year-old male. She reports feelings of depression, anger, and suicidal ideation without a plan or intent. She appears to be her stated age, cooperates during the interview, and maintains good eye contact. Speech is normal in rate, rhythm, and volume. The client's thought processes are organized and goal-directed. She is alert and oriented X2. Insight and judgment are fair.","First session A 13-year-old, assigned male at birth and identifying as female, arrives at your office in a community mental health agency where you work as a mental health therapist. Both parents are also in attendance. The client introduces herself to you as ""Christine,"" although the father says ""Christopher"" each time he addresses the client. The client appears dejected every time her father misgenders her. The client reports experiencing bullying from male peers at school and is upset that her father refuses to use her chosen pronouns or name.    The client reports that she has been feeling increasingly isolated and hopeless since the start of her transition, leading to intrusive thoughts associated with suicide. She is trying to express her identity through clothing, hair, and physical appearance but is not allowed to do so by her father. The client's mother is somewhat more supportive of her transition and has been trying to advocate for her, but her father remains resistant to the idea and is often dismissive of her identity. The client expressed feeling frustrated and helpless in her home life, as she cannot express her gender identity freely.    Once the client's parents leave the room, the client reports wanting to kill herself and tells you about the depression that sets in after being bullied at school or after arguments with her father. She also holds a lot of anger toward her father. Toward the end of the initial counseling session, the client says she feels safe with you and ""would like to work together.""  Fourth session The client has been ""looking forward to working with you"" and appears more comfortable today than in previous sessions. You recommended meeting with her once a week for therapy. You have built a positive rapport, and she no longer considers suicide a coping mechanism for dealing with her problems and stressors. However, when assessing her family relationships, the client states that her dad is ""hard on her.""    She asks if you would mediate between her and her father in your next session, and you agree. She is relieved at the idea of having a mediator present during the conversation with her father and shares her father's expectations of her and how she is being treated differently at home than her siblings. You role-play the future encounter to help the client to be able to verbalize her needs and feelings in a way that will be heard and understood by her father.","The client loves her mother but has difficulties with her father. Her parents differ in child-rearing styles, with her father not understanding her gender presentation. The client has a deep-seated fear of rejection and abandonment from her father due to the ongoing disagreement about her gender presentation. She feels that her father does not accept her for who she is and does not understand her identity. The client has a strong need for her father's acceptance and approval, but her attempts to bridge the gap between them have been unsuccessful. This has caused her to feel disconnected from her father and has created a sense of sadness and insecurity in the client. Neither parent supports her gender choice, but her father actively confronts her daily. Her mother is confused and worried for the client but does not know what to do. The client is high achieving academically and is well-liked by her teachers. In addition, she is involved in a community dance team where she excels. However, she is socially isolated and has few friends. Her classmates mock her for ""acting like a girl"" and bully her on the playground. She is especially bullied by her male peers in school.    The client is displaying symptoms of social anxiety as she has difficulty developing and maintaining relationships with her peers. Her fear of being ridiculed and judged by her peers has resulted in her feeling socially isolated, impacting her self-esteem. The client is anxious in social situations, particularly when interacting with her male peers, and displays a pattern of avoiding social interactions due to the fear of being judged. ","After speaking with the client, you worry that your values do not appear to align with the client's father's values. To avoid value imposition in your joint session, which of the following core counseling skills should you be prepared to use?",Bracketing,Authenticity,Resistance,Congruence,"(A): Bracketing
(B): Authenticity
(C): Resistance
(D): Congruence",Bracketing,A,"Holding your own values internally and not allowing them to impact your work with the client and her father will be paramount. Therefore, the correct answer is (D)",counseling skills and interventions
1309,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","At the start of the session, the foster parents ask the client if she would mind meeting alone with you; she agrees and asks to have access to the toy bin in your office. You and the client begin to play together, and you ask her if she talked to her birth parents. The client says “yeah, Mommy talked about coming home in a few years.” You ask how she feels about living with her mother again, and she says she does not want to be with her because her mother does not want to be with her. You try to process this with the client, and she says that she likes her house and her school and does not want to leave. You meet with the foster parents and the client at the end of the session, and they report that spending quality time with the client on a daily basis has been helpful in improving their relationship. They state that they think they had been too afraid to overwhelm her and that at times they were trying to give her space, but they realize that the intentional time together has been helpful. You empathize with the foster parents and encourage them to continue to spend quality family time with her",Which one of the following attachment styles best defines the client’s relationship with her foster parents?,Disorganized/fearful,Ambivalent/preoccupied,Avoidant/dismissive,Secure,"(A): Disorganized/fearful
(B): Ambivalent/preoccupied
(C): Avoidant/dismissive
(D): Secure",Disorganized/fearful,A,"The client’s behavior is characterized by heightened anxiety, increased irritability, and distance from others, which comprises a disorganized or fearful attachment style. A secure attachment style is when a child feels comfortable enough to communicate wants and needs, knows that their caregiver has their interest and safety in mind, is independent, and has good self-esteem. An avoidant, or dismissive, attachment style is characterized by insecurity, independence, a desire for intimacy but a fear of it, and the placement of distance between the self and others. An individual demonstrating an ambivalent or preoccupied attachment style focuses intensely on having relationships with others and feels very insecure when he or she does have a relationship because of a fear that the relationship will end. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1310,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What is the first step you should take in response to the client's statements about the bullies during today's session?,Identify ways for Logan to cope with his intense feelings,Create a safety plan with Logan,"Reiterate you are a mandated reporter, and what he divulges has consequences",Explore Logan's feelings of anger and assess risk of harm,"(A): Identify ways for Logan to cope with his intense feelings
(B): Create a safety plan with Logan
(C): Reiterate you are a mandated reporter, and what he divulges has consequences
(D): Explore Logan's feelings of anger and assess risk of harm",Explore Logan's feelings of anger and assess risk of harm,D,"When clients express violent thoughts towards others, exploring their feelings and why they are experiencing them is crucial. This will help to determine if the client is a danger to themselves or others and if they need further intervention. Therefore, the correct answer is (C)",counseling skills and interventions
1311,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",Which is not one of the communication styles Gottman identifies as The Four Horsemen in conflict discussions for couples?,Contempt,Stonewalling,Defensiveness,Complaint,"(A): Contempt
(B): Stonewalling
(C): Defensiveness
(D): Complaint",Complaint,D,"Voicing a complaint is different from criticizing your partner. This is not one of the four horsemen identified by Gottman. A complaint indicates the reason you are upset with your partner. (eg, ""I was worried when you were running late and did not call me. I thought we agreed to do that for each other""). Therefore, the correct answer is (A)",counseling skills and interventions
1312,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy","In DBT, all of the following are main focuses of therapy, EXCEPT:",Distress tolerance,Emotional regulation,Mindfulness,Systematic desensitization,"(A): Distress tolerance
(B): Emotional regulation
(C): Mindfulness
(D): Systematic desensitization",Systematic desensitization,D,"Systematic desensitization is an intervention that uses aspects of CBT and applied behavioral analysis; it is not a DBT technique. Systematic desensitization focuses on progressive exposure to greater anxiety-inducing stimuli coupled with relaxation techniques. Mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness are the four focuses of DBT in improving life skills. Mindfulness focuses on becoming more aware of oneself and being present in the moment. Emotional regulation focuses on identifying, labeling, and addressing certain emotions. Distress tolerance focuses on experiencing strong emotions and not reacting impulsively or destructively. Therefore, the correct answer is (D)",counseling skills and interventions
1313, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.",Maria discontinues counseling. Whom should you inform?,The grandmother and the school,Just her grandmother,Just the school,You do not need to inform anyone,"(A): The grandmother and the school
(B): Just her grandmother
(C): Just the school
(D): You do not need to inform anyone",The grandmother and the school,A,"If a minor discontinues treatment against clinical advice and there are consent to release information forms signed with her guardian and school, it is best practice for the child's safety to let them know that their grandchild or their student will no longer be engaged in counseling/discharged, although there may be no law mandating you do so. No further information is needed, however, a thoughtful and safety-minded counselor would advise that they be recontacted for continued care if there is evidence of need, if the client requests it, or if they are in a deteriorated or crisis state. You should also check with your agency's policies, school's expectations or state laws. Therefore, the correct answer is (C)",professional practice and ethics
1314,Initial Intake: Age: 12 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Outpatient Clinic       Type of Counseling: Individual,"Carlos came to the intake with his mother, Claudia. Claudia did most of the talking during the intake while Carlos sat in his chair, slumped down low and avoiding eye contact.","Carlos is a 12-year-old male referred to an outpatient community clinic by the court after he was caught breaking into several cars on his block.
 
History:
Claudia reported that she and Carlos’ father separated two years ago. Since then, Carlos has had frequent suspensions in school for bullying others and fighting. Carlos often threatens students on social media prior to the altercations. Claudia reported that she no longer knows what to do anymore and she hoped that the counselor can fix him or at least report to her what he is thinking when he does these things.",,"Based on the first session notes, Carlos is showing symptoms of?",Bipolar Disorder,Antisocial Personality Disorder,Avoidant personality Disorder,Conduct Disorder,"(A): Bipolar Disorder
(B): Antisocial Personality Disorder
(C): Avoidant personality Disorder
(D): Conduct Disorder",Conduct Disorder,D,"Carlos meets the criteria for conduct disorder because of the following symptoms: initiating physical fights, bullying others, destruction of property, breaking into cars and school truancy. Carlos does not display episodes of mania (elation, self-importance, irritated or agitated) or depression (feelings of sadness, pessimism, hopelessness, difficulty sleeping or concentrating). The minimum age for antisocial personality disorder is 18. Avoidant personality is characterized by social inhibition due to feelings of inadequacy, fear of being ridiculed or hypersensitivity to criticism. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1315,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client has attended and actively participated in all group therapy sessions. You are preparing the group for termination and discussing a “graduation” ceremony. The client has taken on a leadership role in the group, and you have asked him if he would be your “assistant” for the next group of neurodiverse men. The client approaches you, shakes your hand, and uses eye contact as he politely thanks you for the offer. You state you are pleased he has accepted. He then says, in a matter-of-fact tone, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills.”  During the last group session, a member stated, “I didn’t know there were other people on campus that viewed things in the same way that I do","During the last group session, a member stated, “I didn’t know there were other people on campus that viewed things in the same way that I do.” This is an example of which one of the following?",Transference,Altruism,Catharsis,Universality,"(A): Transference
(B): Altruism
(C): Catharsis
(D): Universality",Universality,D,"This member’s statement is an example of universality (one of Irvin Yalom’s curative factors), which is the feeling that one receives when connecting with others. Group members learning that others who live on campus share similar viewpoints will likely reduce isolation, which is a by-product of universality. Catharsis is a psychodynamic term referring to the emotional release of previously repressed energy tied to a traumatic event. Transference is a Freudian concept that describes the redirection of a repressed emotion onto another person. Altruism is another one of Yalom’s curative factors regarding group members learning to help others. Therefore, the correct answer is (D)",counseling skills and interventions
1316, Age: 27 Sex: Female Gender: Female Sexuality: Declined Ethnicity: Hispanic/African American Relationship Status: Single Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents as her stated age with positive signs of self-care related to hygiene and dress. She appears overweight for height as noted in her intake. Her mood and affect are congruent and she appears to be cooperative and forthcoming in her responses. She demonstrates no retardation, spasticity, or hyperactivity of motor activity. She is oriented and demonstrates no unusual thought processes or patterns. Her insight is intact and she identifies goals for therapy. She reports no suicidal ideations, thoughts of harm to self or others, or difficulties with memory, judgement, or concentration. ","You are a counselor in a community agency that provides counseling.  Your client presents with a history of convictions for felony criminal offenses in her early 20s, of weight loss and gains since college, and currently rates herself as approximately 50 pounds overweight. She describes herself in years past as “fat,” “ugly,” and “grotesque.” She reports one long term relationship during high school and college, with a male she tells you was “manipulative, controlling, and emotionally abusive. She reports not “dating-dating” since their break up six years ago. She does report that recently she has engaged in self-destructive behaviors with different people in the context of online relationships. She states that in several cases, she has met men and women online and used elaborate methods, including using multiple telephone numbers and creating false names and life events to establish relationships with these individuals. Several relationships ended abruptly when the individuals, both male and female, made concerted efforts to meet the client, at which time she disclosed the truth to them. She tells you that she feels very badly about what she did, particularly because she had been helping each of the people with different problems in their lives, including one of the women with an abusive spouse, and she believes now these people will have no help.  She attended counseling for several months three years ago but reports she did not tell the counselor everything. Today she tells you that she is now in a professional graduate program for counseling and wants to be open about everything so she can “finally get her life in order.”","Family History:
The client reports her support system as several male and female friends. She feels close to these people though she says they sometimes irritate her. She describes her father as distant and her mother as strict and controlling. She states she and her siblings were punished frequently for not following their mother’s strict expectations for “how young women and young men should act.” She states she and her siblings were required to engage in daily exercise; always dress in “their Sunday best” during childhood; and focus on dieting, food intake, and weight ideals. She tells you she daily engaged in binging and purging from age 13 to age 20, but never told anyone or saw a doctor for this. She tells you that she has not binge/purged for the past five years. She states that her sister did the same and still struggles with it, and two other siblings are in treatment for alcohol and methamphetamine addiction. Additionally, the client tells you that both of her maternal and paternal grandparents have histories of alcoholism, and she smiles when telling you that one of her grandparents was imprisoned for criminal behavior and “is connected.” She says that several other maternal and paternal relatives have criminal convictions.",Which of the following would be the best intervention at this time?,"""It seemed like it was hard for you to connect what happened in your life to your feelings about yourself.""","""That's a big story, where do you want us to start?""","""Can you tell me about your time in jail and how that changed you?""","""You showed your parents that you weren't 'the good girl' anymore.""","(A): ""It seemed like it was hard for you to connect what happened in your life to your feelings about yourself.""
(B): ""That's a big story, where do you want us to start?""
(C): ""Can you tell me about your time in jail and how that changed you?""
(D): ""You showed your parents that you weren't 'the good girl' anymore.""","""It seemed like it was hard for you to connect what happened in your life to your feelings about yourself.""",A,"The client has provided lots of content but had difficulty connecting to herself in the story, as demonstrated by her pauses, when the counselor asked about feelings, and then moving back into content. Individuals with a fragile self-esteem or sense of identity (ie, such as narcissists) have difficulty with insight into their own emotions. Making an observation of what the counselor is observing opens up an opportunity to begin processing emotions with the content. Asking the client to determine where to start allows the client to direct the session, but if the client is struggling with connecting to emotions, the client will be more likely to stay content-focused rather than working therapeutically on process. Making a statement about the client not being ""the good girl"" anymore would likely be received as sarcasm or judgement about the client's actions, rather than listening for the emotions and thoughts underneath the content. Asking about how jail changed her is a good question but if it is asked right now, it changes focus away from the content and difficulty with emotional connection that the client has just demonstrated. It is best to work with the client where they are when there is a therapeutic opening, rather than redirecting to new content. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1317,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ",When would you breach confidentiality as a therapist?,The client is watching pornography on one of the school's computers.,The client tells you he is smoking marijuana with his friends on the weekends.,The client tells you he wants to hurt the bullies from his school.,The client says he is going to a fast-food restaurant and eat twelve burgers all in one sitting.,"(A): The client is watching pornography on one of the school's computers.
(B): The client tells you he is smoking marijuana with his friends on the weekends.
(C): The client tells you he wants to hurt the bullies from his school.
(D): The client says he is going to a fast-food restaurant and eat twelve burgers all in one sitting.",The client tells you he wants to hurt the bullies from his school.,C,"Harm to self and others is a reason to breach confidentiality. Therefore, the correct answer is (D)",professional practice and ethics
1318,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.  Tenth session The family arrives to today's session to review Andie's progress. The mother states that she is happy to see that the conflict between her husband and son is decreasing. She states that they are all utilizing ""I statements"" in order to express their feelings. The father states that he is trying to just let him go through this ""phase"" and find himself. You continue to explore with the family any other contributing factors that could be hindering family dynamics. You also explore an array of interventions that would be appropriate when behavior disturbances occur.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ","In diagnosing a client with Gender Dysphoria in Children, how long must the symptoms be present, and how many symptoms must be exhibited?",At least one year manifested in at least four symptoms,At least one year manifested in at least seven symptoms,At least six months manifested in at least six symptoms,At least three months manifested in at least five symptoms,"(A): At least one year manifested in at least four symptoms
(B): At least one year manifested in at least seven symptoms
(C): At least six months manifested in at least six symptoms
(D): At least three months manifested in at least five symptoms",At least six months manifested in at least six symptoms,C,"To diagnose Gender Dysphoria in Children, there must be a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least six symptoms. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1319,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues.  Third session After determining that you would be able to remain objective with the client, you met with him for a session and continued your assessment. You recommended seeing him once a week for therapy sessions and asked him to check in with you between sessions. You also provided him with a referral for a psychiatric evaluation to determine if medication was warranted for mood stabilization. Today is your third counseling session, and the client arrives 10 minutes late. The client's behavior during the session was increasingly concerning. He appeared disheveled, and his speech was slurred and jumbled, indicating that his level of intoxication was likely high. The client exhibited bizarre behaviors and laughed inappropriately, indicating a potential manic or hypomanic episode. His attention span during the session was limited, and he could not focus on the topics at hand.    When asked, the client admits to drinking before the session and is unable to provide an accurate account of how much he has consumed. He reports going to the local bar down the street from his house to have ""one drink."" He is also unable to provide any information on the location of his emergency contact. This lack of insight and awareness of his current intoxication, combined with the inappropriate behaviors he is exhibiting, prompts you to assess for the next level of intervention that is needed.  Seventh session The client's attendance in weekly therapy sessions has been inconsistent. Today, he presents to his scheduled session, and he hands you a discharge summary from another recent hospitalization. The client states that he was on one of his ""highs,"" went to a bar, and ended up fighting with one of the other customers. He says he has no recollection of how the fight started, but the person he was fighting with told him that ""his life was useless and that he would be better off dead."" The client states that having a few drinks and driving around in his car while listening to music helps him calm down. You validate the client's attempts to identify coping skills.    The client's depression is further evidenced by his lack of motivation and interest in activities he once found enjoyable. He reports feeling overwhelming hopelessness and expresses a pervasive feeling of worthlessness. His low self-esteem is apparent in his statements and is further evidenced by his inability to recall accurately the events leading up to the altercation.    The client's risk for self-harm is elevated, given his recent suicidal ideation. He reports feeling his life has no value and that he would be better off dead. His current safety plan is inadequate to address his risk for self-harm and is further exacerbated by his use of alcohol as a coping mechanism. The client has little insight into his current mental state and cannot accurately identify the signs of his deteriorating mental health. He lacks insight into his coping skills and their potential consequences and is unable to recognize the need for more comprehensive safety planning"," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",What would be the most beneficial referral for the client?,Readmission to inpatient with referral to the discharge plan case manager,Readmission to inpatient with referral to an Outpatient Program,Readmission to inpatient with referral to Residential Treatment Program,Readmission to inpatient with referral to Partial Hospital Program,"(A): Readmission to inpatient with referral to the discharge plan case manager
(B): Readmission to inpatient with referral to an Outpatient Program
(C): Readmission to inpatient with referral to Residential Treatment Program
(D): Readmission to inpatient with referral to Partial Hospital Program",Readmission to inpatient with referral to Residential Treatment Program,C,"The client continues to pose a threat to himself and others with his continued drinking and driving while intoxicated. Therefore, immediate placement in a residential treatment program would be most beneficial for his safety at this time. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1320,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","   ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage\. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining",Which diagnostic feature of OCPD tends to cause difficulties with close relationships?,They must constantly adjust their expectations when perfectionistic standards are not met.,They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism.,They possess ego-dystonic personality traits that are pervasive and less amenable to change.,They disregard family activities and believe leisure time should be an individual pursuit.,"(A): They must constantly adjust their expectations when perfectionistic standards are not met.
(B): They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism.
(C): They possess ego-dystonic personality traits that are pervasive and less amenable to change.
(D): They disregard family activities and believe leisure time should be an individual pursuit.",They are oblivious to the fact that others are annoyed by their inflexibility and perfectionism.,B,"According to the DSM-5-TR features include a preoccupation with rules and details, perfectionism that interferes with progress, excessive devotion to work, counterproductive rigidity about beliefs and morality, an inability to throw away old objects, reluctance to delegate authority to others, rigidity or stubbornness, and hoarding money without spending. Individuals with OCPD possess ego-syntonic traits rather than ego-dystonic traits. Individuals with ego-syntonic features are less amenable to change because there is little to no desire to change. Conversely, individuals with obsessive-compulsive disorder (OCD) have ego-dystonic traits, meaning they experience dissatisfaction with symptoms and desire change. Per the DSM-5, individuals with OCPD “are rigidly deferential to authority and rules and insist on quite literal compliance, with no rule bending for extenuating circumstances” Strict adherence to rules and authority persists despite personal distress while attempting to attain perfection. Leisurely activities are generally forfeited by prioritizing productivity and work. Solo vacations and vacations with others may be postponed, and when they do occur, they are highly structured in an effort to not waste time. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1321,Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 ","Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.",,Cognitive behavioral therapy does not include?,Empty chair technique,Behavioral experiments,Deep muscle relaxation,Cognitive restructuring,"(A): Empty chair technique
(B): Behavioral experiments
(C): Deep muscle relaxation
(D): Cognitive restructuring",Empty chair technique,A,"The empty chair technique is a Gestalt method in which an empty chair is used so the client can express themselves to a ""person"" unavailable to them. Deep muscle relaxation is a progressive tightening and loosening of muscles which allows the person to relax muscles they may not have realized were tense. Cognitive restructuring is a CBT method where someone identifies their irrational thoughts and replaces them with more realistic and productive ones. Behavioral experiments are used often in CBT for someone to test their catastrophic thinking so they can see whether what they fear the most occurs. Therefore, the correct answer is (C)",professional practice and ethics
1322,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","   eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin","At this point in treatment, which of the following assessments would be clinically appropriate to use with the couple?",Beck Anxiety Inventory,Dyadic Adjustment Scale,Minnesota Multiphasic Personality Inventory,Family Environment Scale,"(A): Beck Anxiety Inventory
(B): Dyadic Adjustment Scale
(C): Minnesota Multiphasic Personality Inventory
(D): Family Environment Scale",Dyadic Adjustment Scale,B,"The Dyadic Adjustment Scale, a 32-question scale that assesses each individual’s perception of the relationship and is used to assess for marital satisfaction, would be helpful for assessing each individual’s satisfaction in the marriage and may prompt processing of what brought the couple to the point at which the wife had an affair. The wife has generalized anxiety disorder, which can be tracked using the Beck Anxiety Inventory; however, this would not be the focus of couples counseling. The Minnesota Multiphasic Personality Inventory may give insight into personality traits of both individuals; however, it would not be indicated at this point in counseling. The Family Environment Scale focuses more on the family system as a whole and not just the parental unit. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1323,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.  10th session As you have been working with the client over the past two and a half months, he has made significant progress with treatment goals, including mood stabilization and behavioral control. In the last session, as you reviewed the progress that the client had made over the course of treatment, you both agreed that the client was ready for termination as he felt he had gotten what he needed from therapy. The client was especially pleased when considering his progress in mood regulation and mindfulness, as well as addressing his thrill-seeking behaviors during his manic phases.    For this final session, the client arrived ten minutes late. He appears out of breath as he runs into the room. The client states that he got a call from the hospital where his sister was just admitted. As he describes the phone call, he pauses and looks out the window with tears in his eyes. You ask him how he feels. The client responds quietly, ""I don't know, my sister has been in a serious accident, and I don't know how I'll continue without her support,"" prompting you to recognize that unresolved issues may require additional therapy. You state, ""It sounds like your sister's accident has brought up a lot of emotions for you. You are feeling overwhelmed and unsure about how to cope without her support. It must be difficult to process all of this at once."" The client nods his head. You continue by telling him that it is natural to feel overwhelmed and uncertain in a situation like this. You engage him in a discussion about coping strategies or support systems that have helped him in the past when facing difficult challenges. You also ask him if it would be helpful to have additional therapy sessions during this time to which he replies, ""Yes, I don't want to undo all the progress I've made.""","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.","What recommendation would be most helpful for this client, given the additional revelations?",Adult Care Management support,Yoga and guided imagery exercises,Engage in Bipolar Group Therapy,A local Bipolar support group,"(A): Adult Care Management support
(B): Yoga and guided imagery exercises
(C): Engage in Bipolar Group Therapy
(D): A local Bipolar support group",A local Bipolar support group,D,"Support groups such as Depression and Bipolar Support Alliance groups can be a good resource. Therefore, the correct answer is (B)",treatment planning
1324,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.  Fifth session As today's session starts, the client's mother says she is at her ""wit's end"" because her son is getting worse. As a result, the school may not let the client come back next year. In addition, there has been a major incident at home. The mother, stepfather, and younger sister went for a drive without the client. When they returned, the client was upset and claimed that no one in the family loved him; he wanted to live with his grandmother. The mother responded that his behavior was unacceptable and that he would not live with his grandmother.  Jackson went into his bedroom and began throwing objects around the room in anger after his family left without him. He broke a lamp and overturned his dresser. Jackson's destructive outburst caused damage to his possessions and his room. After his mother told Jackson a second time that he could not live with his grandmother, he started shouting insults at her and his stepfather. Jackson then told them they were not fit parents and only cared about themselves.  In response, his mother told him he was not getting his laptop back until his behavior improved. The client grabbed a dish, threw it against the wall, and threatened to break more items in the home. He said he would continue his destructive behavior until his family realized how much they hurt him on a daily basis and then ran out the door. The stepfather found him wandering the neighborhood and drove him home. Jackson told his stepfather he wished he was dead and not part of their family. You note that the client is pulling his hair as he tells you this. You also notice that he is decompensating. You spend the remainder of the session practicing self-calming skills with him.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",What is the most effective method to help the client express his feelings during therapy?,Use only open-ended questions,Play the video game with him to serve as a distraction,Employ listening and attending skills,Use mostly close-ended questions,"(A): Use only open-ended questions
(B): Play the video game with him to serve as a distraction
(C): Employ listening and attending skills
(D): Use mostly close-ended questions",Employ listening and attending skills,C,"The best approach is to let the client tell you how he is feeling and reflect on his feelings to show him that he is being heard. A simple ""Tell me more about that feeling of being unloved"" could help. Therefore, the correct answer is (A)",counseling skills and interventions
1325,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ","According to the DSM-5-TR, which of the following is considered a differential diagnosis for Major Depressive Disorder?",Premenstrual Dysphoric Disorder,Body Dysmorphic Disorder,Dissociative Amnesia,Anorexia Nervosa,"(A): Premenstrual Dysphoric Disorder
(B): Body Dysmorphic Disorder
(C): Dissociative Amnesia
(D): Anorexia Nervosa",Premenstrual Dysphoric Disorder,A,"Premenstrual Dysphoric Disorder is a differential for Major Depressive Disorder. It is present in the final week before the onset of menses, and that starts to improve within a few days after the beginning of menses. It becomes minimal or absent in the week postmenses. It is marked by a psychosocial stressor that leads to marked impairment. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1326,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","   eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin.  The wife’s anxiety appears to be clinically significant because it impacts the relationship",The wife’s anxiety appears to be clinically significant because it impacts the relationship. Which would be an appropriate first course of action regarding the wife’s treatment for anxiety?,Incorporate cognitive reframing and coping skills for anxiety in couples counseling sessions.,Provide individual counseling to the wife for anxiety.,Provide a referral for individual counseling for anxiety.,Provide a referral for medication management.,"(A): Incorporate cognitive reframing and coping skills for anxiety in couples counseling sessions.
(B): Provide individual counseling to the wife for anxiety.
(C): Provide a referral for individual counseling for anxiety.
(D): Provide a referral for medication management.",Provide a referral for individual counseling for anxiety.,C,"The first course of action would be for the wife to receive individual outpatient therapy for her anxiety because it is clinically significant. You would not provide individual therapy for her because this would create bias in your provision of couples counseling. Medication management might be beneficial for the wife, but it would be helpful for the individual therapist to make this referral because they will be working specifically on her anxiety. Your focus with the couple is their relationship and not the wife’s anxiety. Although cognitive reframing may be helpful for the couple, couples counseling should be focused on the couple’s needs and not on the wife’s individual diagnosis. Therefore, the correct answer is (D)",treatment planning
1327,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.",rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives,Which of the following is considered a differential diagnosis for borderline personality disorder?,Post-traumatic stress disorder (PTSD),Alcohol use disorder,Conduct disorder,Reactive attachment disorder,"(A): Post-traumatic stress disorder (PTSD)
(B): Alcohol use disorder
(C): Conduct disorder
(D): Reactive attachment disorder",Alcohol use disorder,B,"Alcohol use disorder and other substance use disorders are important to consider for these clients with suspected borderline personality disorder. Although the symptoms that these individuals experience may be due to the substance use that is common in individuals with borderline personality disorder, alcohol use disorder must first be ruled out as the primary cause of the individual’s symptoms. Reactive attachment disorder has similar symptoms but is typically a childhood disorder and would not be considered for an adult. Although conduct disorder does have behavioral or relational issues, it would not be considered a differential diagnosis. PTSD commonly co-occurs with BPD, but it is not considered a differential diagnosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1328, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,"While the counselor gains information, the counselor should not?",Deny any cultural biases the counselor is feeling,Gain an understanding of his spheres of influence,Find out about his interests and hobbies,Ask Darrel what he does for work,"(A): Deny any cultural biases the counselor is feeling
(B): Gain an understanding of his spheres of influence
(C): Find out about his interests and hobbies
(D): Ask Darrel what he does for work",Deny any cultural biases the counselor is feeling,A,"Counselors are obligated to be aware and sensitive to other cultures. It is also necessary to acknowledge cultural biases and not try to deny them. Acknowledging one's own biases is the only way to effectively work on overcoming them. A comprehensive assessment not only includes the counselor's self-awareness, but also includes information on many aspects of the person's life including strengths, interests, and hobbies. Finding out what Darrel does for work can give pertinent information on why he looks so tired. Finding out about his spheres of influence can give the counselor an even larger picture of Darrel's support system and other factors that may be influencing his feelings and behaviors. Therefore, the correct answer is (D)",professional practice and ethics
1329,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.",use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends.  The client requests behavioral changes that can help reduce the frequency of masturbation,"The client requests behavioral changes that can help reduce the frequency of masturbation. All of the following behavioral interventions can support a reduction in the desire for masturbation, EXCEPT:",Blocking pornographic websites,Spending time with family or friends,Focusing on improving self-esteem,Exercise,"(A): Blocking pornographic websites
(B): Spending time with family or friends
(C): Focusing on improving self-esteem
(D): Exercise",Focusing on improving self-esteem,C,"Focusing on improving self-esteem might help reduce the frequency of masturbation; however, it is not a behavioral intervention. Exercise releases chemicals in the body that improve mood and can help reduce the desire to masturbate. Spending time with family or friends can be helpful in extinguishing masturbation urges, especially if a root cause of these urges is loneliness. Blocking pornographic websites limits or delays the client’s access to contributory resources for his masturbation, which can provide the client with time to use coping skills to manage the urge to masturbate. Therefore, the correct answer is (D)",treatment planning
1330,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9),"Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece","You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.","The client began a new medication, which has helped with his delusional thinking. He continues to hear voices but reiterates that he does not hear command hallucinations. The client is able to focus on interpersonal relationships and has shown interest in obtaining part-time employment. He reports that he continues to benefit from group therapy. He has identified decreasing maladaptive thoughts and improving social skills as long-term treatment plan goals.  You co-lead the client’s group and use social skills training to help the client with his long-term treatment goals","You co-lead the client’s group and use social skills training to help the client with his long-term treatment goals. Which principle of operant conditioning underlies the use of cueing, coaching, and prompting?",Social modeling,Environmental restructuring,Behavioral practice,Discriminative stimuli,"(A): Social modeling
(B): Environmental restructuring
(C): Behavioral practice
(D): Discriminative stimuli",Discriminative stimuli,D,"The operant conditioning principle underlying cueing, coaching, and prompting is discriminative stimuli. Discriminative stimuli is based on the premise that certain behaviors were reliably reinforced in the past. These reinforced behaviors now serve as the antecedent stimulus that increases the probability of a response because of a history of reinforcing selected behavior (ie, differential reinforcement). Modeling is a social learning concept, making it incorrect. Environmental restructuring influences behavior by permanently changing one’s physical surroundings. Behavioral practice is a component of social skills training but is different than discriminative stimuli in that it involves repeating the learned skill until it reaches the point where it can be successfully generalized to real-life encounters. Therefore, the correct answer is (B)",counseling skills and interventions
1331,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",Which short-term goal would you prioritize as you develop a treatment plan for the client?,Decrease angry outbursts and behaviors,Decrease his defiance toward his mother,Decrease bullying,Decrease anxiety,"(A): Decrease angry outbursts and behaviors
(B): Decrease his defiance toward his mother
(C): Decrease bullying
(D): Decrease anxiety",Decrease angry outbursts and behaviors,A,"You are considering the diagnosis and his school behaviors which have led to expulsions. Decreasing angry outbursts and subsequent behaviors is the most critical goal on which to work. Therefore, the correct answer is (D)",treatment planning
1332,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ","According to the American Psychiatric Association's guidelines for clients with eating disorders, what level of care would be appropriate for the client at this time?",Intensive outpatient,Inpatient treatment,Residential treatment,Partial hospitalization,"(A): Intensive outpatient
(B): Inpatient treatment
(C): Residential treatment
(D): Partial hospitalization",Intensive outpatient,A,"Based on the client's symptoms and presentation, it is appropriate to recommend an intensive outpatient level of care. The client is displaying signs of anxiety, poor body image, restricted eating, compulsive exercise, and avoidance of social situations. These are all warning signs that require an increased level of care. Intensive outpatient treatment provides the support, structure, and guidance necessary to help the client safely explore her issues and develop healthy coping strategies. The intensity of the program allows the client to continue attending school or working while receiving treatment. Therefore, the correct answer is (C)",counseling skills and interventions
1333,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,Destiny is displaying symptoms of Reactive Attachment Disorder. Differentiators between Autism spectrum disorder and Reactive attachment disorder may include all of the following except?,Restrictive interests and repetitive behaviors are associated with Autism spectrum disorder,Both can exhibit a range in intellectual functioning,Reactive attachment disorder does not have cognitive and language delays,Those with reactive attachment disorder have a history of severe social neglect,"(A): Restrictive interests and repetitive behaviors are associated with Autism spectrum disorder
(B): Both can exhibit a range in intellectual functioning
(C): Reactive attachment disorder does not have cognitive and language delays
(D): Those with reactive attachment disorder have a history of severe social neglect",Reactive attachment disorder does not have cognitive and language delays,C,"Individuals diagnosed with reactive attachment disorder and autism spectrum disorder may show cognitive and language delays, as well as a range intellectual functioning. However, individuals diagnosed with autism spectrum do not have to have a history of severe social neglect. Additionally, restrictive interests and repetitive behaviors can be seen with autism spectrum disorder but not reactive attachment disorder. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1334,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.  Eighth session You have been seeing the client for a few months now, and she has consistently come to therapy and has made some progress, but some areas still need work. Regarding the death of her friend, she remains in the denial stage of his passing. She had been prescribed medication to help with her insomnia and depression, which seemed to be helping somewhat. In addition, she is limiting her alcohol intake, but she has not stopped drinking altogether. She had also been working on identifying her triggers for anxious distress, and you discussed several of them during previous sessions.    Today, you focus on the stress the client reports in relationship to her job. You ask, ""What has been going on at work that has been making you feel stressed out?"" She starts to talk about her boss and seems to be caught up in the details, getting lost in her story. You notice her becoming agitated. You ask her to explain what she is feeling and she says, ""overwhelmed, frustrated, and like I can't keep up."" She tells you that just talking about it makes her feel physically uncomfortable. You offer the client some grounding techniques to help her stay in the present moment. You suggest she take a few deep breaths and focus on her breathing. You then ask her to focus on her physical sensations, including any tension or tightness in her body and gently encourage her to release that tension. You suggest she identify something in the room that can help her stay grounded and focus on it if her mind starts to wander.    When she appears to be calm again, you ask her to describe the situation at work that is causing her the most distress in simple terms, without getting caught up in details. The client goes on to explain that her supervisor is often critical of her and she feels as though he does not appreciate the hard work she puts in. You listen to her and empathize, then encourage her to think about specific ways she can address the situation at work. You suggest that she start by making a list of her skills and competencies, so that she can remind herself of her worth when feeling attacked.    Throughout the session, you mirror the client's body language by following her lead. When she leans forward, you lean forward. When she furrows her brows or crosses her arms, you do the same. You also make eye contact with the client, giving her your undivided attention.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",What are you attempting to do when you mirror the client's body language during the session?,Engage the client in reframing,Utilize attending skills,Employ the exaggeration exercise,Demonstrate unconditional positive regard,"(A): Engage the client in reframing
(B): Utilize attending skills
(C): Employ the exaggeration exercise
(D): Demonstrate unconditional positive regard",Utilize attending skills,B,"Attending skills involves the therapist listening to the client and giving them your undivided attention. Therefore, the correct answer is (D)",counseling skills and interventions
1335,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital,,"Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”",,Tony asks that the counselor not tell his wife about wearing her clothes prior to the time she walked in on him. How should the counselor respond?,Are you sure that is what you want to do?,"I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable",That goes against the ground rules we set last week,"Okay, only this time","(A): Are you sure that is what you want to do?
(B): I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable
(C): That goes against the ground rules we set last week
(D): Okay, only this time","I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable",B,"This choice validates Tony's feelings but also talks about a way to honor was agreed upon before the individual session. Prior to the session with Tony, all parties agreed that whatever is stated in the individual session will be shared in the next session. If this is not done, this may disrupt the therapeutic relationship. If the counselor agrees to it just one time, Tony may ask again to keep something from Kathleen and an alliance may form between Tony and the counselor. This would be a violation of trust if Kathleen found out. Selection b does not directly address the issue at hand and choice c may cause Tony to be defensive. Therefore, the correct answer is (D)",counseling skills and interventions
1336,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex."," Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother",Which one of the following would be the most beneficial collaborator(s) for holistic treatment planning in this scenario?,The client’s PCP,A psychiatrist,The client’s friends,The client’s girlfriend,"(A): The client’s PCP
(B): A psychiatrist
(C): The client’s friends
(D): The client’s girlfriend",The client’s PCP,A,"The client’s PCP would be the most beneficial contact for collaboration in a holistic approach because the concern includes the influence of a medical condition. A psychiatrist is an important collaborator for mental health needs, especially when psychopharmacy is required, but this would neglect the focus on the client’s medical needs. The client’s girlfriend and the client’s friends also do not address the physical needs of the client’s medical condition and therefore would not characterize the most holistic approach. Therefore, the correct answer is (A)",treatment planning
1337,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","   e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services",Which statement would best help enhance the client’s motivation to change?,"“You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.”","“Your girlfriend declined to have sex with you, but you’ve decided to keep trying.”","“You’re disappointed your girlfriend is not having sex with you, but just like building a building, intimate relationships are constructed one brick at a time.”","“You’re disappointed that your girlfriend doesn’t want to have sex with you. I believe I can help, but the ball is in your court.”","(A): “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.”
(B): “Your girlfriend declined to have sex with you, but you’ve decided to keep trying.”
(C): “You’re disappointed your girlfriend is not having sex with you, but just like building a building, intimate relationships are constructed one brick at a time.”
(D): “You’re disappointed that your girlfriend doesn’t want to have sex with you. I believe I can help, but the ball is in your court.”","“You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.”",A,"Of all answer options, increasing the client’s motivation to change is best attained by stating, “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you” The statement is an example of an empathetic reflection, a micro skill associated with strengthening the counselor-client relationship. The statement also sets the stage for establishing a discrepancy between the client’s values or expectations and current behaviors. It is a natural lead to discussing what an intimate relationship looks like, the reality of exploring it, and the appropriateness of establishing it. The therapeutic alliance is strongly associated with increased motivation to change. Answer A attempts to engage the client by using his major in architectural design to create an analogy between the building blocks of an intimate relationship and building an actual building. This statement is likely to be misunderstood because individuals on the autism spectrum think concretely and not metaphorically. Telling the client that the ball is in his court is also a statement that, if taken literally, creates a misunderstanding. The statement, “Your girlfriend declined to have sex with you, but you’ve decided to keep trying,” is a paraphrase. A paraphrase reflects the factual aspects of the client’s statements. Paraphrases let clients know that they are being heard, but they are not as powerful as empathetic reflections. Therefore, the correct answer is (B)",counseling skills and interventions
1338,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening","Based on the topics discussed during today’s session, which of the following would be the most appropriate homework assignment?",The couple will engage in sexual intercourse twice over the next week in order to increase intimacy.,The couple will engage in conflict resolution skills when experiencing significant conflict.,The wife will ensure that the husband can go fishing again so he can feel validated.,"Each individual will engage in a significant, loving act toward the other during the next week.","(A): The couple will engage in sexual intercourse twice over the next week in order to increase intimacy.
(B): The couple will engage in conflict resolution skills when experiencing significant conflict.
(C): The wife will ensure that the husband can go fishing again so he can feel validated.
(D): Each individual will engage in a significant, loving act toward the other during the next week.","Each individual will engage in a significant, loving act toward the other during the next week.",D,"The individuals in this couple are experiencing a lack of feeling validation and interest from their partner. Engaging in loving acts would most likely address these deficiencies most effectively. Although engaging in sexual intercourse may lead to validation, this was not the main concern expressed during this session. The wife focusing on guaranteeing that the husband has time to fish displays empathy and support for the husband, but it does not improve their issues with validation and connection. The couple needs to continue working on conflict resolution; however, feelings of connectedness are the couple’s main focus in this session. Therefore, the correct answer is (A)",counseling skills and interventions
1339,Initial Intake: Age: 35 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual,"Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)
 

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.","Legal and Work History:
You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”",What is your next course of action?,Inform Gina you cannot speak with her due to conflict of interest.,Report the incident to the presiding judge over Davone's court order.,Obtain written consent from Davone to speak with his ex-wife.,Do not respond to the voicemail and speak with the PO about confidentiality.,"(A): Inform Gina you cannot speak with her due to conflict of interest.
(B): Report the incident to the presiding judge over Davone's court order.
(C): Obtain written consent from Davone to speak with his ex-wife.
(D): Do not respond to the voicemail and speak with the PO about confidentiality.",Do not respond to the voicemail and speak with the PO about confidentiality.,D,"It is inappropriate in this situation for you to speak with Davone's ex-wife or to any judge involved in his court case due to HIPAA and for other legal reasons. Discussing the voicemail with Davone and the possibility of speaking with his ex-wife can be something accomplished at your discretion as the counselor, however based on his presentation in session and her demands over the phone it is not the best option clinically for your client. Simply leaving the voicemail recorded but unaddressed and reviewing confidentiality with his probation officer (or at least discussing with them how she got your number if not from them) is the best choice. Therefore, the correct answer is (A)",professional practice and ethics
1340,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","Following today's session, the client's husband called you and apologized for his behavior that he feels resulted in his wife being hospitalized. He indicated that he was now willing to do whatever it takes to help his wife get better and asked if you could give him any insight into his wife's current mental health needs. How would you respond?","Without going into detail, you can share your general impressions regarding his wife.",You can suggest actions and behaviors the husband should consider.,"As her husband was a co-occurring participant in her hospitalization, you can share information about his wife's health.",You must maintain the confidentiality of the client's sessions,"(A): Without going into detail, you can share your general impressions regarding his wife.
(B): You can suggest actions and behaviors the husband should consider.
(C): As her husband was a co-occurring participant in her hospitalization, you can share information about his wife's health.
(D): You must maintain the confidentiality of the client's sessions",You must maintain the confidentiality of the client's sessions,D,"It is important for the client to be able to trust the therapist and for the therapist to maintain the confidentiality of the client’s session. It would not be appropriate for the therapist to discuss the details of the client’s session with her husband. Respect for the client’s privacy is essential to maintain a safe and therapeutic environment. Furthermore, the therapist must also ensure that their actions do not violate ethical guidelines or confidentiality laws. This can be difficult to manage when dealing with someone with a close relationship with the client, as it would be necessary to explain why certain information should not be revealed. The therapist must clearly explain the limits of what can and cannot be shared with a third party if it is deemed necessary for the client’s well-being. Therefore, the correct answer is (D)",professional practice and ethics
1341,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past",The client’s thoughts of worthlessness if she is overweight and that she will die as a result represent which of the following cognitive distortions?,Personalization,Emotional reasoning,Overgeneralization,Always being right,"(A): Personalization
(B): Emotional reasoning
(C): Overgeneralization
(D): Always being right",Emotional reasoning,B,"This cognitive distortion is considered emotional reasoning, which is defined as “I feel; therefore, it must be true” Personalization is when the client assumes that she is responsible for what happened and would not define the present cognitive distortion. This cognitive distortion is also not an example of “always being right” because the client is not expressing that the possibility that she is wrong is unacceptable. Overgeneralization is when the client assumes a generalized rule from a singular experience. Overgeneralization may explain why she feels like she is going to die because her mother did, but it does not explain why she feels being overweight means that she has no worth. Therefore, the correct answer is (C)",counseling skills and interventions
1342,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","The client presents as a hurting, confused, and scared individual, who nonetheless is a successful and respected attorney. What is the best way to establish and maintain a working and effective therapeutic relationship in this case?",Set clear boundaries with the client to promote healthy interactions,Help the client identify ways to achieve her goals,Show genuine acceptance and understanding for the client,Avoid making assumptions about her situation,"(A): Set clear boundaries with the client to promote healthy interactions
(B): Help the client identify ways to achieve her goals
(C): Show genuine acceptance and understanding for the client
(D): Avoid making assumptions about her situation",Show genuine acceptance and understanding for the client,C,"Congruence is an important concept in therapeutic counseling. It involves a therapist demonstrating genuine acceptance and understanding for the client by being authentic, honest, and transparent. Congruence also involves conveying empathy and unconditional positive regard towards the client, as well as refraining from judging or minimizing the client's experiences. This helps to create a safe space for clients to open up about their feelings and concerns. Therefore, the correct answer is (B)",core counseling attributes
1343, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.","In response to Avery's parents telling you how difficult it is to get him to sleep, you reply saying ""I completely understand it must be difficult! I am here to help however I can."" This is an example of?",Development of conflict resolution strategies,Empathic responding using validation and therapeutic alliance,Reverse reflection and deflection,Non-judgmental stance,"(A): Development of conflict resolution strategies
(B): Empathic responding using validation and therapeutic alliance
(C): Reverse reflection and deflection
(D): Non-judgmental stance",Empathic responding using validation and therapeutic alliance,B,"This is an example of showing empathy by validating a client's feelings and reinforcing the therapeutic relationship by reminding them of your commitment to give your clinical resources to help alleviate their distress. Answer a) is a fabricated counseling skill. All clinical services should be provided from a non-judgmental position, offering unconditional positive regard as best practice. Developing resolution to their conflicts is at times a collaborative process along with the client, as well as it is a teaching process, that will continue throughout the course of their treatment. If the response were to include strategies, there would be instructions and SMART goals involved. This response was merely using core counseling attributes as a skill to enhance the client's trust and comfort their apparent frustrations. Therefore, the correct answer is (D)",counseling skills and interventions
1344,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","   Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication",Which one of the following assessment instruments provides ADHD rating scales for parents and teachers?,Conners Rating Scale (CRS),ADHD Rating Scale-IV (ADHD-RS-IV) with Adult Prompts,Ages and Stages Questionnaire (ASQ),Woodcock-Johnson IV (WJ IV),"(A): Conners Rating Scale (CRS)
(B): ADHD Rating Scale-IV (ADHD-RS-IV) with Adult Prompts
(C): Ages and Stages Questionnaire (ASQ)
(D): Woodcock-Johnson IV (WJ IV)",Conners Rating Scale (CRS),A,"The CRS has rating scales for parents and teachers. The CRS can be used with children ages 6–18, and it assesses ADHD and associated comorbid disorders. Parent and teacher scales are critical for diagnostic purposes because ADHD must occur in more than one setting (eg, at home and at school). The ADHD-RS-IV with Adult Prompts is used to assess ADHD symptoms in adults. The WJ IV is an intelligence test that evaluates a wide range of cognitive functions with three batteries: the WJ IV Tests of Cognitive Abilities, the WJ IV Tests of Oral Language, and the WJ IV Tests of Achievement. Finally, the ASQ is a socioemotional and developmental screening tool for children between birth and age 6. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1345,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors.  Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor.    You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ","Given the client's outburst, what would your next step be if using a Gestalt approach?","You would model the behavior back to the client by throwing an object that belongs to her, to help her to experience the here-and-now consequences of her actions.","You would seek to redirect the client from her inappropriate outburst, to help the client defuse intense feelings and thus normalize her behaviors.","You would set appropriate boundaries for behavior for the client, in recognition that aggression is part of the client's process.","You would introduce humor as a way to deflect intense emotions from the client's outburst, aiding her in finding ways to self-regulate.","(A): You would model the behavior back to the client by throwing an object that belongs to her, to help her to experience the here-and-now consequences of her actions.
(B): You would seek to redirect the client from her inappropriate outburst, to help the client defuse intense feelings and thus normalize her behaviors.
(C): You would set appropriate boundaries for behavior for the client, in recognition that aggression is part of the client's process.
(D): You would introduce humor as a way to deflect intense emotions from the client's outburst, aiding her in finding ways to self-regulate.","You would set appropriate boundaries for behavior for the client, in recognition that aggression is part of the client's process.",C,"The Gestalt therapist seeks to get the client to experience intense emotions and acknowledge them in the here and now. Therefore, the correct answer is (D)",counseling skills and interventions
1346,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","   . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation.  You consider yourself evangelical and uphold values consistent with church teachings",You consider yourself evangelical and uphold values consistent with church teachings. How should you handle your opposing values?,Speak to your supervisor about referring the client.,Seek guidance and consultation from the client.,Tell your supervisor about the issue and agree to follow-up if it becomes problematic.,Seek professional training in that area and continue to work with the client.,"(A): Speak to your supervisor about referring the client.
(B): Seek guidance and consultation from the client.
(C): Tell your supervisor about the issue and agree to follow-up if it becomes problematic.
(D): Seek professional training in that area and continue to work with the client.",Seek professional training in that area and continue to work with the client.,D,"The best way to handle your opposing values is to seek professional training in that area and continue to work with the client. Seeking professional training and supervision is designed to honor ethical counseling principles, specifically justice, nonmaleficence, and beneficence, and to preserve a safe counseling environment. According to the ACA Code of Ethics (2014), counselors avoid imposing “their own values, attitudes, beliefs, and behaviors” and “seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature” The primary focus of treatment must always be the client’s goals and desired outcome. When opposing values are brought into the counseling process, the counselor is no longer impartial, and there is a danger of harming the client. Seeking guidance and consultation from the client is incorrect because of the power differential and the counselor’s responsibility to obtain professional guidance. Referring the client to another provider is incorrect because “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors (ACA, 2014)”. Therefore, the correct answer is (B)",professional practice and ethics
1347,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.",Which of the following would help you develop trust with the client during this first session?,Explain the phases of counseling so she knows what to expect,Helping the client identify some simple boundaries to implement with her spouse,Setting treatment goals,Collaborating on selecting a support system for the client,"(A): Explain the phases of counseling so she knows what to expect
(B): Helping the client identify some simple boundaries to implement with her spouse
(C): Setting treatment goals
(D): Collaborating on selecting a support system for the client",Setting treatment goals,C,"Setting treatment goals is a collaborative process in counseling that requires the counselor to demonstrate having listened to and understood the client's concerns, values, beliefs, and the desired outcome from counseling. In promoting the welfare of the client, the counselor demonstrates respect for the client and encourages them to trust the counseling process and the therapeutic relationship. Explaining what to expect from counseling occurs at the beginning of the session when reviewing the Informed Consent. Selecting a support system and identifying boundaries are both important parts of the counseling process, but are more effective once the therapeutic relationship and trust have been established. Therefore, the correct answer is (A)",treatment planning
1348,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","   ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.”  You are using the transtheoretical model of change (Prochaska & DiClemente, 1992) to examine the client’s reticence to participate in counseling","You are using the transtheoretical model of change (Prochaska & DiClemente, 1992) to examine the client’s reticence to participate in counseling. This model suggests that change is least likely to occur in which of the following stages:",Action,Maintenance,Contemplation,Preparation,"(A): Action
(B): Maintenance
(C): Contemplation
(D): Preparation",Contemplation,C,"Of the stages listed, contemplation is the one that is least likely to produce change. Prochaska and DiClemente’s (1992) transtheoretical model of change consists of the following linear stages: precontemplation, contemplation, preparation, action, and maintenance. Individuals in stage 1, or the precontemplation stage, lack awareness of behaviors that may require change. In stage 2, the contemplation stage, individuals are aware that changes need to be made but are ambivalent about taking action. In stage 3, the preparation/determination stage, individuals acknowledge the detrimental consequences of their behavior and get ready to make a change. The action stage, or stage 4, is also known as the willpower stage because the person acknowledges that a change needs to be made and is taking steps to change. Finally, in stage 5, the maintenance stage, individuals take the action steps required to sustain change. Termination or relapse may follow the maintenance stage if changes are not necessary or sustained. Therefore, the correct answer is (D)",counseling skills and interventions
1349,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.",tion. Family History: The husband and wife have been married for 13 years. They report that they met when friends introduced them and that they dated for about 2 years before getting married. The couple have two children: two daughters (ages 7 and 10). The couple reports that they have been in “parent mode” for the past few years and have not been emotionally connected to each other because their attention has been predominantly focused on their children,Which of the following is a unique ethical consideration for couples counseling versus individual counseling?,Professional competency,Autonomy,Dual relationships,Extensions of the counseling boundaries,"(A): Professional competency
(B): Autonomy
(C): Dual relationships
(D): Extensions of the counseling boundaries",Autonomy,B,"Autonomy is a core counseling value and is more difficult to maintain in couples counseling because there are two individuals that are both due their right to autonomy. Both individuals have varying needs, and you must balance focusing on the collective needs with focusing on the individual needs. Dual relationships, extensions of the counseling boundaries, and professional competency are factors that are less influenced by the dynamic of couples counseling. Therefore, the correct answer is (A)",professional practice and ethics
1350, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.",Which of Raul's behaviors would not necessarily meet criteria for his ADHD diagnosis?,Impulsivity,Falling asleep in class,Desire for validation,Asking you repeat a question,"(A): Impulsivity
(B): Falling asleep in class
(C): Desire for validation
(D): Asking you repeat a question",Desire for validation,C,"There is no evidence to support Raul's ""class clown"" behaviors have anything to do with ADHD. Common behaviors of children with ADHD involve inattention and impulsivity. While falling asleep in class in and of itself is not a criterion for ADHD, it is possible Raul feels overwhelmed or disengaged in class, therefore due to his inattentive type processing he may become sleepy when bored. It is also possible over-stimulation at other times of the day or night may make it difficult for him to get needed rest when it is more appropriate. If given too much information to process at once, a client with ADHD might lose focus and be incapable of remembering what was just said to them causing them to ask you to repeat it. Using single step directions and relatively short comments in conversations with clients whose ADHD is untreated can be helpful for them to process more easily what you are saying. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1351,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","  You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown.  The client is wearing a low-cut blouse and short shorts while stating that she attempted suicide due to her last boyfriend “ghosting” her",The client is wearing a low-cut blouse and short shorts while stating that she attempted suicide due to her last boyfriend “ghosting” her. Carl Jung would most likely view this as an expression of which one of the following?,Persona,Anima,Electra complex,Parapraxis,"(A): Persona
(B): Anima
(C): Electra complex
(D): Parapraxis",Persona,A,"Carl Jung would most likely view the combination of the client’s attire and her recent suicide attempt stemming from a bad breakup as her persona. Jung described the persona as “the social face the individual presented to the world—a kind of mask, designed on the one hand to make a definite impression upon others, and on the other to conceal the true nature of the individual” (Jung, 1953). The client’s sexualized manner of dress may serve as a means of concealing the true nature of her pain and underlying fear of abandonment. Jung is also known for the Electra complex, which he used to describe a female’s unconscious desire for her father’s love and attention. The anima, another concept originating from Jung, refers to the unconscious feminine side of a man. Finally, parapraxis is a Freudian concept used to describe an unconscious slip of the tongue or Freudian slip. Therefore, the correct answer is (A)",counseling skills and interventions
1352,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,To obtain more information the counselor should first?,Interview Harold's coworkers,Determine a diagnosis,Conduct a drug test,Conduct a biopsychosocial,"(A): Interview Harold's coworkers
(B): Determine a diagnosis
(C): Conduct a drug test
(D): Conduct a biopsychosocial",Conduct a biopsychosocial,D,"A comprehensive biopsychosocial is usually the first step of the intake and assessment process to gain information on a client's past in the main life domains. It is not the counselor's responsibility to interview Harold's coworkers because of the complaints, and meeting with them may cause suspicion from Harold. It is too early to determine a diagnosis. Although Harold's coworker indicated possible drug use, a drug test is not yet indicated. A drug screening is usually part of the initial biopsychosocial. A drug test may be necessary if the drug screening indicates so. Therefore, the correct answer is (A)",counseling skills and interventions
1353,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","You meet with the client 2 weeks after the initial intake because she refused to come for the session scheduled the past week. Because of the cancellation, you decide to change the focus of your session to meet the client’s needs for comfort and security over the foster parents’ need for guidance and skills. The client engages a little more in interacting with you, and you praise her for her involvement. At one point in the session, the client hits you and goes and sits down to continue playing. At the end of the session, you provide the foster parents with ways that they can increase attachment and positive interactions with your client. You empathize with the foster parents regarding their desire to help the client feel loved and cared for",Which one of the following therapeutic foci is most effective for a 4-year-old with attachment difficulties?,Rational emotive behavior therapy,Psychodynamic therapy,Bibliotherapy,Play therapy,"(A): Rational emotive behavior therapy
(B): Psychodynamic therapy
(C): Bibliotherapy
(D): Play therapy",Play therapy,D,"Play therapy would be the most effective approach for this client because she is 4 years old and would benefit from playing out life circumstances instead of talking through them. Rational emotive behavior therapy would likely be above the cognitive level of the client because it requires the client to process rational and irrational thought processes. Bibliotherapy involves the use of books for therapy; the client is likely too young to benefit from this focus. Psychodynamic therapy focuses on identifying and processing one’s emotions; the client is not at a cognitive level at which she can participate in this type of therapy. Therefore, the correct answer is (B)",counseling skills and interventions
1354,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.  Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is ""officially sleeping in the spare bedroom"" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, ""We don't talk anymore. He just berates me all the time, and that hurts a lot."" As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, ""She's a mess. I don't know what to say.""    You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed.    Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ",Which of the Four Horsemen of the Gottman Methods of Couples Therapy is the husband exhibiting in his interactions with his wife?,Stonewalling,Defensiveness,Contempt,Criticism,"(A): Stonewalling
(B): Defensiveness
(C): Contempt
(D): Criticism",Contempt,C,"The second horseman is Contempt. This horseman goes beyond criticism to being downright mean and disrespectful. According to Gottman, contempt was the greatest predictor of divorce. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1355, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.",What would be the most effective person-centered objective within the client's treatment plan goal of addressing trauma?,Client will engage in narrative and exposure therapy interventions weekly for six months.,Client will learn new coping skills to help ameliorate anxious distress.,"Client will process her trauma by discussing and receiving feedback on thoughts, emotions, and behaviors on a weekly basis with therapist.",Client will identify at least three triggers that cause stress reactions in her daily life and determine her connection to her root trauma through weekly discussion for six months.,"(A): Client will engage in narrative and exposure therapy interventions weekly for six months.
(B): Client will learn new coping skills to help ameliorate anxious distress.
(C): Client will process her trauma by discussing and receiving feedback on thoughts, emotions, and behaviors on a weekly basis with therapist.
(D): Client will identify at least three triggers that cause stress reactions in her daily life and determine her connection to her root trauma through weekly discussion for six months.",Client will identify at least three triggers that cause stress reactions in her daily life and determine her connection to her root trauma through weekly discussion for six months.,D,"Objectives must call the client to action while also being SMART (specific, measurable, achievable, realistic, timely). Answer a) is not specific, measurable, or timely. Answer b) is not person-centered; it is too direct in its interventions which might be challenging for a person with high anxiety who is processing her unresolved trauma while transitioning psychiatric medications. The client has already accomplished answer d) by electing to re-engage in therapy when referred. Therefore, the correct answer is (C)",treatment planning
1356, Initial Intake: Age: 14 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Hispanic - Mexican American Relationship Status: Single Counseling Setting: School-based Type of Counseling: Individual,"Raul presents as irritable and anxious, with congruent mood and affect. Raul is casually dressed, appears to be overweight for his age and height, and is sweating with nervous hand motions. Raul has difficulty making eye contact, takes long pauses prior to answering questions, and often asks you to repeat the question after a long pause. Raul denies SI/HI or hallucination/delusion. He refers to an incident in his past he considers to be “trauma” but is uncomfortable discussing with you. When asked about his father, he sheds a tear which he immediately wipes away and returns to a scowl on his face with arms crossed, saying “there’s nothing to talk about.” Raul does admit to several instances of aggression with others such as “shoving a kid,” “kicking a desk” and “cursing out the principal.” You ask if he has ever been on medication for ADHD. He says, “No, I don’t think so. My doctor told my mom a few times to fill out some forms, but I don’t think she ever did.”","Diagnosis: Attention-deficit hyperactivity disorder, predominantly inattentive type (F90.0), Conduct disorder, unspecified (F91.9)
 

You are a counseling intern working for an agency that sends counselors into grade schools to work with their students on longer-term mental health issues. Raul is referred to you by his assistant principal for multiple in classroom infractions of interrupting, bullying, and being a “class clown.” In meeting with Raul and his mother, she shares that the principal accused Raul of bullying kids on the bus, and defacing property. She says, “Kids will be kids, they’re probably just too sensitive.” Raul’s mother works full-time and has an active social life, leaving Raul to stay at home alone frequently after school or on weekends. His mother appears very casual and does not seem concerned about Raul’s behaviors. She does mention Raul’s diagnosis of ADHD was given by his pediatrician, but he has never received psychiatric services. In front of his mother, Raul is quiet and acts well-behaved; after his mother leaves, he tells you he gets frustrated with her for leaving him alone but would never admit it to her directly. He refuses to state that he feels lonely, sharing that he spends most of his alone time playing live video games with other people across the country. He also denies bullying other kids.","Education History:
Raul’s teachers inform you of his behaviors throughout his freshman year in high school, that have according to them been ongoing since Raul’s middle school years. Raul is often reported for being inappropriate in class by making impulsive remarks to try and get others to laugh, disrupting the class, or falling asleep and appearing distracted. The school is concerned with his academic progress and has discussed moving his status up a higher-level Tier so he can be monitored further and made available to special programming geared towards students in jeopardy of failing.
 
Family History:
Raul lives with his mother and occasionally one of his mother’s boyfriends who come and go intermittently. Raul has one older sister who lives in the next town. Raul’s father lives in Mexico with several of his half and step siblings with whom Raul has minimal contact. Raul’s father is unable to enter the U.S. and has been absent most of Raul’s life. Raul reports his father is an alcoholic, but that where he lives, they “don’t think of things like that” because that is what his father told him. Raul’s grandmother also lives in Mexico but has been a continual presence in his life via phone calls, mail, and is his primary caretaker when he does visit Mexico, which has occurred twice.","After several more sessions with Raul over three months, you conclude he is intrinsically unmotivated for counseling and has no interest in applying taught skills or achieving stated objectives. He is continually resistant and demonstrates no insight into his behaviors. How should you proceed?",Move up to twice weekly sessions.,Proceed with discharge.,Discuss alternate options with Raul and mom.,Discuss alternate options with mom and school.,"(A): Move up to twice weekly sessions.
(B): Proceed with discharge.
(C): Discuss alternate options with Raul and mom.
(D): Discuss alternate options with mom and school.",Discuss alternate options with Raul and mom.,C,"When coming to a place with a client where they are not showing evidence of improvement, it is best to have a conversation centered around what is best for them moving forward. In this case, speaking with Raul and his mother are the only individuals necessary for this conversation. Discharging right away is not the best choice therapeutically for Raul unless this becomes both of their decision after a thorough discussion of the consequences of termination. Increasing frequency of sessions will not necessarily improve client motivation. Working to resolve meeting their needs in a variety of ways, or discussing referrals and community resources that might be helpful for them, is the best choice. Therefore, the correct answer is (C)",treatment planning
1357, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.","Assuming you can obtain consent from Maria's grandmother to continue counseling, you discuss with Maria the goals of counseling sessions while her family is in crisis. What should you tell her?","""I am going to teach you how to cope with this tragedy step by step.""","""We will be discussing your traumatic recall and emotional processing to avoid dissociation.""","""We will work together on helping you and your siblings feel safe and supported.""","""We can talk about anything you want, and I won't tell anyone because it's private.""","(A): ""I am going to teach you how to cope with this tragedy step by step.""
(B): ""We will be discussing your traumatic recall and emotional processing to avoid dissociation.""
(C): ""We will work together on helping you and your siblings feel safe and supported.""
(D): ""We can talk about anything you want, and I won't tell anyone because it's private.""","""We will work together on helping you and your siblings feel safe and supported.""",C,"The goals of crisis therapy are to promote a sense of safety after a trauma, help keep a client calm, promote a sense of self-efficacy, encourage community or victim connectedness, and instill a sense of hope. In the first few hours or days following a significant trauma, a client may not be ready to address their grief and loss, as they are still in shock and likely unable to process the event as well as they could weeks later through cognitive therapy. A teenager is unlikely to be motivated for counseling if they feel they will be forced to discuss a pre-written agenda, and in Maria's case it is clear she is unwilling to share her own thoughts or feelings about what happened. Using clinical language is also challenging for a teenager to connect when using simpler language would be more helpful. Telling them they can talk about whatever they want is mostly true, however you want to inform her that the purpose of the sessions is to help her through this trauma - and neglecting to share that may also come off as insensitive. Furthermore, telling a minor you will not share anything they tell you is misleading as you are required by law to break confidentiality if she reports being abused, plans to hurt herself, or is going to harm someone else. Therefore, the correct answer is (D)",treatment planning
1358,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling  Marital Discord Diagnoses:  You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago.  The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of  The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce",Which one of the following methods treats childhood trauma by using bilateral stimulation to activate portions of the brain and release blocked emotional experiences?,Acceptance and commitment therapy,Interpersonal psychotherapy,Neuro-linguistic programming,Eye movement desensitization and reprocessing,"(A): Acceptance and commitment therapy
(B): Interpersonal psychotherapy
(C): Neuro-linguistic programming
(D): Eye movement desensitization and reprocessing",Eye movement desensitization and reprocessing,D,"Eye movement desensitization and reprocessing treats childhood trauma by using bilateral stimulation to activate portions of the brain and release blocked emotional experiences. Eye movement desensitization and reprocessing is based on the adaptive information processing model and requires specialized training for use; it involves a sequence of steps used to remove distressing emotional blocks so healing can begin. Neuro-linguistic programming providers claim that there is a connection between neurological processes, language, and patterns of behavior that can be learned through experience or programming. Critics of the method suggest that the theory is supported by anecdotal evidence only (ie, it is not an evidence-based practice). Acceptance and commitment therapy uses various techniques to help individuals accept (instead of fight) their present-moment thoughts and feelings so behavioral changes can occur. Finally, interpersonal psychotherapy is a time-limited intervention used to improve one’s social functioning to decrease emotional distress. It addresses the components of a person’s social isolation, grief, life transitions, and/or interpersonal disputes. Therefore, the correct answer is (C)",counseling skills and interventions
1359,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.  Fourth session The client appears energetic during this session. He presents as much more carefully groomed and in an elevated mood. He states, ""It sure has been a journey these past few days."" He reports that he met a woman at a local bar, and after spending the night together at a local hotel, they ended up taking a spontaneous road trip to Florida. He talks about the weekend as ""mind-blowing"", and states that this adventure has helped him design his new goal, which will be ""life-changing.""    He goes on to say that his boss ""didn't appreciate my free spirit because I had a bunch of voicemails from her waiting for me when I got home."" He laughs when he relates that he had turned his phone off, so he didn't have to be ""brought down."" He recognizes that he had made commitments to work over the weekend, but he states, ""If you met this girl, you'd know why I did it."" Then laughs.    You listen to the client's story intently and encourage him to talk more about his experience. Then you explore his feelings around the situation and his decision to leave work without making prior arrangements to cover his absence. You also discuss with the client the potential consequences of his actions and help him consider how to move forward in a way that is not harmful or dangerous. You ask him to think about his goals and create an action plan to help him reach those goals. Together, you and the client come up with strategies for the client to move forward in a healthy way.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.","The client has presented with a matrix of issues related to his manic and depressive states related to Bipolar I, including substance use. Of the following, which would be the least relevant when targeting the cyclical mood impairment associated with Bipolar I Disorder?",12 Step Program,Mindfulness-Based Cognitive Therapy,Interpersonal and Social Rhythm Therapy,Dialectical Behavioral Therapy,"(A): 12 Step Program
(B): Mindfulness-Based Cognitive Therapy
(C): Interpersonal and Social Rhythm Therapy
(D): Dialectical Behavioral Therapy",12 Step Program,A,"The 12-step program would address the client's substance use problem but not the mood component of Bipolar I Disorder. Therefore, the correct answer is (A)",treatment planning
1360, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.","Regarding Avery's comments about desired gender, which of the following courses of action is the most clinically appropriate?",Do nothing unless Avery or his parents bring it up again as part of a problem,Add diagnosis of gender dysphoria and include gender confusion as part of goals,Do nothing because gender dysphoria for children his age is unsubstantiated,Refer parents to a support group for children coping with transgender issues,"(A): Do nothing unless Avery or his parents bring it up again as part of a problem
(B): Add diagnosis of gender dysphoria and include gender confusion as part of goals
(C): Do nothing because gender dysphoria for children his age is unsubstantiated
(D): Refer parents to a support group for children coping with transgender issues",Do nothing unless Avery or his parents bring it up again as part of a problem,A,"Avery was referred for counseling to address symptoms resulting from his primary diagnosis of ADHD and both of his parents are requesting help with dysregulation related to this issue only. Neither parent has expressed concern or problematic behavior resulting from gender identity confusion, merely it was mentioned as a remark that was made. While gender dysphoria can very well be a legitimate concern for a child his age, begin the treatment planning process focusing on presenting problems related to the diagnosis. Should Avery or his parents bring up gender confusion later in counseling, the issue can certainly be addressed and explored at that time. While the counselor may have a personal theory of its connection to Avery's behavioral problems, it is best practice to first rule out known existing conditions. Referrals to support groups or other referrals, should only be made when the counselor deems it appropriate outside of clinical counseling, once the problem and need have been thoroughly assessed. Therefore, the correct answer is (C)",professional practice and ethics
1361,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","In working with this client to facilitate insight into her personality, emotions, and behaviors, which of the following would likely be the most helpful intervention?",Values checklist,Feeling wheel,Empty chair exercises,Family genogram,"(A): Values checklist
(B): Feeling wheel
(C): Empty chair exercises
(D): Family genogram",Family genogram,D,"The main cause of BPD is childhood trauma and unhealthy family relationships. A family genogram, whether using CBT or DBT for treatment can help facilitate the client's understanding of historical patterns that have shaped her personality. This insight can be used to help the client identify negative core beliefs and skills that can be modified for improving distress tolerance and interpersonal relationships. Empty chair exercises are best used for clients who already possess insight and the ability to manage distress. Values checklists and feeling wheels are effective tools for helping clients identify the emotions they are feeling and the values that are most important to them. These are helpful in counseling but would not be as effective in facilitating insight as seeing familial patterns of interpersonal relationships. Therefore, the correct answer is (D)",counseling skills and interventions
1362,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",Which is not a question you would ask during a biopsychosocial assessment?,Do you currently use any substances?,What is your annual household income?,What brings you here today?,Are you currently taking any medication?,"(A): Do you currently use any substances?
(B): What is your annual household income?
(C): What brings you here today?
(D): Are you currently taking any medication?",What is your annual household income?,B,"This is not a question you would ask during a biopsychosocial assessment because it does not relate to the evaluation of an individual's physical, psychological or social health. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1363,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services.  You are supervising a counseling resident, and their established client has canceled several sessions in a row","You are supervising a counseling resident, and their established client has canceled several sessions in a row. Which of the following would you encourage the counselor to do?",Contact the client to encourage them to trust the therapeutic process and continue to have sessions.,Support the client by providing an option to have a referral if they think that counseling is not working.,Follow up with the client to ascertain the reason for their cancellations.,Cancel ongoing sessions until the client can commit to regular sessions.,"(A): Contact the client to encourage them to trust the therapeutic process and continue to have sessions.
(B): Support the client by providing an option to have a referral if they think that counseling is not working.
(C): Follow up with the client to ascertain the reason for their cancellations.
(D): Cancel ongoing sessions until the client can commit to regular sessions.",Follow up with the client to ascertain the reason for their cancellations.,C,"Determining the reason for the cancellations is most important because this can open up a dialogue for getting back on track in the counseling relationship. It may be helpful to cancel future sessions if the client will receive cancellation fees, but this does not get to the bottom of what is happening with the client. It can also be helpful to encourage the client to trust the process, but this does not open up dialogue about what they are experiencing. If the client would like a referral, you should support them. However, it is more helpful to process what is causing the cancellations because it may be related to why the client is in treatment, and if unresolved, they may continue to have this issue with the next therapist. Therefore, the correct answer is (A)",professional practice and ethics
1364,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.  Third session You and the client have agreed to meet for biweekly therapy sessions as she feels she needs extra support right now. This is your third session with the client, and she presents looking exhausted and can barely speak. You consider alcohol use, but there is no smell of alcohol, and the client's eyes do not seem dilated. She is neither slurring her words nor stumbling. You can sense that she is exhausted, both mentally and physically. She shares that she has not slept in 48 hours and is struggling with nightmares about her deceased friend.    She says, ""Why did he have to die? I feel like it's my fault."" Next, you ask her, ""What do you think caused your friend's death?"" but she looks away and shakes her head, unwilling to answer. You then try to explore the nightmares she has been experiencing, but she becomes irritable and angry. Finally, she breaks down and begins to cry. You allow her time to cry, knowing that it is a way for her to release some of the pain she is feeling. After a few minutes, you ask the client if she would like to talk about what is going on in her life. She agrees and starts talking about how overwhelmed she feels. She hates her job, her past, and her present. The client feels like everything is too much for her to handle. You listen patiently as she talks about her feelings.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",How would you best support the client's autonomy in this session?,Share your own personal experiences to try to relate to the client's situation.,Allow the client to lead the conversation and explore the topics that are most important to her.,Use reflective listening to steer the conversation towards specific treatment goals.,Use silence as a way to encourage the client to continue talking.,"(A): Share your own personal experiences to try to relate to the client's situation.
(B): Allow the client to lead the conversation and explore the topics that are most important to her.
(C): Use reflective listening to steer the conversation towards specific treatment goals.
(D): Use silence as a way to encourage the client to continue talking.",Allow the client to lead the conversation and explore the topics that are most important to her.,B,"This option acknowledges the importance of the client's autonomy and respects her right to make decisions about what she wants to discuss in therapy. By allowing the client to lead the conversation, the therapist can create a safe and supportive environment that encourages the client to feel comfortable expressing her thoughts and emotions. Therefore, the correct answer is (C)",counseling skills and interventions
1365,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest.  You and the client’s mother develop an incentive chart for the client. The mother uses a token system to reward skills learned in family therapy, and she uses planned ignoring when the client displays maladaptive behaviors","You and the client’s mother develop an incentive chart for the client. The mother uses a token system to reward skills learned in family therapy, and she uses planned ignoring when the client displays maladaptive behaviors. This is an example of which one of the following?",Exposure and response prevention (ERP),Contingency management (CM),Motivational interviewing (MI),Habit reversal training (HRT),"(A): Exposure and response prevention (ERP)
(B): Contingency management (CM)
(C): Motivational interviewing (MI)
(D): Habit reversal training (HRT)",Contingency management (CM),B,"CM is based on the principle of operant conditioning and involves shaping desired behaviors. CM uses “if, then” contingencies to provide or withhold rewards in response to predetermined behaviors (eg, “if” the client stops playing video games after being asked the first time, “then” he can stay up 15 minutes past his bedtime). A token economy is a form of CM that uses positive reinforcement and extinction. Tokens serve as behavioral reinforcements and are administered when the targeted or desired behavior occurs. When the client displays maladaptive behavior, the mother ignores the behavior. Planned ignoring removes the desired response (eg, attention) through extinction. MI is a collaborative approach used to help clients resolve ambivalence and increase motivation. ERP is used with children experiencing anxiety or panic disorder; it involves incrementally exposing the child to anxiety-related triggers in a safe setting to reduce or eliminate anxiety-related responses (eg, rituals). HRT is an intervention used with children who have tics or Tourette’s syndrome. HRT techniques include identifying sensations occurring directly before the tic to respond to that urge in a new way. Therefore, the correct answer is (B)",treatment planning
1366, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",How should you format a goal for suicidal ideation?,describe levels of SI as more or less severe,conduct updated assessments monthly,ensure the goal aims to eliminate SI,project seeing reduction in six months,"(A): describe levels of SI as more or less severe
(B): conduct updated assessments monthly
(C): ensure the goal aims to eliminate SI
(D): project seeing reduction in six months",ensure the goal aims to eliminate SI,C,"Your goal as the counselor should be to work towards elimination of SI and a return to a previous state of functioning before the SI began. Reduction or elimination of SI does not have to take six months; effective strategies implemented can yield positive results within days or weeks. However, if a client is not improving or is worsening, psychiatric interventions may be necessary. A client may also have long-term ideations without ever increasing in severity and still function well in daily life; but it is ethical and best practice to continually aim for elimination of this ""norm"" for their ultimate safety. Risk elevates with severity of ideations which progress to methods and plans, but a treatment plan goal is not considered strong if it aims to ""reduce severe SI to mild SI"". Check-ins regarding suicidality, whether informal or C-SSRS formatted, are appropriate at every visit until there has been a steady level of low-risk thoughts or behaviors. Again, therapists must aim to make their clients feel completely safe without any form of SI. Therefore, the correct answer is (A)",treatment planning
1367,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.  Fifth session This is your fifth weekly session with the client, and she states that she likes the ""structure"" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, ""I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal.""    You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, ""I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships."" You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family.    During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she ""had other stuff going on.""  Seventh session During today's session, the client tells you that she read a few of the chapters in the book you recommended on human sexuality, and she is starting to feel more comfortable with herself. At your suggestion, she started keeping a journal to organize her thoughts and feelings about her sexuality. She says that she has ""pretty much decided to end my engagement and take some time to explore who I am and what it means to be in a relationship with another woman."" She relates that she still feels homesick at times, but her roommate has been supportive and understanding. She smiles and says, ""My roommate surprised me the other day by cooking a traditional dish that I told her about that my mom used to cook for us growing up. It was so comforting to have a reminder of home like that."" You continue to explore the client's thoughts on telling her parents about her newfound identity, and she says that although the idea of coming out to them and breaking off her engagement is frightening, she knows it is ""the right thing to do."" You provide guidance on how to approach this sensitive subject in a way that may be best received by her family. You also provide additional resources that may help her learn more about navigating conversations around sexuality and sexual orientation with family and friends. The client notes that if all goes well, she'd like to take her roommate back home with her for a visit during a school break so they can spend time together away from school.",,"You say to the client, ""It sounds like you have made a difficult decision to end your engagement, take some time to explore yourself, and be honest with your parents about your newfound identity. You are also feeling more comfortable learning about yourself as well as exploring what it means to be in a relationship with another woman."" What skill are you using with this statement?",Summarization,Reflection of feeling,Paraphrasing,Confrontation,"(A): Summarization
(B): Reflection of feeling
(C): Paraphrasing
(D): Confrontation",Summarization,A,"You are taking all that the client said and repeating it back to her. Summarizing is a skill that can be used at the beginning, middle, or end of a session. Sometimes it covers certain issues discussed over many sessions. Therapists also use this skill to clarify long, complex stories that clients share. Therefore, the correct answer is (A)",counseling skills and interventions
1368, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,Which of the following diagnoses can be ruled out based on the symptoms Theodore is exhibiting?,Normal grief reaction,Hoarding,Adjustment disorder,Persistent Depressive Disorder (Dysthymia),"(A): Normal grief reaction
(B): Hoarding
(C): Adjustment disorder
(D): Persistent Depressive Disorder (Dysthymia)",Persistent Depressive Disorder (Dysthymia),D,"There is not enough information yet to rule out anything except Persistent Depressive Disorder (Dysthymia) in which one criterion is that the symptoms persist for at least two years. Adjustment Disorder is a possibility as the initial criteria is an emotional response to an identifiable stressor, within three months. Hoarding is another diagnosis to consider as Theodore does not want to get rid of anything that reminds him of his wife. However, it is also important to consider normal reactions to grief before finalizing a diagnosis. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1369,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss.  Which approach would help the client understand that depression is an illness (i\. e., not a moral failing) stemming from difficult life events (e\. g","Which approach would help the client understand that depression is an illness (i.e., not a moral failing) stemming from difficult life events (e.g., complicated bereavement)?",Interpersonal therapy,Psychoanalytic therapy,Gestalt therapy,Person-centered therapy,"(A): Interpersonal therapy
(B): Psychoanalytic therapy
(C): Gestalt therapy
(D): Person-centered therapy",Interpersonal therapy,A,"Interpersonal therapy is a form of cognitive therapy based on the assumption that depression is an illness rather than a moral failing. Interpersonal therapists operate on the premise that interpersonal problems fall into four separate categories: grief and loss (eg, complicated bereavement), including trouble reestablishing social ties soon after the loss; a major life change or role transition; conflict in a valued relationship; or social isolation. Psychoanalytic therapy stresses the importance of discovering unconscious forces that drive behavior. Person-centered therapy uses the core facilitative conditions of unconditional positive regard, empathy, and genuineness. Finally, gestalt therapy focuses on successfully integrating the mind and body through present awareness. Therefore, the correct answer is (B)",counseling skills and interventions
1370,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ",What action step would you recommend for the client during the first session?,Recreating the situation where the client had her first panic attack,Work with the client on identifying cognitive distortions,Use a journal to self-monitor the frequency of panic attacks,Request the client reconsider taking medication for her panic attacks,"(A): Recreating the situation where the client had her first panic attack
(B): Work with the client on identifying cognitive distortions
(C): Use a journal to self-monitor the frequency of panic attacks
(D): Request the client reconsider taking medication for her panic attacks",Use a journal to self-monitor the frequency of panic attacks,C,"Journaling is a helpful tool for those experiencing panic attacks to help self-monitor the frequency of their attacks. By tracking the time between attacks, a person can gain insight into the triggers that might be contributing to the attacks, as well as gain an understanding of the severity of their symptoms over time. It can also provide a sense of control and help clients identify behavioral patterns. Keeping a journal can also help track the effectiveness of any techniques used to manage panic attacks, allowing the client to make adjustments if needed. Finally, Journaling can empower individuals to take ownership of their process and make informed decisions about their care. Therefore, the correct answer is (D)",treatment planning
1371,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","The couple comes into the session and sits down. Their body language does not appear as uncomfortable as it has in previous sessions because they are sitting a little closer together. You ask both individuals what they need to work on. The wife says that she knows that she needs to rebuild trust, and the husband says that he wants to know more about what happened in the affair before they move forward. The couple report that they tried to engage in sex, but that the husband stopped during intercourse. The husband states that he could not get the idea out of his mind that his wife does not find him attractive because she was with a woman. You ask the husband what it means for their marriage if his wife does not find him attractive, and he states that it means he will not be able to please her. You then ask him what it means for the relationship if he cannot please her, and he responds that it means he cannot be a good husband. You follow up asking what it means if he cannot be a good husband, and he says that they will have a miserable marriage. You support effective communication strategies and empathize with the couple. After the session, the wife comes back to get her coffee that she left and says that she knows that she hurt her husband and is in the wrong, so she will do whatever her husband needs to rebuild trust",Which CBT technique did you use in the session summary when you responded to the husband’s statement about not feeling that his wife is attracted to him?,Radical acceptance,Guided discovery,Cognitive challenging,Downward arrow,"(A): Radical acceptance
(B): Guided discovery
(C): Cognitive challenging
(D): Downward arrow",Downward arrow,D,"The downward arrow technique uses the client’s own statements to follow their thought process to its roots, which usually reveals the underlying cause of why the original thought is hurtful. The client’s original thought progressed from feeling that his wife is not attracted to him to fears that they will have a miserable marriage. Identifying this underlying fear can be helpful in targeting the deeper feelings that should be of focus during therapy. Radical acceptance is not a CBT technique and focuses on accepting the situation as it is. This may be helpful in accepting that the affair did indeed happen so that they can make a decision to either move forward together or separately. Guided discovery is a CBT technique that reflects on thoughts and feelings to discover the client’s thought process. Although this situation was about discovering the client’s thought process, the downward arrow technique is the specific method for how this discovery was completed. Cognitive challenging is a technique that focuses on challenging irrational or illogical beliefs or thoughts. Therefore, the correct answer is (A)",counseling skills and interventions
1372,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,Nadia is showing symptoms of?,Disruptive dysregulation disorder and autism,Disruptive dysregulation disorder and intellectual disability,Bipolar disorder and autism,Bipolar disorder and intellectual disability,"(A): Disruptive dysregulation disorder and autism
(B): Disruptive dysregulation disorder and intellectual disability
(C): Bipolar disorder and autism
(D): Bipolar disorder and intellectual disability",Bipolar disorder and intellectual disability,D,"Nadia is showing symptoms of bipolar disorder by risk taking behaviors as well as manic and depressive episodes. She is also showing intellectual development disorder with an IQ less than 70 to 75. Disruptive Mood Dysregulation disorder is ruled out as irritability is not the prominent feature. Although intellectual disability is common among individuals with autism spectrum disorder, Nadia is not showing apparent discrepancy between level of social-communicative skills and other intellectual skills. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1373,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","The client has arrived 15 minutes late for your scheduled session. When you approach the waiting room, you find her loudly talking on her cell phone. She abruptly ends the call and follows you back to your office. She is visibly shaken and angry. She explains that her soon-to-be ex-husband is a “master manipulator” and is “ruining my life.” She remains confident that she can stop drinking but states she can only do so once her family situation is under control. After all, she states, “You would drink too if you had my problems.” She begins to de-escalate as the session progresses, and she is able to identify and prioritize treatment issues. Her sleep continues to be a concern. Upon further exploration, she indicates she is having nightmares and has been for quite some time. The two of you work together to prioritize treatment plan goals. Her mood and demeanor brighten as the session concludes.  Your client states she is currently not ready to stop drinking. You respond, “It’s up to you to decide if and when you are ready. No one can make that choice for you","Your client states she is currently not ready to stop drinking. You respond, “It’s up to you to decide if and when you are ready. No one can make that choice for you.” Which core principle of professional ethical behavior is best reflected in this response?",Justice,Autonomy,Fidelity,Veracity,"(A): Justice
(B): Autonomy
(C): Fidelity
(D): Veracity",Autonomy,B,"According to the ACA’s Code of Ethics (2014), there are six core principles of professional, ethical behavior: autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. This question asks you to identify the best match between your statement and an ethical principle. Conveying to the client that it is up to them to decide whether or not they stop drinking reflects the principle of autonomy. Autonomy, or “fostering the right to control the direction of one’s life” (ACA, 2014), respects the client’s independence, which supports and empowers self-determination. Veracity is truthfulness. Fidelity involves respecting commitments and honoring promises. Lastly, justice promotes fair and equitable treatment toward all clients. Therefore, the correct answer is (C)",professional practice and ethics
1374,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What might be most helpful in facilitating the client's involvement in therapy?,Provide skill sets to teach the client about how to cope with bullying.,"Assignments focused on addressing bullying, encouraging your collaborative efforts.",Invite the client's parents to attend therapy to provide support and information to learn how to cope with bullying.,Consider play therapy so the client can begin talking about what is happening.,"(A): Provide skill sets to teach the client about how to cope with bullying.
(B): Assignments focused on addressing bullying, encouraging your collaborative efforts.
(C): Invite the client's parents to attend therapy to provide support and information to learn how to cope with bullying.
(D): Consider play therapy so the client can begin talking about what is happening.",Consider play therapy so the client can begin talking about what is happening.,D,"Play therapy is still highly effective in this age range, as playing out scenarios can help children process complex emotions, traumatic experiences, or stressors. Therapists guide the play and provide support. As children mature, verbal discussion techniques may blend with play therapy. The first step is helping a child/adolescent to open up about their experiences. Next is a therapist's job: to gain a client's trust and help them figure out an effective way to deal with the situation. Therapists specializing in assisting clients to cope with bullying can help your clients speak up about their experiences without fear of repercussions. Therefore, the correct answer is (D)",counseling skills and interventions
1375,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","The husband and wife come into the session and sit as far as they can from each other on the couch, and their individual body positions are oriented away from each other. You ask for any updates in the couple’s relationship, and the husband states that they have not been talking about the affair and continue to only communicate regarding the kids. You attempt to process with the couple what the affair means for their relationship and what events led up to the affair. During the session, the husband stops talking and looks away from his wife when she talks about how she became frustrated that her husband did not spend quality time with her prior to the affair. She thinks that this led to her seeking attention from a man outside of the couple’s relationship.  The Gottmans’ four horsemen all have behavioral interventions that support the communication style",The Gottmans’ four horsemen all have behavioral interventions that support the communication style. Which would be an appropriate intervention for stonewalling?,Talk about feelings using “I” statements,Remember the partner’s positive attributes,Use empathetic listening,Take a break and then reconvene after the client is calmer,"(A): Talk about feelings using “I” statements
(B): Remember the partner’s positive attributes
(C): Use empathetic listening
(D): Take a break and then reconvene after the client is calmer",Take a break and then reconvene after the client is calmer,D,"Taking a break and returning to the conversation when the partner is calmer would be an appropriate behavioral response to stonewalling. Using empathetic listening is beneficial, but it does not assist the client in calming down to return to a more communicative state. Remembering positive traits and using gratitude are helpful in managing feelings of contempt, but they do not address stonewalling. Using “I” statements is helpful, but it does not put the client in a state to process thoughts and feelings because he needs to return to a calm state to engage in effective communication. Therefore, the correct answer is (B)",counseling skills and interventions
1376,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","   ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family",How can you best engage the client and her daughter in the early stages of treatment?,Constructing a multigenerational genogram,Summarizing key concerns and identified areas of focus,Normalizing feelings associated with the aging process,Advising against “catastrophizing” and “negative predictions”,"(A): Constructing a multigenerational genogram
(B): Summarizing key concerns and identified areas of focus
(C): Normalizing feelings associated with the aging process
(D): Advising against “catastrophizing” and “negative predictions”",Summarizing key concerns and identified areas of focus,B,"Summarizing the client’s key concerns and identified areas of focus would best engage the client and her daughter. The daughter is not the client; however, she presents today as a collateral contact and an individual who may impact engaging the client in treatment. Summarizing is a communication skill used to tie together various issues and feelings expressed by the client. This is helpful because it narrows the client’s identified areas of focus, helps the client feel heard, and allows the counselor to ask for corrections and clarifications. Individuals with MND have cognitive difficulties beyond the normal aging process, making answer A incorrect. Although constructing a genogram provides valuable information on the family, it is not the best way to engage the client in treatment. Giving advice does not contribute to engagement and should be reserved for safety issues and should be used sparingly, if at all, during treatment. Catastrophizing and negative predictions are cognitive distortions and irrational beliefs found in rational-emotional therapy and cognitive therapy, respectively. Therefore, the correct answer is (B)",treatment planning
1377,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following interventions will help the client work through his grief?,Invite the client to bring in pictures of his father and share stories about him in session.,Invite him to begin journaling about some of his own life events that his father missed.,Invite the client to limit all reminders of his father's death to prevent triggering himself.,Invite him to think about how his life might have been different had his father lived.,"(A): Invite the client to bring in pictures of his father and share stories about him in session.
(B): Invite him to begin journaling about some of his own life events that his father missed.
(C): Invite the client to limit all reminders of his father's death to prevent triggering himself.
(D): Invite him to think about how his life might have been different had his father lived.",Invite the client to bring in pictures of his father and share stories about him in session.,A,"PTSD has complicated the client's ability to grieve normally so as he is able to begin grieving, it is helpful for him to begin reminiscing about his father. Individuals with persistent complex bereavement disorder (PCBD) often exhibit difficulty with this process (Criterion C3). Symptoms of PCBD include life role confusion or a diminished sense of identity without the deceased (Criterion C11) and excessive avoidance of reminders of the loss (B6). Thus, responses b, c, and d are not helpful interventions. Journaling and contemplating life events his father missed or how his life might have been different is more likely to trigger emotions related to dissatisfaction, frustration, and anger rather than acceptance of the loss. Inviting the client to avoid all reminders of the loss encourages embracing avoidance of the loss, a symptom found in both PTSD and PCBD. Therefore, the correct answer is (A)",counseling skills and interventions
1378,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.  Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, ""I can't do this. You tell them."" Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents.    You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, ""We know that something is going on."" He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, ""We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl."" You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her.    The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that ""did this to our daughter."" The initial conversation is difficult, but you provide support as the family talks through their feelings.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ",The client has just exhibited great courage and growth in disclosing her situation to her parents. How should you respond to the parent's struggle in processing their daughter's pregnancy?,Provide emotional support for their experience,"Remind the parents that they are here to support their daughter, and ask them to leave if they can't.",Provide psychoeducation about adolescent pregnancy,Give unconditional support to your client and address enmeshment issues in the family.,"(A): Provide emotional support for their experience
(B): Remind the parents that they are here to support their daughter, and ask them to leave if they can't.
(C): Provide psychoeducation about adolescent pregnancy
(D): Give unconditional support to your client and address enmeshment issues in the family.",Provide emotional support for their experience,A,"The parents have just found out that their teenage daughter is pregnant. They were unaware that she even had a boyfriend, so this news is understandably a lot for them to take in. Before you can determine how to proceed with the client, you should validate the parent's emotional reaction and allow them to have the space to process this news. Therefore, the correct answer is (D)",counseling skills and interventions
1379, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.",Which goals should be included in Malik's treatment plan?,Elimination of anxiety and cultural stress,Elimination of suicidal thoughts and reduction in anxiety,Reduction of anxiety and elimination of cultural stress,Reduction of suicidal thoughts and depression,"(A): Elimination of anxiety and cultural stress
(B): Elimination of suicidal thoughts and reduction in anxiety
(C): Reduction of anxiety and elimination of cultural stress
(D): Reduction of suicidal thoughts and depression",Elimination of suicidal thoughts and reduction in anxiety,B,"There is no acceptable level of suicidal thoughts when considering goals for a depressed client. As a counselor, you should always strive to help your client eliminate suicidality and return to a previous level of functioning. In doing so it is likely some measure of depression will further be alleviated. Elimination of anxiety is not a realistic goal, but one can greatly reduce the anxiety they experience through various cognitive and other behavioral interventions. The reduction of stress experienced because of acculturation transitions is also a healthy goal, but given the options above, addressing suicidal thoughts must be prioritized. Therefore, the correct answer is (B)",treatment planning
1380,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ",Which of these issues take priority when working with the client?,Anxiety and difficulty focusing,Emotional distance of husband,Client's fear of dying,Ability to concentrate and forgetfulness,"(A): Anxiety and difficulty focusing
(B): Emotional distance of husband
(C): Client's fear of dying
(D): Ability to concentrate and forgetfulness",Client's fear of dying,C,"The client's fear of dying is the most important problem to address, as it is her primary source of distress. If not addressed, it will be difficult for her to make progress in therapy. The therapist needs to explore her fear of death, and any other related topics that are the cause her distress and panic attacks. Therefore, the correct answer is (C)",professional practice and ethics
1381,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice",How would you navigate gift giving with the client?,You decline the gift because to do so would not be culturally offensive to this client.,You decline the gift because she is a talented artist and the painting is high in monetary value.,You accept the gift but explain that agency policy prohibits you from reciprocating.,You accept the gift because rejecting the gift would hurt the client.,"(A): You decline the gift because to do so would not be culturally offensive to this client.
(B): You decline the gift because she is a talented artist and the painting is high in monetary value.
(C): You accept the gift but explain that agency policy prohibits you from reciprocating.
(D): You accept the gift because rejecting the gift would hurt the client.",You accept the gift because rejecting the gift would hurt the client.,D,"You accept the gift because rejecting the gift would hurt the client. In weighing beneficence and malfeasance, it can be reasonably determined that rejecting the gift does more harm than accepting it. The gift represents the culmination of hard work and the return to enjoying things she loves. She credits the counselor for helping her through that journey. Therapy is coming to a close, and she has worked hard to achieve personal success. The ACA Code of Ethics (2014) states, “Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift” For this client, the gift’s monetary value is of lesser significance than what it represents. The client’s culture does not recognize small gifts as a token of respect and gratitude. Lastly, the policy for reciprocating is not necessarily a stipulation for receiving the client’s gift. Therefore, the correct answer is (D)",professional practice and ethics
1382,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.","Millie agrees to enter your referred treatment program, a state-run facility that does not require her father's insurance as payment. Her father has left several voicemails for you, asking which program she is in and how to reach her. What is the most helpful response?",Call the father back to apologize and explain why you cannot tell him.,"HIPAA prevents you from divulging this information, so you do not call back.",Contact the treatment program and tell them to call Millie's father.,"You can tell him she is in detox within the state, but not the name of the facility.","(A): Call the father back to apologize and explain why you cannot tell him.
(B): HIPAA prevents you from divulging this information, so you do not call back.
(C): Contact the treatment program and tell them to call Millie's father.
(D): You can tell him she is in detox within the state, but not the name of the facility.",Contact the treatment program and tell them to call Millie's father.,C,"This is the most helpful option as Millie's counselor because, while HIPAA does not permit you to divulge the information to her father since she is 18 years old and did not sign the consent form you provided, you can help facilitate communication with the family by letting the facility know the family is trying to make contact. It will be up to her new facility to then work with Millie on signing a release form and communicating with her father. Calling the father back only to tell him you cannot help him is still violating the boundaries of HIPAA since Millie did not sign consent for you to communicate with him. Simply ignoring the voicemails altogether without further action as in answer a is neglectful of the family's needs, even if you are unable to influence the outcome of their contact. Therefore, the correct answer is (D)",professional practice and ethics
1383,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",The client indicates she has trouble managing her emotions and is using self-harm as an outlet for her feelings of guilt and shame. This is also leading to the deterioration of her relationships with others. What should you consider first with the client during this first session?,Creating a structure for the client's therapy sessions,Addressing the client's difficulty with trust,Explore the reasons for the client's self-mutilating behaviors,Identifying the client's source of feeling dissatisfied with herself and others,"(A): Creating a structure for the client's therapy sessions
(B): Addressing the client's difficulty with trust
(C): Explore the reasons for the client's self-mutilating behaviors
(D): Identifying the client's source of feeling dissatisfied with herself and others",Addressing the client's difficulty with trust,B,"Developing a trusting rapport with the client is key to having a successful initial session. This is especially true if the client has trust issues, as progress in therapy will be severely hampered without a strong foundation of trust between therapist and client. During the initial session, the therapist must strive to create a safe and secure relationship with the client. Therefore, the correct answer is (B)",counseling skills and interventions
1384,Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual,"Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.","Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.",,?When the counselor responded “It sounds like you have told your story many times…” she was utilizing?,Reflection of feeling,Paraphrasing,Focusing,Clarification,"(A): Reflection of feeling
(B): Paraphrasing
(C): Focusing
(D): Clarification",Paraphrasing,B,"Paraphrasing can be used to reiterate or clarify information. It shows the client that the counselor is listening and understands what they said. Clarification is asking the client to confirm what they said or a counselor's interpretation of what they said. A reflection of feeling focuses on the feelings of the client. In this instance there was no feelings mentioned. Focusing is a technique that happens internally where they consciously direct their attention to something in the session. Therefore, the correct answer is (C)",counseling skills and interventions
1385,Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3),"Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea","You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.","   ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression.  You tell the client, “Imagine waking up one morning and a miracle had occurred. You notice that your problems ceased to exist","You tell the client, “Imagine waking up one morning and a miracle had occurred. You notice that your problems ceased to exist. What would this look like for you?” This technique is associated with which one of the following?",SFBT,REBT,DBT,Person-centered therapy,"(A): SFBT
(B): REBT
(C): DBT
(D): Person-centered therapy",SFBT,A,"SFBT is a short-term, solution-oriented approach used to help clients improve motivation and make measurable behavioral changes. The “miracle question” is a solution-focused technique that helps clients envision their future without the problem. Person-centered therapy uses the core facilitative conditions of unconditional positive regard, empathy, and genuineness. REBT is based on the assumption that irrational or self-defeating beliefs help the client stay “stuck” and serve as barriers to change. DBT is a type of CBT that involves teaching the skills of mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Therefore, the correct answer is (A)",counseling skills and interventions
1386,"Name: Chad Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.2 Bulimia Nervosa, Moderate Age: 16 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client is appropriately dressed but disheveled. He is dressed in clothes associated with anime characters. Concentration is drifting. His speech is somewhat low, and he keeps his head low to avoid making eye contact with you. His mood is anxious. There is no suicidal ideation. Thought content shows no current homicidal ideation or plans. Thoughts are appropriate. The estimated level of intelligence is in the low average range with abstract thinking.","First session You are a mental health therapist who works for an agency specializing in helping teens with eating disorders. The client is 16 years old. He presents for therapy along with his mother. You start by welcoming both of them into your office. Then you introduce yourself, explain your role as a therapist, and briefly describe the experience you have in treating eating disorders. Next, you ask the client to explain and his mother to share with you why they came to see you today and what their expectations are for therapy. The mother begins by telling you, ""My son is doing dangerous things to his body. He needs help, but he won't listen to me."" The client rolls his eyes and replies, ""She doesn't get it. Look at her. She's fat and is always overeating!"" His mother's face turns red and she starts to yell at him. You remain neutral and ask them both take a few deep breaths and give each other some space. You explain that your goal is to create a trusting relationship with the client and his mother so that you can start working together towards understanding the issues that bring them to counseling and how to best help. You ask the mother to take a seat in the waiting room while you speak with her son for the first part of the session. She reluctantly agrees and leaves the room.    Once the mother leaves, you start by letting the client know that you understand that this situation is difficult, and that you are here to help. You focus on building rapport with the client, emphasizing that you are here to help him. You ask him open-ended questions to get to know more about him, and to help him feel seen and understood. You acknowledge the client's feelings of being misunderstood and provide empathy by validating that it must feel difficult not having his mother understand what he is going through. You also recognize his mother’s concerns by saying, ""It sounds like your mom is really worried about you."" He tells you that his mother is constantly trying to control him and that he does not understand why she is always so angry all the time. You continue your assessment with structured questioning to understand the client’s current experiences with food, including what he likes to eat and how often he eats. At the end of your discussion with the client, you thank him for being open and honest with you. You acknowledge how brave it is to come in and start talking about his experiences. You invite him to bring his mother back in to the office so you can start working together and discuss the next steps.  Fourth session It has been three weeks since the first counseling session, and you have agreed to meet for weekly sessions. You have been able to develop a positive rapport with the client, and he arrives to the scheduled session on time. When you ask him how he has been feeling, he tells you that he has been experiencing some anxiety. He has been having trouble sleeping and difficulty concentrating. He tells you that during his last cheerleading routine at a football game, he froze up and forgot what to do. You ask him if his anxiety may have anything to do with being bullied years ago. He tells you, ""I don't wanna talk about that. My anxiety is about cheerleading. Ugh! Haven't you been listening to what I've been saying?"" You remain calm and acknowledge the client's frustration. You reply, ""You're angry with me because you feel that I'm not listening. Am I hearing you right?"" He glares at you. You apologize, saying that you are sorry that something you said made him upset and ask him to tell you more about his anxiety.    The client takes a few deep breaths and begins to tell you about the anxiety he feels towards cheerleading. He mentions that his mother used to be a cheerleader and she often tries to relive her glory days through him. He tells you he feels like his mother is always pushing him to do more and be better, but ""she just doesn't get how hard it is for me."" He also talks about feeling guilty when he fails to meet her expectations. You respond by saying, ""It sounds like there's a lot of pressure on you from your mom. How do you cope with these expectations?"" He says that he has been trying to distract himself from his feelings by watching television, playing video games, and eating. You take a moment to process this information and validate his feelings. You and the client agree to explore some healthier coping strategies, along with continuing to build a stronger connection between him and his mother. You also discuss the importance of having a support system of people who can lend an ear when he needs someone to talk to and provide emotional support."," The client does well in high school. He is concerned that he could quickly gain weight and no longer be in optimum shape for cheerleading and gymnastics. The client's self-esteem is closely related to his weight and body image, and he appears to lack insight into the dangers of his current eating behaviors. Stressors & Trauma: The client tells you throughout elementary school he was overweight. As a result, he was bullied by other boys and girls alike. They would leave notes on his desk saying ""fatty"" or ""crispy crème."" One student pushed him down in the schoolyard, and all the others stood in a circle around him and laughed as the client cried. Pre-existing Conditions: No significant medical issues were reported based on his last medical exam. He does, however, admit to eating four hamburgers and a large bag of French fries at a fast-food restaurant ""as a treat"" about four or five times a week. He shares that after these fast food ""splurges,"" he goes home and purges to not gain weight. Feeling guilty after each episode, he does not eat anything the next day and doubles his workout routine. ",How can the client develop a support network to help with his disorder?,The client should be provided with information about eating disorder groups in the area for people his age.,The client cannot develop a support system for his disorder until he accepts that it is a problem.,The client should be encouraged to reach out to his church friends to provide support.,The client should be encouraged to connect with his school friends to provide support.,"(A): The client should be provided with information about eating disorder groups in the area for people his age.
(B): The client cannot develop a support system for his disorder until he accepts that it is a problem.
(C): The client should be encouraged to reach out to his church friends to provide support.
(D): The client should be encouraged to connect with his school friends to provide support.",The client cannot develop a support system for his disorder until he accepts that it is a problem.,B,"Since the client is in denial and does not believe he has a problem, support for bulimia is not possible. Therefore, the correct answer is (B)",counseling skills and interventions
1387,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.  Fifth session The client has been seeing you for individual therapy sessions every week. You have developed a strong rapport with her and collaborated on treatment goals, with her overall goal being to have a positive outlook on her life. During the last session, you gave her a homework assignment to begin keeping a journal, using the ABC model of rational emotive behavior therapy to identify self-defeating beliefs and understand how they are contributing to her emotional distress. You have also been working with her to process her feelings about her separation and develop coping skills.    During today's session, she seems depressed, as she tells you her husband met with an attorney and officially filed for divorce. You explore her journal entries, noting one in particular in which she describes an experience in which she was driving and saw her husband sitting outside a café with ""the other woman."" She circled back a few times in her car, hoping he would see her. In her mind, she fantasized that he would leave his new girlfriend and drive away with her, and everything would return to normal. You ask her to tell you more about what ""normal"" means to her. She says, ""I guess I just want things to go back to how it was before. When I mattered, when I felt loved, and when he was committed to our marriage."" You acknowledge her feelings and explain that while it may not be possible to go back to exactly how things were, there is still hope for the future. You express compassion and understanding, emphasizing that there is no right or wrong way to feel. She states, ""I just have mixed feelings about everything! I feel angry and betrayed by my husband, but sometimes I want him to come back. I start to feel lonely and realize the reality of my situation and that I have no purpose anymore and am alone. What's the point? My kids don't care; I have nothing in my life now. Things are so painful I'd be better off dead."" You reassure her that you are here to support her as she works through all of her difficult emotions.",,"Using an REBT approach, what irrational belief does the client hold that you plan dispute during therapy?","""Nothing I do is ever good enough.""","""I am undeserving of love and happiness due to this separation.""","""I must be loved and accepted by my husband in order to have value.""","""I must always be strong and never show my emotions.""","(A): ""Nothing I do is ever good enough.""
(B): ""I am undeserving of love and happiness due to this separation.""
(C): ""I must be loved and accepted by my husband in order to have value.""
(D): ""I must always be strong and never show my emotions.""","""I must be loved and accepted by my husband in order to have value.""",C,"This is an irrational belief because it suggests that the client's self-worth is inextricably linked to her relationship with her partner and his actions. This type of thinking fails to recognize that being single does not diminish her value and worth as a person, and should be addressed during the therapeutic process. Therefore, the correct answer is (C)",counseling skills and interventions
1388,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","The client comes to the counseling center during walk-in hours. The client is continuing to experience a manic episode. She reports that she went out to dance with friends the previous evening and ended up buying a gram of cocaine for $100 and reported doing several lines throughout the night. The client says that she has never used any drugs before and that it scared her that she would spend that much money on drugs and that she used drugs at all. You empathize with the client’s frustration with her behavior and provide psychoeducation on impulse control to support her. The client appears tired as evidenced by her affect and slow movements, and she also appears to have poor hygiene because her clothes have visible stains and she has a slight body odor",Which one of the following assessments will assist you in monitoring the severity of the client’s manic episode?,Brief Symptom Inventory,General Behavior Inventory,Patient Health Questionnaire 9 (PHQ-9),Minnesota Multiphasic Personality Inventory (MMPI-2),"(A): Brief Symptom Inventory
(B): General Behavior Inventory
(C): Patient Health Questionnaire 9 (PHQ-9)
(D): Minnesota Multiphasic Personality Inventory (MMPI-2)",General Behavior Inventory,B,"The General Behavior Inventory assesses the presence and severity of manic and depressive symptoms; therefore, it is the most appropriate tool for monitoring the severity of the client’s symptoms. The MMPI-2 can support a bipolar I or II diagnosis, but it would not be beneficial in regularly measuring the severity of symptoms. The PHQ-9 is the major depressive disorder portion of the full PHQ that can help with the diagnosis and measurement of depressive symptom severity over time. The Brief Symptom Inventory measures many areas of symptomatology and may be useful in providing support for a bipolar diagnosis, but it does not provide measurement for the severity for manic episodes. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1389,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing.  You suspect that the client might have depression","You suspect that the client might have depression. Which one of the following statements is a helpful cognitive reframing of the client’s statement of “I will get frustrated and won’t enjoy playing guitar, so I won’t play at all”?","“I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.”","“I should wait until tomorrow, and I’ll play guitar at 6 pm after dinner.”","“I might enjoy playing guitar; therefore, I’ll try to play for a few minutes.”","“I will play guitar when I’m ready, which is when I feel a bit more motivated.”","(A): “I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.”
(B): “I should wait until tomorrow, and I’ll play guitar at 6 pm after dinner.”
(C): “I might enjoy playing guitar; therefore, I’ll try to play for a few minutes.”
(D): “I will play guitar when I’m ready, which is when I feel a bit more motivated.”","“I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.”",A,"When considering depression, activities often seem like they will not be as enjoyable as they are in reality; therefore, it is important to try them anyway. When using cognitive reframing, it is important to consider the notion that if no changes are made, things will remain the same. Encouraging the client to remind himself that he may enjoy the simple process of playing guitar is not as relevant because it does not account for the client’s ability to effect change. The notion that the client should wait until he is “ready to play” allows space for him to find excuses not to play if he is struggling with the impacts of depression and ADHD. Although creating a plan to complete a goal can help the client in goal achievement, it likely will not empower the client to manage his present emotions and thoughts. Therefore, the correct answer is (D)",counseling skills and interventions
1390, Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual,"Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.","Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.","Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.","Interventions, teaching deep breathing, thought stopping techniques and restructuring of negative thoughts all describe which treatment plan objective?",Malik will be able to list 5 triggers and 5 coping skills to ameliorate distress.,"Malik will explore, discuss, and process experiences of trauma.",Malik will learn how to apply mindfulness and CBT when experiencing anxiety.,Malik will identify at least three needed areas of improvement and verbalize them.,"(A): Malik will be able to list 5 triggers and 5 coping skills to ameliorate distress.
(B): Malik will explore, discuss, and process experiences of trauma.
(C): Malik will learn how to apply mindfulness and CBT when experiencing anxiety.
(D): Malik will identify at least three needed areas of improvement and verbalize them.",Malik will learn how to apply mindfulness and CBT when experiencing anxiety.,C,"Deep breathing is a supportive mindfulness intervention that helps clients reduce anxiety independently. Thought stopping and cognitive restructuring techniques are also significant interventions used for avoiding instances of anxiety and panic or developing long-term patterns of resolving anxiety-provoking thought patterns. Answers a, b and d are all effective objectives to include in Malik's treatment plan but only answer c accurately reflects the objective that would match the listed interventions. Therefore, the correct answer is (C)",counseling skills and interventions
1391,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.  Third session During the previous session, you met with the client and his father. You recommended meeting with the client for weekly individual sessions with parental check-ins periodically. Today, you are seeing the client by himself. You use a video game to attempt to engage with the client; he is responsive. While the client is playing the video game, you proceed to gather information. You determine that his major difficulty is his struggle with rule inconsistencies between his parents' homes. He says that his father allows him more freedom than his mother, which results in frequent arguments. When the client is at his father's house, he is allowed to stay up later and watch television for longer periods of time. His mother has stricter rules about bedtime and screen time, which creates tension between the client and his father when he visits his mother's home. The client struggles with navigating these different expectations from both of his parents, leading to feelings of confusion and depression. Additionally, the client expresses frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home due to their lack of acceptance toward him. The client tells you that his soon-to-be step-siblings are ""mean"" and tease him. He tells you that sometimes he thinks about running away and fantasizes that he has a special power like ""The Flash, the superhero who is the fastest human on Earth."" You validate his feelings and share a brief personal story with him about who your favorite superhero was when you were his age.    You explain to the client that it is important for him to understand his emotions, and help him think of healthy ways to cope with them. You mention the idea of him joining the school track team. The client appears excited about your suggestion. You also explain how communication is key in creating successful relationships. Since he is feeling overwhelmed by all the rule inconsistencies between his parents' homes, you suggest developing a consistent rule system with both of his parents. This way, the client can feel secure in knowing what kind of behaviors are expected from him regardless of which home he visits.    You observe the client as he processes all that you have discussed during the session. You encourage him to continue talking and share his thoughts with you. He acknowledges that it is difficult for him to switch between his parents' homes, but he feels a little more hopeful after talking with you today. You remind him of the importance of communication, expressing his needs in a respectful manner, and maintaining healthy boundaries with others.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ","As you develop a treatment plan, what do you identify as a significant barrier that must be addressed in order for therapy to be effective?",The client's difficulty in communicating his needs and feelings,The client's struggle with navigating different expectations between his parents' homes,The client's tendency to fantasize about having special powers,The client's frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home,"(A): The client's difficulty in communicating his needs and feelings
(B): The client's struggle with navigating different expectations between his parents' homes
(C): The client's tendency to fantasize about having special powers
(D): The client's frustration over feeling like an unwelcome guest in his soon-to-be step-family members' home",The client's struggle with navigating different expectations between his parents' homes,B,"This is a treatment barrier as the client has difficulty transitioning between the two households and understanding how to behave in each home, which affects his ability to make positive changes in his life and engage in therapy. The therapist can provide guidance and support to help him navigate these expectations. By doing so, the client may be able to make progress in his therapeutic goals. This is an important step in helping the client address both his internal and external challenges. Therefore, the correct answer is (A)",counseling skills and interventions
1392, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.",Which presenting problem would you begin to assess first and which corresponding tool would you administer?,suicidal thoughts; HDRS,suicidal thoughts; C-SSRS,panic attacks; PDSS,panic attacks; BAI,"(A): suicidal thoughts; HDRS
(B): suicidal thoughts; C-SSRS
(C): panic attacks; PDSS
(D): panic attacks; BAI",suicidal thoughts; C-SSRS,B,"Suicidal ideation must always be prioritized in the assessment phase of counseling as results may lead towards higher levels of care needed. The C-SSRS (Columbia-Suicide Severity Rating Scale) is the best evidence-supported tool to assess the client's needs most quickly and thoroughly. Once a client is cleared for continuing the session safely, especially while in a telehealth session, other areas like panic can then be addressed. If the client is rated high risk for suicidality, the content of the session might then shift towards making referrals either for in-person care or possibly inpatient psychiatric services. The HDRS (Hamilton Rating Scale for Depression), PDSS (Panic Disorder Severity Scale), and the BAI (Beck Anxiety Inventory) are all helpful tools that can be utilized in the assessment phase or as part of an ongoing treatment plan goal to further identify and define areas of need; they are however not considered the best options for crises interventions or specifically ruling out suicidality as the C-SSRS measures and informs history and present indicators of ideations, plans, intent and actual suicidal attempts. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1393,Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional,"Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express","You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.","The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex","Based on the client’s presenting problems, all of the following would be a beneficial intervention for the girlfriend to use to support the client during sex EXCEPT:",Positive affect,Eye contact,Comfort with silence,Immediacy behaviors,"(A): Positive affect
(B): Eye contact
(C): Comfort with silence
(D): Immediacy behaviors",Comfort with silence,C,"Although comfort with silence can be a positive trait in a relationship, the client is still working through addressing negative self-talk and it would likely increase anxiety if silence is uncomfortable for him. Immediacy behaviors would involve the client’s girlfriend responding to what she sees the client experiencing either through reassuring statements, questions, or behaviors. Positive affect promotes a more positive environment and would likely result in a more positive experience. Eye contact demonstrates that she is present with him and attentive to him and would also promote a positive experience. Therefore, the correct answer is (C)",counseling skills and interventions
1394,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","   ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer",Which one of the following DSM-5-TR criteria is indicative of agoraphobia?,Fear of being trapped in situations in which escape is perceived as unlikely,Fear of being judged in social situations,Fear of parting with possessions despite excessive acquisition or clutter,Fear of being separated from an attachment figure,"(A): Fear of being trapped in situations in which escape is perceived as unlikely
(B): Fear of being judged in social situations
(C): Fear of parting with possessions despite excessive acquisition or clutter
(D): Fear of being separated from an attachment figure",Fear of being trapped in situations in which escape is perceived as unlikely,A,"Fear of being trapped in situations in which escape is perceived as unlikely is a DSM-5-TR criterion for agoraphobia. Separation anxiety disorder is characterized by separation from an attachment figure. The fear of being judged in a social situation is associated with social anxiety disorder. Hoarding disorder involves the fear of parting with possessions despite excessive acquisition or clutter. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1395, Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual,"The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.
","Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.",,An assessment that would be most beneficial to gain initial information is?,Adult Behavior Checklist,Myers-Briggs Type Indicator,Strong Interest Inventory,NEO Personality Inventory,"(A): Adult Behavior Checklist
(B): Myers-Briggs Type Indicator
(C): Strong Interest Inventory
(D): NEO Personality Inventory",Adult Behavior Checklist,A,"The Adult Behavior Checklist (ABCL) is a brief, self-report checklist in which someone selects whether he/she is having difficulty in the areas of attention, mood, conduct, anxiety and worry. This would be an appropriate and non-invasive assessment for Darrel to complete. If it is indicated that Darrel is indeed unsure of his career path, the Strong Interest Inventory can help Darrel match his interests with potential education, career, and leisure activities. The Myers-Briggs Type Indicator is used to evaluate personality types to help clients better understand themselves including learning style, social interaction styles, which occupational path they may be suited for, or insight into their behaviors. The NEO is another personality inventory widely used in career and individual counseling, career development and employee training. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1396,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning",With which of the following would there be a beneficial collaboration that would require a release of PHI?,Psychiatrist,Parents,PCP,Disability resource center,"(A): Psychiatrist
(B): Parents
(C): PCP
(D): Disability resource center",Disability resource center,D,"The school’s disability resource center would be helpful in seeking accommodations for the client in her classes. The Americans with Disabilities Act covers most mental health disorders and could assist the client with maintaining academic progress while she is working through starting to manage bipolar disorder. The client does not currently see a psychiatrist and also has not mentioned her PCP and does not appear to see them in any way that would require collaboration. Collaboration with the client’s parents is not indicated because the client is currently living at school away from her parents. Therefore, the correct answer is (A)",professional practice and ethics
1397,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.",Which treatment plan goals must be included in Shania's chart?,alcohol dependence and cocaine use,anxiety and trauma,all disorders listed must be treated,depression and anxiety,"(A): alcohol dependence and cocaine use
(B): anxiety and trauma
(C): all disorders listed must be treated
(D): depression and anxiety",depression and anxiety,D,"While all disorders may be noted in a client's chart, not all conditions qualify for working on goals in outpatient counseling. Because of the nature of a substance use disorder, when a client is actively using or has not reached remission status, it is presumed to be addressed in a substance use facility. Once the substance use moves into remission and the client is being seen in an outpatient counseling agency, that agency will have no need to directly address an active substance use disorder but will be treating mental health and subsequent effects of past substance use. Additionally, a client may have other listed disorders or conditions that can be labeled as ""referred"" or ""deferred"", not necessitating direct treatment either. But because Shania's depression and anxiety are listed disorders and are complications of past trauma, these two at least need to be included in the treatment plan. Therefore, the correct answer is (C)",treatment planning
1398,"Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate","Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent","You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”","The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. You address her ambivalence to change, as well as obstacles she has experienced in the past. When discussing exercise, the client states, “You don’t understand! I’ve tried exercise, and it never works.” You provide the client with self-monitoring sheets to record the following in real-time: daily food intake, maladaptive eating patterns, and thoughts and feelings that accompany binge eating. She is hesitant but agrees to give it a try for one week.  After her setback, the client states, “I’ll never control my eating","After her setback, the client states, “I’ll never control my eating.” Which of the following maladaptive styles of thinking is reflected in the client’s statement?",Self-fulfilling prophecy,Dichotomous thinking,Catastrophizing,Overgeneralization,"(A): Self-fulfilling prophecy
(B): Dichotomous thinking
(C): Catastrophizing
(D): Overgeneralization",Overgeneralization,D,"Overgeneralization is a maladaptive thinking style that uses one event to create a sweeping rule for all other situations. This is reflected in the client’s statement: “I’ll never be able to control my eating” The setback is one event, and the general rule for the client is that this setback means the client will never succeed at controlling her eating. Catastrophizing occurs when a person embellishes a situation in such a way that the outcome is exaggerated. (Eg, “This setback means I’m a failure at life!”) Dichotomous thinking, or black and white thinking, occurs when one engages in all-or-nothing beliefs. (Eg, “I binged after breakfast. My whole day is ruined”) Self-fulfilling prophecy is used when making future predictions and then acting in ways that guarantee the prediction comes true. (Eg, “I’ll always be defined by my weight”). Therefore, the correct answer is (B)",counseling skills and interventions
1399,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group, and they appear to be starting to become more comfortable with one another. You noticed that throughout the past week, when you saw your clients on their unit, they were spending more time together and that they are all talking when they come in for the session. During the session, you and the clients discuss past experiences that led to them engaging in the crimes that led to their incarceration. During this conversation, client 1 is talking about his father and how he killed a pedestrian while driving. Client 4 then asserts that client 1’s father is going to hell for killing someone. You cut off client 4 and redirect the attention back to client 1",Which of the following would demonstrate appropriate use of “cutting off” for client 4?,Ignore what was said by client 4 because you do not want to give it attention and reinforce his desire for conflict.,Remind client 4 that what he said was against the goals of the group and that he might be asked to leave if he continues.,Engage with client 4 in conversation about the beliefs he holds and then return to client 1.,Tell the client that what he said was not helpful or supportive regarding the goals of the group and then encourage client 1 to continue.,"(A): Ignore what was said by client 4 because you do not want to give it attention and reinforce his desire for conflict.
(B): Remind client 4 that what he said was against the goals of the group and that he might be asked to leave if he continues.
(C): Engage with client 4 in conversation about the beliefs he holds and then return to client 1.
(D): Tell the client that what he said was not helpful or supportive regarding the goals of the group and then encourage client 1 to continue.",Tell the client that what he said was not helpful or supportive regarding the goals of the group and then encourage client 1 to continue.,D,"Cutting off would be telling client 4 that what he said was not acceptable in the group setting and then redirecting back to client 1. Engaging with client 4 about his beliefs would likely cause more harm, and this would not be a helpful intervention. You should not ignore client 4’s statements because you want to support client 1 and set a precedent for what is acceptable in the group. Telling client 4 that what he said was against the group goals is helpful; however, threatening expulsion from the group does not support client 4 and might not be indicated at this point. Therefore, the correct answer is (C)",counseling skills and interventions
1400,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","   e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family",Which one of the following anxiety rating scales includes a version that allows a parent to fill out scales on their child?,The Generalized Anxiety Disorder-7 (GAD-7),Hamilton Anxiety Rating Scale (HAM-A),Patient Health Questionnaire (PHQ-9): Parent Report,The abbreviated Conners Parent Rating Scale (CPRS-HI),"(A): The Generalized Anxiety Disorder-7 (GAD-7)
(B): Hamilton Anxiety Rating Scale (HAM-A)
(C): Patient Health Questionnaire (PHQ-9): Parent Report
(D): The abbreviated Conners Parent Rating Scale (CPRS-HI)",The Generalized Anxiety Disorder-7 (GAD-7),A,"The GAD-7 is an anxiety rating scale that includes an instrument for use with adolescents and a version that allows a parent to fill out scales on their child. The GAD-7 is a seven-item self-administered instrument used to identify some of the criteria for general anxiety disorder and to determine symptom severity. The CPRS-HI is a questionnaire that asks parents about symptoms related to attention-deficit hyperactivity disorder. There is also a version for teachers. The HAM-A is a 14-item scale that measures the severity of anxiety symptoms. It does not have a version for parents to complete on their child. The PHQ-9: Parent Report is used to measure depression rather than anxiety. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1401,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest.  The client has recently become eligible for special education services, including an Individualized Education Program (IEP)","The client has recently become eligible for special education services, including an Individualized Education Program (IEP). Which one of the following federal laws mandates that an IEP must be completed within 30 days of eligibility?",Title VII of the Civil Rights Act of 1964,Section 504 of the Rehabilitation Act of 1973,Individuals with Disabilities Education Act (IDEA),Title II of the Americans with Disabilities Act (ADA),"(A): Title VII of the Civil Rights Act of 1964
(B): Section 504 of the Rehabilitation Act of 1973
(C): Individuals with Disabilities Education Act (IDEA)
(D): Title II of the Americans with Disabilities Act (ADA)",Individuals with Disabilities Education Act (IDEA),C,"For students in institutions receiving federal funding, three federal laws protect the rights of students with disabilities: IDEA, Section 504 of the Rehabilitation Act of 1973, and Title II of the ADA. Of the three, IDEA is the only law that mandates an IEP (to be completed within 30 days of eligibility) to provide a free appropriate public education in the least restrictive environment. An IEP is a written document that identifies the specialized instruction and servicesthat an individual receives. Section 504 of the Rehabilitation Act of 1973 is a civil rights law, as opposed to IDEA, which is a federal special education law. Section 504 offers accommodations for students with a mental or physical impairment that interferes with their learning. The ADA offers civil rights protections for all individuals with disabilities. Title VII of the ADA prohibits state and local governments from discrimination, which applies to federally funded public schools. Therefore, the correct answer is (B)",professional practice and ethics
1402,"Name: Anxiety Group Therapy Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.1 Generalized Anxiety Disorder Age: 0 Sex Assigned at Birth: Female Gender and Sexual Orientation: Not applicable, Ethnicity: Various Marital Status: Not Applicable Modality: Group Therapy Location of Therapy : Agency  ",The group members appear to be insightful about their illness. Clients ages are 25 and older. All members are well-groomed and present with clean hygiene.,"First session You are a therapist in an agency starting a group for clients with anxiety. The group will consist of seven participants. It is a homogeneous, closed group which will meet once a week on Wednesday evenings for an hour and a half for twelve weeks. The group's goal is to help clients diagnosed with Generalized Anxiety Disorders and other anxiety-related issues. An intern will co-facilitate the group with you. You are forming an outline for the group's goals, screening questions, and termination process. You will be observing candidates for the group to facilitate participant selection.  Fourth session All seven members have been coming to your group for three weeks. The group is made up of married, single, and divorced females. Some have children and some do not. Ages range from 25 to 33 years old. It is multiculturally diverse. As group sessions progress, you note that some group members are starting to take risks, while others are still not fully trusting you and the group's co-facilitator. Most of the clients generally worry about their family and loved ones. Some are more afraid of getting ill and dying because of COVID-19. You lead the group in a guided meditation before you start making the rounds to calm everyone down and have them feel centered.  Sixth session You and your intern, who has never facilitated a group, meet five weeks after intake with the group members. One of the members shows up late to the group despite knowing the norms and rules. This member is from a Hispanic background. One of the other members, an African-American woman, says angrily, ""You're wasting our time when you arrive late to every session. We have to pause for you. I have anxiety and need help. If you do not need help from the group, why don't you leave!"" The Hispanic woman starts to cry and says, ""Mind your business. I'm taking care of my dying mother and also have anxiety, so shut up!"" You have to intervene as other members are getting frazzled and upset. You ask the intern to carry on with the group as you ask the two members to step outside.",,Which therapeutic approach may work best with a group whose members are working on anxiety issues?,Jungian therapy,Cognitive-behavioral therapy,Contextual therapy,Existential therapy,"(A): Jungian therapy
(B): Cognitive-behavioral therapy
(C): Contextual therapy
(D): Existential therapy",Cognitive-behavioral therapy,B,"The basis of this therapy is that thoughts drive one's feelings and behaviors rather than external events, people, or circumstances. As one changes, therefore, thoughts can feel better despite the situation or what one does or does not control. This is most helpful. Therefore, the correct answer is (B)",treatment planning
1403,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.  Tenth session It's been two and a half months since you first started seeing the client for weekly therapy sessions. Today, your client appears calm and relaxed. You review her progress and highlight her areas of growth since the start of therapy. The client states that she feels more empowered to challenge her negative thoughts and is able to recognize when her anxiety is beginning to spiral. She has been using the coping skills she learned in the previous sessions to manage her stress levels more effectively. The client also reports a weight loss of 5 pounds since beginning therapy, which she is pleased with and attributes to the mindfulness techniques she has been practicing. You discuss her weight loss and the importance of mindful eating practices. You explain to the client that weight loss is a secondary outcome of therapy and that it is more important to focus on living a healthy lifestyle than a number on a scale. The client expresses her understanding and appreciation for the guidance.    When you ask her to rate her level of anxiety, she indicates that she is much less anxious than when she first started therapy. Her preoccupation with illness has decreased, though it has not gone away completely. She reports that her colleagues have noticed the change in her attitude and confidence. She is able to stay present and focus on her job, without constantly worrying about negative judgement from her co-workers. She tells you that she has been keeping up with the journaling homework that you assigned in a previous session and it has been a helpful outlet for her to express her thoughts. She has also been practicing progressive muscle relaxation during her breaks at work and after she gets home in the evenings. The client is still drinking wine to help her relax, but you have determined that her alcohol use does not warrant clinical intervention. You discuss spacing out your sessions and she agrees to try meeting with you twice a month. At the end of the session, she asks if you could email her a copy of her therapy records so that she can refer back to them periodically in order to continue making progress.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",How would you best demonstrate active listening skills in this session?,"""From what you have told me and what I've observed in our sessions, you've made some significant progress in therapy. How would you feel about spacing out our sessions?""","""It sounds like you're doing really well. You must be proud of yourself for all of your hard work!""","""That's great that you've lost weight. I know it's been a struggle for you, and I'm glad the mindfulness exercises have been so helpful.""","""I'm glad to hear that your anxiety has decreased and that you've been able to stay present at work. You sound relieved that you can focus on your job without worrying about judgement from others.""","(A): ""From what you have told me and what I've observed in our sessions, you've made some significant progress in therapy. How would you feel about spacing out our sessions?""
(B): ""It sounds like you're doing really well. You must be proud of yourself for all of your hard work!""
(C): ""That's great that you've lost weight. I know it's been a struggle for you, and I'm glad the mindfulness exercises have been so helpful.""
(D): ""I'm glad to hear that your anxiety has decreased and that you've been able to stay present at work. You sound relieved that you can focus on your job without worrying about judgement from others.""","""I'm glad to hear that your anxiety has decreased and that you've been able to stay present at work. You sound relieved that you can focus on your job without worrying about judgement from others.""",D,"Active listening is an important part of any therapeutic session. It involves showing empathy, understanding and respect for the client by actively attending to their verbal and non-verbal communication. When using active listening, the therapist paraphrases what the client has said, mirrors their emotions and shows non-judgmental interest in their experience. Therefore, the correct answer is (C)",counseling skills and interventions
1404, Initial Intake: Age: 20 Gender: Male Sexual Orientation: Homosexual Race/Ethnicity: African American Relationship Status: Single Counseling Setting: University counseling center Type of Counseling: Individual,"Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.","Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.","Education and Work History:
Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.
 
Current Living Situation:
Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.",Why is anxiety disorder listed as primary before major depression?,Anxiety is the primary underlying stressor,You cannot work on depression before anxiety,Anxiety is more clinically serious,Diagnoses must be listed alphabetically,"(A): Anxiety is the primary underlying stressor
(B): You cannot work on depression before anxiety
(C): Anxiety is more clinically serious
(D): Diagnoses must be listed alphabetically",Anxiety is the primary underlying stressor,A,"Anxiety is the underlying condition which exacerbates Jonny's ability to cope, which the develops into a depressive state. Jonny has no evidence in this case of experiencing depression isolated from heightened anxious states. It is assumed that if anxiety is properly treated, depressive episodes will be eliminated or reduced. Answers a) through c) are incorrect statements. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1405,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",Which is the most effective strategy to increase the parents' feelings of empowerment?,Family dynamics training,Parent education programs,In-home intervention by a specialist,Medical referral,"(A): Family dynamics training
(B): Parent education programs
(C): In-home intervention by a specialist
(D): Medical referral",Parent education programs,B,"Such programs have been shown to reduce parental anxiety and increase parental feelings of empowerment. Therefore, the correct answer is (B)",counseling skills and interventions
1406, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,"When Autumn sat down, she noticed some files of some other students in front of the counselor. Autumn suddenly stated that she had to go and left the counselor's office. Although Autumn could only read the names and not see the content of the files, this is a violation of the ethical code regarding?",Confidentiality,Providing information to third parties,Supervision,Trust,"(A): Confidentiality
(B): Providing information to third parties
(C): Supervision
(D): Trust",Confidentiality,A,"The counselor seems to have violated the confidentiality of other students which goes against the ethical codes B1c. Respect for Confidentiality and B6b Confidentiality of Records and Documentation. Although this may be an issue to be addressed in supervision, it is not a violation of supervision standards. Providing information to third parties sometimes occurs when information is requested by third party payors. This must be authorized by the client. Although there is not ethical code for trust, seeing the files on the counselor's might affect Autumn's feelings of trust. Therefore, the correct answer is (C)",professional practice and ethics
1407,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week.  The client’s parents have offered you dinner every week since you have started therapy with the client",The client’s parents have offered you dinner every week since you have started therapy with the client. All of the following are ethical considerations regarding gifts EXCEPT:,The reason the parents are offering the meal.,Accepting the meal may count as compensation to the clinician for services rendered.,Declining a meal might be offensive due to the client’s culture.,The monetary impact of accepting the meal.,"(A): The reason the parents are offering the meal.
(B): Accepting the meal may count as compensation to the clinician for services rendered.
(C): Declining a meal might be offensive due to the client’s culture.
(D): The monetary impact of accepting the meal.",Accepting the meal may count as compensation to the clinician for services rendered.,B,"Compensation for services would fall under the ACA Code of Ethics section on bartering rather than ethical considerations for gifts (ACA, 2104). Bartering would involve further consideration and planning to include a written contract and is not being demonstrated in the offering of a meal. It is important to consider the cultural implications of declining a gift if it negatively affects the counseling relationship. Monetary impact is important because you would not want to regularly accept meals if it puts a financial strain on your client’s family. It is also important to consider the motive for giving the gift because the parents may have expectations for a gift in return, which may complicate or strain the counseling relationship. Therefore, the correct answer is (A)",professional practice and ethics
1408, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,Carl and Lori have decided that they want to work out their marital issues. A technique that the counselor should not use is?,Allowing the couple to argue so they can release their feelings,Video tape couple's therapy sessions to playback,Behavioral therapy,A non-directive client Rogerian approach,"(A): Allowing the couple to argue so they can release their feelings
(B): Video tape couple's therapy sessions to playback
(C): Behavioral therapy
(D): A non-directive client Rogerian approach",Allowing the couple to argue so they can release their feelings,A,"It is important for the counselor to prevent the heightening of emotions to the point where therapy cannot be accomplished. If the counselor feels that tension is escalating to the point of an argument, the role of the counselor is to bring down the emotions and guide the couple to effective communication techniques. Additionally, it is to help the couple gain insight into their relationship patterns and to provide techniques to improve relationship functioning. By videotaping couple interactions and replaying this in sessions, couples gain more insight on how they may appear to the other person. Other couples may find a more non-directive approach useful, where the focus is on listening to one another and clarifying intention. Lastly, behavior therapy using positive reinforcement and rewarding behavior when one person in the couple does something that the other one finds positive may be effective. Therefore, the correct answer is (A)",treatment planning
1409,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.  Ninth session Logan arrives at the session a few minutes late and apologizes. He says that he was outside playing kickball with his class. He reports that he has been feeling better about being in school lately. His classmates are friendlier to him, or at the very least, ""they don't bother me so much,"" He is now eating lunch back in the lunchroom. He is learning to play soccer and plans to ask his parents if he can join the summer league. Next, you call Logan's mother and share his progress in counseling with her. Finally, you examine Logan's care plan and assess for any changes needed.    Logan's progress in counseling has been notable as he has demonstrated increased social engagement and involvement in extracurricular activities. It appears that the therapeutic interventions implemented have successfully addressed his initial concerns regarding social anxiety and peer relationships. In addition, Logan's newfound interest in soccer and desire to join a summer league further demonstrates his willingness to engage with peers and develop new skills.    In conversation with Logan's mother, you emphasize the importance of fostering a supportive home environment to encourage Logan's growth and self-confidence. The mother expresses gratitude for the improvements in her son's well-being and commits to facilitating Logan's involvement in the summer soccer league. Additionally, she agrees to maintain open communication with the counselor to address any potential concerns that may arise in the future.    Upon reviewing Logan's care plan, the counselor determines that the current therapeutic goals and interventions remain appropriate and relevant to Logan's ongoing progress. However, it may be beneficial to introduce supplementary strategies to further enhance his self-esteem and resilience and promote effective communication and problem-solving skills. By doing so, Logan will be better equipped to navigate any challenges that may emerge as he develops and maintains positive relationships with his peers.    After the session, you receive a phone call that your wife has passed away. In the midst of the sudden loss of your beloved wife, you find yourself struggling to maintain your usual level of composure, which is understandable, feeling overwhelmed and emotionally drained during this difficult time. Being a therapist, you recognize the weight of your emotional burden and decide to reach out to your supervisor to discuss your struggles. After a heartfelt conversation, you feel a sense of relief and connection with your supervisor, who has provided you with support and understanding.    As the conversation draws to a close, you make an unexpected request of your supervisor: that she attend your wife's memorial and wake so that she can meet your family and share in the memories of your loved ones. This request may seem a lot to ask, but you feel comforted by the thought of having someone close to you share in this challenging time. You also ask if she can take over your caseload as you deal with your wife's passing.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What are the steps in managing the transitional nature of terminating a client involved with bullying as they approach ending therapy?,Summarize where they were when they began therapy and the changes that have occurred.,Complete an overview of what they have learned and the changes they have accomplished.,Ask the client what they have learned and what aspects of their past history still need to be addressed.,Explore further problems they might encounter going forward as they progress.,"(A): Summarize where they were when they began therapy and the changes that have occurred.
(B): Complete an overview of what they have learned and the changes they have accomplished.
(C): Ask the client what they have learned and what aspects of their past history still need to be addressed.
(D): Explore further problems they might encounter going forward as they progress.",Complete an overview of what they have learned and the changes they have accomplished.,B,"Reiterate with this client to understand how this role of the victim impacts their lives and teach coping skills for moving forward, such as assertive communication and boundary-setting. In addition, some victims of bullying benefit from support groups or group therapy as a part of transitioning through therapy, in which people who have experienced similar types of victimization can support one another in healing. Therefore, the correct answer is (B)",counseling skills and interventions
1410,"Name: Timmy Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F84.0 Autism Spectrum Disorder, Level 2 Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Black Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","The client speaks using only a few words. There is no report of echolalia or other repetitive or overly formal use of language. You ask him to say ""hi,"" and he opens his mouth wide, smiles, and laughs. He sustains direct eye contact with you for about two seconds. When you ask him to show you where his mother is, he points to her, looks back at you, and begins to laugh again. There are no reported or observed preoccupations and no reported or observed sensory symptoms to date.","First session You are a mental health therapist in a school setting. The client is referred to you by your school district to complete an evaluation. The client and his mother enter the session. The mother is prompting the client in a ""toddler-like"" voice to sit in the seat. The mother tells you that the client is becoming increasingly ""violent"" in the home setting, and she and her husband are not equipped to teach their son the skills he needs to regulate his emotions. In addition, she states that he needs some social exposure to others. He is nonresponsive to subtle social cues and has difficulty when others cannot understand his needs. She states that they need professional help and requests assistance in getting him ""the education he deserves"". You listen carefully to the mother's concerns and ask additional questions about her son's behavior, both at home and in school, as well as any history of mental health treatment or diagnoses.    You explain to the client’s mother that you will provide an assessment of her son’s social and emotional needs and use evidence-based interventions to help him develop effective strategies for regulating his emotions and interacting with others. You review your therapy procedures in detail, including your expectations regarding how often the client and family should come for sessions and what to expect in terms of treatment outcomes. You also discuss any potential risks associated with therapy and the importance of open communication between family members, the client, and yourself during treatment. The mother expresses her understanding of your expectations and agrees to follow through with treatment. You encourage her to ask questions if she has any concerns or needs clarification about any part of the therapy process.  Fourth session You have arranged for the client to have a one-on-one aid at school. You review his progress with his team of teachers and give them necklaces with visual cues to help communicate with him. The aid brings the client in for his weekly session with you today. The client sits and stares. At times he will rock and make loud noises. You hand him a stress ball and model for him how to squeeze it. The client starts to giggle as he squeezes the stress ball. You show the client the picture of a person laughing. You clap for the client and tell him ""good job."" The client mimics you and starts to clap. You ask the client if he would like to try playing a game with you. He nods his head in agreement and looks at you with anticipation. You choose a simple matching game with different shapes, colors, and sizes. Through this game, you encourage him to take turns and practice communication skills. As the session progresses, you provide verbal praise for his efforts and watch as he slowly builds a sense of trust in you. You create opportunities for him to share small stories about himself and encourage him to express his feelings through drawings or writing exercises. Through these activities, you provide a safe and comfortable environment for him to explore his emotions and interact with others.    Following your session with the client, you contact his mother with an update on his progress. You discuss the importance of continuing therapy on a regular basis and explain what kinds of progress she can expect to see as time goes on. You also provide her with resources such as books, websites, and support groups that she can use to help reinforce the skills her son is learning in therapy. Finally, you outline a plan for continuing treatment and develop a timeline for when the family should check back in for sessions. The client's mother expresses her appreciation for your assistance and her agreement to follow through with the treatment plan.  Ninth session The client's one-on-one aide presents to this session with the client. The client is crying and having difficulties following the aid's directives in the hallway. You walk into the hall and show the client a picture with ""a quiet sign."" You open your door, and he reluctantly walks in and begins to kick the toy bins. You show him the ""no"" visual sign and shake your head no. You sit on the floor quietly until he joins you on the floor. You pull out a deck of visual cue cards and place them in front of him. He points to a picture of a boy being mean to another classmate, then starts to cry harder.    You allow some extra time for the client to process his emotions. You then explain to him that it is not okay to kick the toy bin, and that he can use his words or draw pictures of what he feels instead. You provide reassurance that you are there to help him learn how to control his feelings in a better way. You then select some calming activities such as squeezing the stress ball and playing a matching game. As he begins to gain control of his emotions, you reinforce positive behaviors with verbal praise and approval. Throughout the session, you actively listen and provide opportunities for him to express himself in whatever manner is comfortable to him. You end the session by drawing a picture of yourself and your client, with both of you smiling together. You explain that this is what happens when you work together to find positive ways to cope with emotions.","The client has a close-knit family, and his parents strive to support their son in any way they can. They have little outside support, however, and have been overwhelmed by their child's needs. The client has been home-schooled and lacks social skill development. Parents report that lately he refuses to do school work; as he gets older they will not have the skills to teach him what he needs to know academically. They feel it is now best for him to learn how to thrive socially and emotionally in a public school setting. ",What best demonstrates your use of unconditional positive regard?,Assisting the client in focusing on a life story that is divergent from the problem-saturated story narrative,"Understanding and sharing the feelings of the client, expressed through body language, eye contact, and general sensitivity",Supporting the client's expressions without interrupting and engaging in active observation,"Prompting engagement of the intellectual, physical, spiritual, and emotional self in an active way in session using psychodrama, thereby allowing the client to learn from the moment.","(A): Assisting the client in focusing on a life story that is divergent from the problem-saturated story narrative
(B): Understanding and sharing the feelings of the client, expressed through body language, eye contact, and general sensitivity
(C): Supporting the client's expressions without interrupting and engaging in active observation
(D): Prompting engagement of the intellectual, physical, spiritual, and emotional self in an active way in session using psychodrama, thereby allowing the client to learn from the moment.",Supporting the client's expressions without interrupting and engaging in active observation,C,"Although the description has been adjusted for non-verbal communication, this describes a technique called ""unconditional positive regard"". Therefore, the correct answer is (A)",counseling skills and interventions
1411,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","    book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends.  During the end of the session, the parents express concern about bills for these services, wanting to ensure that they pay them appropriately","During the end of the session, the parents express concern about bills for these services, wanting to ensure that they pay them appropriately. When considering fees, which of the following is the most appropriate response when the payment amount for a session causes economic hardship for the client and they are unable to pay?",The clinician will inform the client about the use of a collection agency in the process of obtaining informed consent and will seek support from the agency when collection is needed.,The clinician will write off the session as pro bono because this would best support the client.,The clinician will use a collection agency if fees cannot be paid.,The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent.,"(A): The clinician will inform the client about the use of a collection agency in the process of obtaining informed consent and will seek support from the agency when collection is needed.
(B): The clinician will write off the session as pro bono because this would best support the client.
(C): The clinician will use a collection agency if fees cannot be paid.
(D): The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent.",The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent.,D,"The most ethical consideration according to the ACA Code of Ethics is providing an opportunity for the client to make a payment prior to seeking a collection agency (ACA Governing Council, 2014). Using a collection agency is ethical if the client is informed of this in the informed consent process and if they have been provided a chance to pay the fees. Writing off the sessions as pro bono should not be the first consideration because you want to settle on a payment rate that the client can pay prior to considering providing services for free. Therefore, the correct answer is (C)",professional practice and ethics
1412,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",Which best describes the diagnostic criteria for a manic episode?,"Symptoms of the mood change are noticeable by other people, but the timing is dependent on the severity.",Symptoms of the mood change must last at least four days.,Symptoms of the mood change must last at least two weeks.,Symptoms of the mood change must last at least one week or require hospitalization.,"(A): Symptoms of the mood change are noticeable by other people, but the timing is dependent on the severity.
(B): Symptoms of the mood change must last at least four days.
(C): Symptoms of the mood change must last at least two weeks.
(D): Symptoms of the mood change must last at least one week or require hospitalization.",Symptoms of the mood change must last at least one week or require hospitalization.,D,"To fulfill the criteria of a manic episode, the duration of symptoms must be present at least one week, and the symptoms must be severe enough to cause ""marked impairment in functioning"" or ""necessitate hospitalization"". If the symptoms are severe enough to warrant hospitalization, the duration does not matter. If the client was hospitalized while experiencing the ""high energy"" symptoms, this communicates the level of severity, and you are looking at a manic episode. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1413, Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.","Given Taylor's level of distress in the first session, how should you proceed?",Validate her feelings,Justify her reaction with words of approval,Remain silent and offer her a tissue,Challenge her irrational beliefs,"(A): Validate her feelings
(B): Justify her reaction with words of approval
(C): Remain silent and offer her a tissue
(D): Challenge her irrational beliefs",Validate her feelings,A,"The practice of validating your client's feelings is not the same as justifying their thought process or approving of their reaction to their problem. Validation of feeling is the quickest and most effective way to gain your client's trust and show that you will help them resolve their issue and reduce their stress while showing compassion and understanding for their perceptions. Your job will be to work with them on identifying cognitive distortions and challenge them on their own. Silence has an important function in the listening process, but your client has just told you they feel no one cares and has concluded their sharing for the moment. It is appropriate to respond at this moment in this counseling interaction. Offering someone a tissue while they are crying can be considered a disruption in their emotional process, signifying, ""here is a tissue, so you can stop crying"". The counselor should always have tissues available or provide them when asked. Therefore, the correct answer is (D)",counseling skills and interventions
1414,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ","Of the following, which would be the most decisive factor in determining whether to self-disclose during this session?",The correlation of the therapist's experience with that of the client,The specific goals of the session,The severity of the client's symptoms,The client's age and maturity level,"(A): The correlation of the therapist's experience with that of the client
(B): The specific goals of the session
(C): The severity of the client's symptoms
(D): The client's age and maturity level",The specific goals of the session,B,"In any situation where a therapist is considering self-disclosing, it is important to consider the specific goals of the session and determine whether self-disclosure will be of benefit in achieving them. In this case, the primary goal would be to help Michael and his parents understand the cause of his distress and develop strategies to address it. Self-disclosure may help build a connection between therapist and client, as well as providing a practical example of how to cope with anxiety. Therefore, the correct answer is (A)",professional practice and ethics
1415,"Initial Intake: Age: 32 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Agency, state-run Type of Counseling: Individual and family","Shania is disheveled, has tangential and fast rate speech and is fidgety with twitching in her motor movements. Shania makes consistent eye contact and leans in close when she becomes upset and begins to cry. Shania admits to having suicidal thoughts and attempt behaviors in her past, but says she no longer feels suicidal. Shania denies homicidal ideations, hallucinations, or delusions. She shares how when she was heavily using drugs and alcohol, she would become paranoid and frequently experience delusional thinking with manic presentation but only while actively on psychoactive substances. Shania has an extensive physical and emotional abuse history since childhood but is a poor historian with the timeline of events. She attributes her anxiety to her trauma as she remembers feeling anxious around her parents since she was a child. She tells you she has no desire to use drugs again but is frequently worried about her temptations to drink when she is stressed or around members of her extended family who drink. Shania’s depression and anxiety have increased more recently due to her family being evicted from their rental apartment and having to stay in a hotel room for the past few weeks.","Diagnosis: Major Depressive Disorder, recurrent, unspecified (F33.9), Anxiety Disorder, unspecified (F41.9), Alcohol dependence, uncomplicated, in early remission (F10.20), Cocaine Use Disorder, unspecified with cocaine-induced mood disorder, in remission (F14.94)
 

You are an intern providing mental health counseling sessions to adults and children struggling with economic and legal issues and are given a referral to conduct an evaluation for Shania, a 32-year-old woman with three children. Shania has temporary guardianship of her youngest two daughters but is undergoing a custody battle to win back full custody of all her kids. Her oldest, age 12, is under guardianship of her parents in another state. Shania tells you in the intake session that her father beats her 12-year-old with his belt and her mother verbally abuses her, but that she isn’t taken seriously when reporting. Shania says because of her legal and substance use history, and due to her reports often being vague on details and directly attempting to influence her court hearing results, officials do not follow through on investigations. Shania further shares that her youngest daughter is struggling with psychiatric and behavioral issues, has used violence against her when angry and cannot sit still, most nights only sleeping for two or three hours. She can no longer afford medications and no longer has health insurance.","Substance Use History:
Shania has been in long and short-term treatments several times in her 20s for alcohol dependency and cocaine use. She had all her children while under the influence or in remission from using substances and has had minimal contact with their fathers. The man she is currently living with is not the biological father of the children but has taken to caring for them as his own while he is in a relationship with Shania.
 
Work History:
Shania has never been able to keep a job for long because of her substance use, which has contributed to her depression and has caused suicidality in her past. Shania has worked in several retail, food and other merchandising chains but has just recently become unemployed again. This is what contributed to her inability to pay rent and eviction. She asks you for help with getting government assistance as she has no family she can rely upon for support.","You know a psychologist in a previous agency you have worked for who is trained in conducting ADHD testing, but his services are not free. You offer Shania a referral for ADHD testing and mention the service costs. Shania gets very upset. How should you respond?","""I'm sorry Shania, I didn't mean to upset you. I just wanted you to know your options.""","""There's nothing to be upset about. When you're ready you can call him.""","""Never mind, don't worry about it, so sorry! Maybe I can get him to do it pro bono.""","""Shania, everything is going to be okay. Everything happens for a reason.""","(A): ""I'm sorry Shania, I didn't mean to upset you. I just wanted you to know your options.""
(B): ""There's nothing to be upset about. When you're ready you can call him.""
(C): ""Never mind, don't worry about it, so sorry! Maybe I can get him to do it pro bono.""
(D): ""Shania, everything is going to be okay. Everything happens for a reason.""","""I'm sorry Shania, I didn't mean to upset you. I just wanted you to know your options.""",A,"The best way to respond to Shania for upsetting her is to simply apologize. She is clearly either upset she will be unable to pay for services she wants, or frustrated you made the suggestion knowing her financial situation. Either way, showing your swift condolences is the quickest road to helping her lower any defenses and continue sharing her feelings with you. Answer b) is invalidating, answer c) is placating to her sorrowful state while also offering to break professional boundaries to accommodate her, and answer d) while sounding positive to some is in fact generalized shallow encouragement. Therefore, the correct answer is (A)",professional practice and ethics
1416,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,The best referral for the counselor to make after the second session is?,Nothing else currently,Psychological testing,Group therapy,Psychiatric consult,"(A): Nothing else currently
(B): Psychological testing
(C): Group therapy
(D): Psychiatric consult",Group therapy,C,"Shar's comments of not feeling like they belong, along with their positive outlook from knowing they are ""not alone"" shows that they may benefit most from group counseling at this time. Psychological testing or a psychiatric consult do not seem necessary currently. Individual therapy alone may be okay, but the addition of group therapy seems warranted at this time so that Shar can have a feeling of belonging. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1417,"Client Age: 48 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Separated Counseling Setting: Private practice Type of Counseling: Individual Presenting Problem: Alcohol use Diagnosis: Alcohol Use Disorder, Moderate, Provisional (F10.20)","Mental Status Exam: The client’s hands tremble, and she becomes tearful on several occasions. There is mild perspiration on her forehead. She endorses feeling hopeless about the future but denies suicidal ideation. The client shows no signs of intoxication or impairment. She presents as well-dressed with good hygiene. Both affect and mood are dysphoric. She apologizes several times for crying and states she has been “a mess” lately due to not sleeping for the last several days. Her demeanor becomes somewhat defensive when asked about her drinking, and she appears to minimize the impact this has had on her life. Fam","You are a counselor working in private practice evaluating a 48-year-old female with a history of alcohol misuse. Three weeks ago, the client was hospitalized due to alcohol poisoning. She explains that she was in a blackout before waking up in the hospital and was told her BAC was 0.26, just over three times the legal limit. This occurred on the evening she discovered that her husband was having an affair. The client briefly attended a drug and alcohol intensive outpatient program (IOP) but felt she was not improving with group therapy and would like to try individual therapy instead. She admits that there are times in her life when she has abused alcohol but does not believe she is an alcoholic. The client experiences frequent anxiety and admits to using alcohol “just to take the edge off” and to help her fall asleep. Her alcohol intake increased nearly six months ago when her youngest child left for college. During this time, her husband of 25 years announced he was leaving and filing for divorce. She struggles with being an “empty nester” and is mourning the loss of the life she and her husband built together.","   ily and Work History: The client worked briefly as an office manager but became a stay-at-home mom once she had kids. As a devout Catholic, she reports feeling heartbroken and ashamed that her husband is filing for divorce. The couple frequently entertained guests at their home, which abruptly stopped after their separation. Her oldest daughter is not speaking to her and is “taking her father’s side,” which has caused her great sadness and resentment. Her middle child, who lives locally, is married with children but does not allow the client to visit her grandchildren unsupervised. She believes her children’s father has spread lies about her alcohol use and feels he “drinks just as much” but appears to do so with impunity. The client’s mother was addicted to pain pills, and her father was diagnosed with bipolar disorder. The client witnessed interpersonal violence between her parents as a child and often felt unsafe growing up. History of Substance Use and Addictive Behavior: The client first started drinking at the age of 14. Her drinking increased significantly while in college and in her early 20’s. The client was able to stop drinking through her three pregnancies but began to drink daily when her children became school-aged. She acknowledges that drinking during the day first started while waiting in the school’s carpool line and increased when her husband returned home from work. She has received three DUIs and had the third offense expunged. After the third DUI, she was court-ordered to attend Alcoholics Anonymous. She stated she resented having to “get a piece of paper signed” and being asked to attend 90 meetings in 90 days. The client denies substance use beyond experimenting with marijuana in college. She concedes that alcohol has been problematic in the past but feels she can successfully control her intake","Given the client’s treatment history, which one of the following would provide you with a multidimensional biopsychosocial assessment to determine if outpatient counseling is an appropriate level of care?",National Institute on Drug Abuse (NIDA) screening tool,Prevention and Early Intervention (PEI) criteria,"Early Periodic Screening, Diagnosis, and Treatment (EPSDT) standards",American Society of Addiction Medication (ASAM) guidelines,"(A): National Institute on Drug Abuse (NIDA) screening tool
(B): Prevention and Early Intervention (PEI) criteria
(C): Early Periodic Screening, Diagnosis, and Treatment (EPSDT) standards
(D): American Society of Addiction Medication (ASAM) guidelines",American Society of Addiction Medication (ASAM) guidelines,D,"ASAM guidelines can be used to assess a client’s level of care and ensure that counselors are providing integrated, seamless, and ongoing service planning. The client began outpatient treatment after prematurely leaving inpatient therapy. ASAM uses a multidimensional approach that considers the biopsychosocial needs of each client, including substance dependency and withdrawal, to determine placement. PEI criteria are unrelated to substance use and instead provide placement for older adults at risk for developing severe mental disorders. EPSDT standards support the comprehensive health needs of children younger than age 21 who receive public health insurance. Finally, the NIDA screening instrument is used to determine an individual’s level of risk associated with substance use. Depending on the risk level, the provider will advise the patient on their drug use, assess their readiness to change, arrange for a referral, or continue to offer support. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1418, Initial Intake: Age: 37 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/non-Hispanic Relationship Status: Married Counseling Setting: Mental health counseling agency Type of Counseling: Individual telemedicine,"Leah is casually dressed, presenting with anxious mood and affect. Speech is of fast rate but with normal tone. Breathing is shallow from speaking fast, you note she stops to take deep breaths before continuing. Leah denies SI/HI, reports many protective factors, and admits that nothing in her life is “really that wrong.” Leah demonstrates good insight and judgment into the nature of her concerns.","Diagnosis: Generalized Anxiety Disorder (F41.1), Adjustment disorder with mixed anxiety and depressed mood (F43.23)
 

Leah is referred to your counseling agency by the U.S. Department of Veterans Affairs (VA) mental health program due to their inability to accommodate her because of their high caseloads. Leah is a 37-year-old married woman with a 2-year-old child and is a disabled combat veteran who served 8 years in active-duty Air Force service. Both you and Leah work full-time as mental health counseling interns in your respective practices. Leah struggles to manage her own anxiety which causes both interpersonal and professional problems for her. Leah reports experiencing trauma related to deployments, past divorce, death of a pet and birth trauma with her daughter. Leah tells you she needs someone to process everything with regularly as she does not want to exhaust members of her family with her stress. Leah’s biggest problem, she shares, is that she knows how to resolve her negative thoughts that lead her to act impulsively but cannot apply her skills when she feels overwhelmed."," 
Education and Work History:
Prior to military life Leah worked several different jobs since the age of 13. Leah joined the Air Force at age 21, worked overseas as well as in the states, and had several deployments including one year in Kabul, Afghanistan as a Staff Sergeant during her fifth year of service. Leah obtained her bachelor’s degree right after separation, and then returned to Afghanistan as a contractor. Following this experience, she completed her master’s degree in counseling. She admits she is “skeptical” working with someone who has the same amount of experience as herself.
 
Family History:
Leah grew up with two younger siblings, and her parents divorced when she was 11. Due to joint custody, her and her siblings moved back and forth weekly every Friday until she originally left home for college at 18. Both of Leah’s parents remarried; her father having three more children with her stepmother, and Leah inheriting a stepsister when her mother married her stepfather. Leah was also previously married to an Army Sergeant while active duty, but her husband had an affair and left her prior to her military separation.","What tool can help you learn more about Leah's reported ""impulsivity""?",Adult Needs and Strengths Assessment (ANSA),CBT thought record,Young Schema Questionnaire (YSQ),Adult ADHD Self-Report Scale,"(A): Adult Needs and Strengths Assessment (ANSA)
(B): CBT thought record
(C): Young Schema Questionnaire (YSQ)
(D): Adult ADHD Self-Report Scale",CBT thought record,B,"A Cognitive Behavioral Therapy thought record can help both you and Leah understand how a triggering event makes her feel, followed by what automatic thoughts Leah has in the moment and how she responds to situations with her behaviors. The record further helps Leah develop insight into her underlying distorted core beliefs and challenges her to develop healthier thought processes while also reducing her maladaptive reactions to stressful stimuli. This can help inform the diagnostic process during intake as well as be applied later in counseling. The ANSA is a comprehensive tool used for clients and treatment teams to score progress and goals and helps determine appropriate level of care and quality improvement; it is primarily only used as insurance requirements dictate and can be useful in the intake process but will not provide any details regarding Leah's behaviors as it is there for you to mark down your perspectives of her functioning based on information you already have. The YSQ is related to long-term personality deficits and is conducted when applying schema therapy interventions; this can be useful as a treatment intervention but will not target a better understanding of how Leah behaves impulsively and her reasons. There is no evidence to suggest Leah struggles with ADHD, as impulsivity can be present in adults without ADHD. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1419,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","The client reports that he has been sleeping more than usual and that this is affecting his ability to get to work on time. He reports that his boss started noticing his tardiness and has given him a verbal warning. Combined with the fear of losing his job, he expressed worry regarding increased conflict with his girlfriend and feeling more “on edge.”  You were a supervisor in a previous job and have experience supervising employees who are tardy",You were a supervisor in a previous job and have experience supervising employees who are tardy. What should you do to support this client with improving his situation at work?,Provide the client with psychoeducation on sleep hygiene.,Encourage the client to explain his struggle with managing sleep to his supervisor in order to increase the supervisor’s empathetic response.,Tell the client about your experience as a supervisor and ways that you supported employees in improving attendance.,Reinforce the message that the client needs to improve his attendance or his job may be affected further.,"(A): Provide the client with psychoeducation on sleep hygiene.
(B): Encourage the client to explain his struggle with managing sleep to his supervisor in order to increase the supervisor’s empathetic response.
(C): Tell the client about your experience as a supervisor and ways that you supported employees in improving attendance.
(D): Reinforce the message that the client needs to improve his attendance or his job may be affected further.",Provide the client with psychoeducation on sleep hygiene.,A,"Personal experience may be helpful in providing insight from the point of view of a supervisor; however, the main focus should be on sleep hygiene because this is the issue that is affecting the client’s functioning. Encouragement to talk to their supervisor would not solve their problem with sleep, encourages the client to disregard the causative issue, and may cause more issues at work. A counselor should be aware of their own personal experiences and how they may affect objectivity. Therefore, the correct answer is (C)",professional practice and ethics
1420, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,"All of the following statements are true regarding counseling, except?",It would be an ethical breach to take sides in this situation.,"At the onset of couple's counseling, the counselor must clearly define roles in the counseling relationship.",The counselor should respond that they are both wrong.,The couple is considered the client.,"(A): It would be an ethical breach to take sides in this situation.
(B): At the onset of couple's counseling, the counselor must clearly define roles in the counseling relationship.
(C): The counselor should respond that they are both wrong.
(D): The couple is considered the client.",The counselor should respond that they are both wrong.,C,"It would not be appropriate for the counselor to indicate who is right or wrong. It is up to the counselor to help the couple to communicate with one another. According to ethical standards, the counselor must clearly define roles at the onset of counseling, which includes the understanding that the couple is considered the client in marital counseling. Taking sides in couple's counseling is unethical and can damage the therapeutic process. Therefore, the correct answer is (B)",professional practice and ethics
1421,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.","Considering the information provided, which referral should you make first for this client before any other?",Refer him to a psychologist for mental health testing prior to beginning treatment,Refer him to a psychiatrist for evaluation and medication management,Refer him to his family physician for a complete physical,Refer him to a community group to help build relationships,"(A): Refer him to a psychologist for mental health testing prior to beginning treatment
(B): Refer him to a psychiatrist for evaluation and medication management
(C): Refer him to his family physician for a complete physical
(D): Refer him to a community group to help build relationships",Refer him to his family physician for a complete physical,C,"Counselors are not medical experts but are expected to recognize physical symptoms of stress and substance use that may need to be evaluated. The client complains of increasing stress and substance use, as well as recent chest and shoulder pain, which should be evaluated by a medical professional prior to beginning a course of treatment that may increase the client's stress. The client does not currently need referral to psychology or psychiatry. Licensed counselors in most states have the ability to determine diagnosis and treat without oversight. Clients with BPD may sometimes be treated with medications but while the client is using recreational substances and pain medication, other medications should not be recommended. If the client is interested in medication for treatment of BPD and is willing to discontinue his use of other substances, psychiatry will be an effective future referral. The client's personality traits have made relationships difficult so referral to a group aimed at forming relationships with other healthy adults is not likely to be effective at this time. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1422,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Given the information provided, what should the counselor focus on during the initial part of the session?",The client's need to have his wife help him see another perspective,The client's inability to express regret or remorse for his actions,The client's feelings about his job and whether he is truly happy in it,The client's feelings about himself and how others view him,"(A): The client's need to have his wife help him see another perspective
(B): The client's inability to express regret or remorse for his actions
(C): The client's feelings about his job and whether he is truly happy in it
(D): The client's feelings about himself and how others view him",The client's feelings about himself and how others view him,D,"The client's reaction to his supervisor highlights his feelings about himself and how others view him and is the most important area to focus on for this part of the session. The client's reaction to his supervisor is indicative of people with NPD or narcissistic traits. These individuals tend to have a very fragile self-esteem which makes them extremely sensitive to criticism, making them feel ashamed, humiliated, and that they have no value at all. The client's inability to understand another perspective without help and his difficulty expressing regret or remorse are also indicative of people with NPD or narcissistic traits. Because this client possesses insight, it is most helpful to work with him on understanding how his feelings about himself and others' perceptions of him impact his self-esteem. Helping the client to understand his self-esteem as the problematic factor in his relationship with himself and others, will later allow him to work on improving his ability to empathize and acknowledge potential or actual mistakes without injury to his self-esteem. The client's current job is not a factor in this event; it is the relationship between the client and the criticism that the client has internalized into a self-esteem injury. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1423,Initial Intake: Age: 70 Gender: Female Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian/Non-Hispanic Relationship Status: Widowed Counseling Setting: Private Practice Telemedicine Type of Counseling: Virtual Individual,"Mary presents with anxious mood and congruent affect. Speech is normal rate and tone, motor movements within normal limits. Denies hallucinations, delusions, suicidal or homicidal ideation. Mary is well-dressed, adorned with makeup, jewelry, and stylish hairstyle. Mary frequently resists the urge to cry as evidenced by smiling and deflecting when becoming tearful. She tells you she wants to work on herself but appears mildly offended whenever given feedback or asked a personal question and then changes the subject.","Diagnosis: Anxiety disorder, unspecified (F41.9), Adjustment disorder, unspecified (F43.20)
 

You are an associate counselor and receive a new referral for a virtual client through your company’s telehealth practice. Mary is a 70-year-old widow who lives alone with her dog in a 55+ active living community. Mary moved to her town to live closer to her daughter and son-in-law when she lost her husband suddenly to cancer four years ago. Mary is struggling with feeling comfortable leaving the house or engaging in any social gatherings outside of being with her children. She wants to make friends her age and take local activity classes, but her anxiety prevents her from committing to plans. Mary has been widowed for four years but has not yet committed to counseling or attendance in grief support groups. She has felt insecure socially since her husband died, but reports being a “social butterfly” before his passing. She admitted to only visiting her husband’s grave on his birthday but is unable to do so any other time. Also, since the COVID-19 outbreak, Mary’s fears and concerns have increased as she is immunocompromised. She asks you for counseling but cannot define what she wants to get out of it."," 
Family History:
Mary was married to her children’s father for 25 years until he had an affair and left her for the other woman. After a few years, Mary met her late husband and was married another 20 years until he became diagnosed with lymphoma and died within three months of being diagnosed. Mary has three older sisters, all of whom live in different states but come to visit seasonally. She celebrates her late mother’s birthday annually, expressing symptoms of grief each year, and becomes inconsolable on the anniversaries of her late husband’s passing. She tells you only country music calms her down.
 
Work History:
Mary was a stay-at-home mother and wife for both of her marriages, working several jobs in-between marriages as a children’s dental receptionist and an antiques shopkeeper. She opened her own shoppe after meeting her late husband where she sold and displayed southern home décor. She had to close her store down when her husband moved for work. She spent much of her free time making greeting cards and crafts at home, until her hands developed arthritis and she lost enjoyment of her hobbies. She now lives off social security and her late husband’s estate that he left for her.",You ask Mary what she values most. How will knowing this information be useful?,To better understand what clients care about in general,Helping Mary say it out loud will motivate her to change,Treatment plan goals can be prioritized based on her values,Use as motivation in case she elects to quit therapy,"(A): To better understand what clients care about in general
(B): Helping Mary say it out loud will motivate her to change
(C): Treatment plan goals can be prioritized based on her values
(D): Use as motivation in case she elects to quit therapy",Treatment plan goals can be prioritized based on her values,C,"Mary will be more likely to commit to her treatment plan goals and follow through with underlying objectives if they are structured around what is most important to her in the end. Mary already knows what she values; it is unlikely making an audible declaration will affect her actual behaviors without working regularly on interventions. Using this information to manipulate her decisions is unethical. Therefore, the correct answer is (C)",treatment planning
1424,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.  Sixth session You have seen the client every week since the initial intake. During today's session, the client tells you she has written a suicide note and left it in her room. Her mother is waiting in the lobby for the session to end. You tell the client you must bring her mother into the session and discuss the suicide note. You explain to the client that her mother's presence is necessary to explore and understand why the suicide note was written. The client expresses frustration and says, “You can’t bring my mom in here! She won’t understand why I wrote the note!” You empathize with her feelings, but also explain that it is important to discuss the reasons for writing the suicide note with her mother present. You reassure the client that you will guide the conversation to explore why she wrote the note and support her in addressing any underlying issues. You explain that understanding these reasons is an essential step toward moving forward and developing healthier coping strategies. The client reluctantly agrees, but insists on speaking with you alone first before bringing her mother into the session. You emphasize that it is important for her to be honest about her emotions and to talk about her experiences in order to identify the root cause of her distress. Throughout the conversation, you provide validation and affirmation in order to create a safe space for her to express her feelings. You remind her that she does not have to face the situation alone, and that you can work together to find a way forward.    Once the client has had an opportunity to share her thoughts and feelings, you ask if she is ready for you to invite her mother in. She agrees, and the mother joins you in session. You explain to the mother that her daughter wrote a suicide note and that the two of you have been discussing the suicide note and why it was written. You emphasize that your goal is to better understand the circumstances leading up to this situation, so that you can work together to find a way forward. You state that your primary focus is on finding solutions, rather than assigning blame or judgment. The mother looks at you in disbelief and says, ""What do you mean, she wrote a note saying she was going to kill herself? What are we doing here? I'm paying you to help my daughter, not make things worse!"" She grabs her daughter's hand and storms out, after expressing her anger loudly the whole way to her car.    You are unsure of how to proceed, so you discuss the case with your supervisor. Your supervisor listens and notes your concerns, offering advice and guidance on better handling the situation. He then suggests that you reach out to the client's primary care physician to discuss the possibility of hospitalization and other forms of support that might be available to the client. After further discussion, you call the client's physician and discuss the options.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ",What should you first do when the client discloses leaving a suicide note?,Have the mother transport the client to an inpatient facility.,Create a safety plan,Call 911,Conduct a suicide risk assessment,"(A): Have the mother transport the client to an inpatient facility.
(B): Create a safety plan
(C): Call 911
(D): Conduct a suicide risk assessment",Conduct a suicide risk assessment,D,"This is the correct answer as this would give you more insight into where the client is in regard to suicide risk. It will also provide you with objective information to substantiate or refute your assertion that the client needs hospitalization. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1425,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,"In determining a preliminary diagnosis, the counselor should first consider?",Cultural factors,Subject of the hallucinations,Time of day,Substance use,"(A): Cultural factors
(B): Subject of the hallucinations
(C): Time of day
(D): Substance use",Substance use,D,"Delusions and hallucinations may be caused by substance use. It is important to first rule out any physical causes such as substance use, brain injury, or other medical conditions. After these are ruled out, it is important to consider cultural factors. In certain cultures, hallucinations and delusions are part of the cultural norm. Time of day and subject of the hallucinations are not relevant for determining a preliminary diagnosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1426,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","    flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya",All of the following would be appropriate short-term goals for the client following or during a manic episode EXCEPT:,Engage in good sleep hygiene.,Identify and learn to replace thoughts and behaviors that trigger or maintain manic symptoms.,Identify the thoughts and beliefs that support depression.,Improve impulse control.,"(A): Engage in good sleep hygiene.
(B): Identify and learn to replace thoughts and behaviors that trigger or maintain manic symptoms.
(C): Identify the thoughts and beliefs that support depression.
(D): Improve impulse control.",Identify the thoughts and beliefs that support depression.,C,"The client is still experiencing a manic episode; therefore, focusing on depression is not the main goal because it is not the most prevalent symptom. Focusing on cognitive processing skills and behaviors that trigger or maintain manic symptoms is important in order to work toward decreasing manic symptoms. Sleep hygiene is an important short-term goal because the client is currently not sleeping well and needs support with increasing her sleep. The client needs to work on impulse control because she is engaging in frequent late-night shopping sprees. Therefore, the correct answer is (C)",treatment planning
1427,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","   e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination",The DSM-5 defines gender dysphoria as distress stemming from a marked incongruence between one’s assigned gender and which of the following?,One’s reassigned gender,One’s preferred gender,One’s experienced gender,One’s suppressed gender,"(A): One’s reassigned gender
(B): One’s preferred gender
(C): One’s experienced gender
(D): One’s suppressed gender",One’s experienced gender,C,"The DSM-5 defines gender dysphoria as “a marked incongruence between one’s experienced/expressed gender and assigned gender” The concept of preferred gender implies that one’s gender identity is a choice, which is different than one’s experienced gender. Researchers have found that gender identity can be influenced by prenatal factors, including in utero exposure to or absence of exposure to testosterone (Roselli, 2018). According to DSM-5-TR, gender reassignment “is an official (and usually legal) change of gender” Lastly, gender dysphoria involves incongruence between one’s assigned gender and one’s expressed (rather than suppressed) gender. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1428,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.  Eighth session The client and his mother arrive for today's session. You begin by meeting with the client alone and plan to speak with his mother afterwards. You ask the client how he has been doing since last week. He is quiet and shrugs his shoulders. You take a moment to notice his non-verbal cues and then gently ask him, ""It looks like something is on your mind. Do you want to tell me about it?"" He hesitates for a moment and then says, ""I don't know. My mom told me that I have to stop playing video games so much. She said it's getting in the way of my homework. But I don't have any friends and video games are the only thing that makes me feel better. It's not fair. My mom gets to do whatever she wants."" You listen attentively and validate his feelings. You explain to him that it is important to have a balance between recreational activities and taking care of responsibilities, like doing your homework. You say, ""Your mom has a job, right? Sometimes she has to take care of things like going to work or paying bills, and it's the same when we have responsibilities at school. It takes time and effort, but if we do it, then it can free up some time for fun activities like playing video games."" He shrugs and says, ""Yeah, I guess.""    You continue the session by discussing his behavior in school and ask him if he can think of any positive experiences he has had since the last session. He thinks for a moment, then starts to shout excitedly, ""Yes! There was something!"" You intervene by giving him a choice of writing down his feelings or starting over with a quieter tone. He stops, takes two breaths, then proceeds to tell you about his experience in the school playground, where he managed to stay calm when he was provoked by a classmate. He said that his teacher was watching and praised him for staying calm. She gave him a sticker and told him that he could choose the game they would play at recess. You congratulate him on his success and praise him for his efforts.    After you conclude the session with him, you invite his mother to your office and direct the client to wait in your waiting room. You talk to his mother to determine how her home parent training is going and review the client's treatment plan with her. His mother states that when she tried to set boundaries on gaming time, he had a ""melt down"". You suggest that she could consider increasing the amount of time he can play his video games in increments if he meets certain goals, such as completing all of his homework or cleaning up his room. She agrees to try this during the upcoming week. She also mentions that her son continues to struggle socially. When she told him that he could invite a friend over for pizza, he said, ""What friend? Making friends is dumb. Who needs them anyway?""    Following the session, you receive a phone call from the client's father who states that he has recently reconnected with his family. He says, ""My wife told me that you've been working with my son. I know he's got some issues. I'm trying to get back in his life and make things right. What should I do?""","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ","Following today's session, you attend a staff meeting to discuss the needs of different clients and how best to provide them with quality care. You are asked to provide a clinical opinion regarding your prognosis for this client and rationale for why have you come to that conclusion. What do you say?",Pessimistic due to the severity of the client's past behavior.,Optimistic due to early intervention for the client and the mother's engagement in parent management training.,Optimistic due to the client's early intervention in therapy and engaging in social skill development.,Pessimistic due to the client's refusal to engage in therapy.,"(A): Pessimistic due to the severity of the client's past behavior.
(B): Optimistic due to early intervention for the client and the mother's engagement in parent management training.
(C): Optimistic due to the client's early intervention in therapy and engaging in social skill development.
(D): Pessimistic due to the client's refusal to engage in therapy.",Optimistic due to early intervention for the client and the mother's engagement in parent management training.,B,"This response reflects the positive developments that have taken place in this client's treatment since early intervention and the mother's active engagement in parent management training. Therefore, the correct answer is (A)",professional practice and ethics
1429, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Alcoholism and late-stage medical complications with depression and anxiety
Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",What information would be most helpful to collect that would support Bob's continued stay in rehab?,protective factors,mental health history,education history,wife's willingness to take him back,"(A): protective factors
(B): mental health history
(C): education history
(D): wife's willingness to take him back",protective factors,A,"Learning what protective factors Bob has for recovery will be crucial to helping support his continued rehabilitation. Finding close family members, children who might be willing to help him, friends who can reinforce his need for care, defining his spiritual beliefs, or even peer groups or activities he is involved with that can be an asset to understanding Bob and what he values would support your counseling of Bob. Learning his mental health and education history is important but does not necessarily help in maintaining Bob's attendance in rehab, and his wife's willingness to take him back if he leaves rehab early might even motivate him to leave. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1430,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","   age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement",What other information would you need to substantiate the diagnosis of substance use disorder (SUD)?,Strong desire or urge to use the substance,Additional consequences involving law enforcement,Levels of dependence and use for both substances,The effects of acculturation on substance use,"(A): Strong desire or urge to use the substance
(B): Additional consequences involving law enforcement
(C): Levels of dependence and use for both substances
(D): The effects of acculturation on substance use",Strong desire or urge to use the substance,A,"Craving is described in the DSM-5-TR as a strong desire or urge to use of the substance. Criminal behavior and dependency are no longer criteria for SUD. The effects of acculturation on substance use are important to assess but would not help substantiate the diagnosis of SUD. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1431,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss.  You help the client process the loss of her grandmother by educating her on Elizabeth Kubler-Ross’s stages of grief",You help the client process the loss of her grandmother by educating her on Elizabeth Kubler-Ross’s stages of grief. Which one of the following accurately depicts this theory?,The stages of grief are often cyclical rather than linear.,Individuals in the first stage of grief may lash out and blame others for their loss.,"In the last stage of grief, individuals experience disbelief, shock, and sadness.",All cultures experience grief in the same fashion.,"(A): The stages of grief are often cyclical rather than linear.
(B): Individuals in the first stage of grief may lash out and blame others for their loss.
(C): In the last stage of grief, individuals experience disbelief, shock, and sadness.
(D): All cultures experience grief in the same fashion.",The stages of grief are often cyclical rather than linear.,A,"Elizabeth Kubler-Ross’s stages of grief are often cyclical rather than linear. While there are defined stages of grief, all individuals experience grief differently, with most moving back and forth between the stages of denial, anger, bargaining, depression, and acceptance. Cultural differences are found in varying practices, rituals, and beliefs that a person incorporates into cultural expressions of grief. Individuals in the second (ie, anger) stage of grief may lash out and blame others for their loss. In the first (ie, denial) stage of grief, individuals experience disbelief and shock, and in the fourth (ie, depression) stage, individuals experience sadness. Therefore, the correct answer is (C)",counseling skills and interventions
1432,"Name: Tony Clinical Issues: Feeling alone and disconnected from children Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 66 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well dressed and well-groomed. He appears healthy for his stated age. Speech flow is normal, and eye contact is appropriate. The client is cooperative with adequate rapport. His thought process is logical. He expresses feeling angry, ""even though there is nothing to be angry about."" You do not observe any physical evidence of anger. When asked to describe a time when he felt angry recently, he mentions a road rage incident. His affect is more sad than angry.","First session You are a licensed mental health professional working in a private practice setting. The client is a 66-year-old male who is returning to therapy with you. When he called to schedule the appointment, he asked if he could meet with you for dinner beforehand and offered to pay. He presents for his session today, reporting that he has been experiencing what he labels ""anger,"" but he cannot figure out where these feelings are coming from. He says he often talks to himself and ruminates over problems to find solutions. He is seeking your help to improve his relationship with his children. He felt that working with you in the past was helpful, and now that his children are all adults and he is financially secure, he has the time and resources to spend with them.    The client has a history of difficulty in forming and maintaining meaningful relationships, particularly with his children. He has a history of conflict with them and has difficulty with communication and boundaries. He has had difficulty constructively expressing his feelings and has frequently resorted to outbursts of anger and aggression. He has had difficulty positively expressing his needs and has often felt overwhelmed and frustrated by his inability to be heard or understood.    The client also has difficulty with impulse control and self-regulation, contributing to his difficulty managing his anger. He has frequently engaged in self-destructive behaviors to manage these feelings and has had difficulty finding effective coping strategies to control his emotions. He has also reported a pattern of avoidance, in which he avoids or withdraws from difficult situations rather than confront them.    At the end of today's session, the client asks if he can go ahead and schedule therapy appointments with you every Tuesday for the next month so that he is ""guaranteed"" a spot. You can accommodate his request and plan to see him again in one week.  Fourth session The client has been seeing you every Tuesday and likes to schedule his weekly appointments a month in advance. Last week, you asked him to bring in a list of the triggers for his anger and the strategies he has tried in the past to manage it. You explained that this would help you create an individualized treatment plan with specific goals and objectives to work on throughout therapy. Furthermore, you suggested coming up with potential coping strategies to employ if/when he finds himself in a situation in which he feels the need to withdraw or avoid. You also stressed the importance of identifying and addressing any underlying issues contributing to this behavior.    Today, you spend the session exploring his anger and constant road rage, and you help him identify his feelings. He recognizes that the rage comes from a sense of being disrespected and feeling taken advantage of. As you continue that discussion, the client has a revelation. He recognizes that he also feels insignificant, unappreciated, and taken advantage of by his adult children. He wonders aloud if they like him. You focus on providing a positive therapeutic empathic response to meet his need to connect in relationships.  Seventh session The client was a ""no show"" for his session last week. You did not hear from him and ended up reaching out to him to reschedule. He arrives at this session on time and is eager to talk about a situation that occurred with his daughter. He had reached out to her to talk about repairing the relationship, and after some convincing, she had agreed. She came to pick him up to go for lunch, and while they were in a car together, he used a term that is now considered politically incorrect to refer to one of her friends. His daughter got upset with him and would not speak with him any further. He attempted to defend himself by saying that the term he used was not derogatory.    He presents this as ""yet another example"" of his children not liking him, and ""never giving him a chance"". He does not know how to move forward. He tells you that he ""can't do anything right"" and is a failure where his children are concerned. He mentions that this episode was especially frustrating, because he has so happy at arranging this meeting. You disclose your own frustration with one of your family members and explain that sometimes that person only seems interested in connecting with you when they need help. You also incorporate a strengths-based approach to build the client's resilience.",,Which best describes the therapeutic benefit of using self-disclosure with the client?,To normalize his experience,To facilitate growth,To help minimize the impact of the experience with his daughter,To continue to cement rapport,"(A): To normalize his experience
(B): To facilitate growth
(C): To help minimize the impact of the experience with his daughter
(D): To continue to cement rapport",To normalize his experience,A,"Self-disclosure can be a means of building rapport with clients, which is essential to the counseling relationship. Counselors often choose to disclose something about themselves and their lives to aid in the development of trust that is necessary for counseling to be effective. Therefore, the correct answer is (A)",counseling skills and interventions
1433,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling  Marital Discord Diagnoses:  You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago.  The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of  The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce",Which approach considers the implications of the client’s early childhood experiences in the context of the couple’s clinical presentation?,Solution-focused relationship therapy,Person-centered couples therapy,Cognitive-behavioral couples therapy,Emotionally focused couples therapy,"(A): Solution-focused relationship therapy
(B): Person-centered couples therapy
(C): Cognitive-behavioral couples therapy
(D): Emotionally focused couples therapy",Emotionally focused couples therapy,D,"Created by Sue Johnson, emotionally focused couples therapy considers the influence of early childhood experiences on emotional connection and attachment. The impact of the client’s experiences of neglect likely affects her emotional engagement and feelings of safety and security in the relationship. Counselors using emotionally focused couples therapy help decrease relational distress using steps found in the following three sequential stages: (1) de-escalation, which is used to help the couple see their pattern of negative interactions characterized by self-reinforcing cycles; (2) restructuring interactions—shaping new experiences for couples to connect and form emotional attachments with one another; and (3) consolidation and integration, which is the process used to help clients apply their newly shaped connections to their presenting problems. Person-centered and other humanistic therapies are a part of emotionally focused couples therapy; however, this is not a stand-alone treatment for attachmentCognitive-behavioral couples therapy is a short-term intervention that uses social learning theory and behavioral therapy concepts to help clients cognitively reconstruct beliefs that contribute to relationship distress. Although certain “core beliefs” may be grounded in a partner’s childhood experiences, couples CBT does not exclusively examine attachment. Lastly, solution-focused therapy for couples is a short-term approach used to help assess a couple’s strengths by inquiring about times when there are exceptions to the problem. Solution-focused therapy is not commonly used to examine early childhood experiences or the origins of attachment. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1434,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ","During intake, what should you do first?",Complete a more thorough intake interview by completing a biopsychosocial.,Immediately report the bullying incident to the authorities at the school for an investigation to ensure the client's safety.,Document the bullying with input from both the client and his mother in your therapy session notes.,Attempt to develop a therapeutic rapport with the client and mother with empathy.,"(A): Complete a more thorough intake interview by completing a biopsychosocial.
(B): Immediately report the bullying incident to the authorities at the school for an investigation to ensure the client's safety.
(C): Document the bullying with input from both the client and his mother in your therapy session notes.
(D): Attempt to develop a therapeutic rapport with the client and mother with empathy.",Immediately report the bullying incident to the authorities at the school for an investigation to ensure the client's safety.,B,"To reassure the mother as she has come to you and is in session and protect the client, initiate the Federal and state laws mandate for an investigation procedure that the school will follow, with immediate intervention steps after receiving reports of bullying. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1435,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment.  You conduct a DSM-5-TR Cultural Formulation Interview (CFI) with the client",,To establish a means for incorporating cultural considerations and clinical symptoms as the sole basis for making an accurate DSM-5-TR clinical diagnosis,To provide culturally specific guidelines to assist with determining the client’s readiness and motivation to change,To enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem,To help determine if the client is open to working with a culturally different counselor,"(A): To establish a means for incorporating cultural considerations and clinical symptoms as the sole basis for making an accurate DSM-5-TR clinical diagnosis
(B): To provide culturally specific guidelines to assist with determining the client’s readiness and motivation to change
(C): To enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem
(D): To help determine if the client is open to working with a culturally different counselor",To enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem,C,"The benefits of using the DSM-5-TR CFI would be to enhance clinical understanding of the client’s cultural identity and the cultural definition of the identified problem. The APA developed the CFI as a holistic, person-centered approach to better understand the influence of cultural identity on the client’s clinical presentation and treatment. The CFI is a 16-question interview that covers four domains of assessment: cultural definition of the problem (questions 1–3); cultural perceptions of cause, context, and support (questions 4–10); cultural factors affecting self-coping and past help seeking (questions 11–13); and cultural factors affecting current help seeking (questions 14–16). The CFI is not to be used as the sole basis for determining a diagnosis. Although use of the CFI may help determine the client’s readiness and motivation to change, this is not the primary purpose of the interview. Determining if the client is open to working with a culturally different counselor is not the intended purpose of the CFI. Therefore, the correct answer is (D)",counseling skills and interventions
1436,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session and reports that he and his wife have been getting along better since the last session following some conversations about what they can do to get through this situation together. The client says that he wants to work on figuring out what he is going to do for work next. You and the client discuss possible options, and he says a friend offered him a job at his restaurant. The client says that he is considering it just for the money but that he has never been a server before and has some reservations. You conduct a career interest assessment and discuss the results",Which of the following assessments would be the most helpful in identifying possible career options for this client?,Motivational Appraisal of Personal Potential,Work and Social Adjustment Scale,Enneagram personality test,Myers-Briggs Type Indicator,"(A): Motivational Appraisal of Personal Potential
(B): Work and Social Adjustment Scale
(C): Enneagram personality test
(D): Myers-Briggs Type Indicator",Motivational Appraisal of Personal Potential,A,"The Motivational Appraisal of Personal Potential career assessment identifies career options based on an individual’s interests. The enneagram and the Myers-Briggs Type Indicator are personality tests, and, although they may identify traits about a person that may be helpful in processing options, they do not focus on career options. The Work and Social Adjustment Scale is an assessment that identifies how mental health functioning affects functioning in multiple areas of a client’s life. Therefore, the correct answer is (D)",counseling skills and interventions
1437,7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.","When you tried leading Millie into deep breathing to alleviate anxiety, she refused. Which strategy will work best with Millie?",Mood Diary and Journal Assignments,Motivational Interviewing,Confrontation,Guided Imagery Meditations,"(A): Mood Diary and Journal Assignments
(B): Motivational Interviewing
(C): Confrontation
(D): Guided Imagery Meditations",Motivational Interviewing,B,"Millie does not present as being willing to follow instructions or take suggestions and is thoroughly occupied by her own interests, making answers b and c undesirable options. Millie also presents as highly irritable and defensive, making answer d an unlikely useful choice. Motivational Interviewing skills, when used correctly, can help Millie identify barriers to her achieving goals, refine areas of resistance to change, and hopefully increase her willingness to change based on her own internal sense of priorities. Therefore, the correct answer is (A)",counseling skills and interventions
1438,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Based on the information provided, what intervention would be most helpful for the client to understand how he developed patterns that he finds problematic in his relationships?",Setting and maintaining boundaries,Journaling,Two-chair exercises using client's mother as second chair,Processing the mother and client relationship,"(A): Setting and maintaining boundaries
(B): Journaling
(C): Two-chair exercises using client's mother as second chair
(D): Processing the mother and client relationship",Processing the mother and client relationship,D,"Processing the mother and client relationship is most helpful for this client. Self-esteem is developed through early interactions with others, especially one's primary caregivers. Many of the client's current behaviors mimic those he used when relating to his mother, whom he described as extremely critical and not meeting his needs or those of others. It will be helpful to have the client process how his own self-esteem developed and how he internalized strategies to protect himself from self-esteem injuries. Journaling is a helpful process for clients who are able to access emotions and insight as they will often use their writings to begin working out their thoughts and feelings outside of session. This client may benefit from journaling as therapy continues but currently uses protective strategies to prevent self-esteem injuries. Setting and maintaining boundaries is a helpful communication and behavioral skill that the client may benefit from later in counseling to help curb some of his narcissistic traits related to jealousy and entitlement. These are not likely to be helpful at this point in therapy. Using the two-chair method to work through mother-client difficulties maybe helpful in therapy later. At this time, it is most important for the client to begin understanding the relationship and its impact on his personality. Therefore, the correct answer is (C)",treatment planning
1439,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.  Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience.    You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",What is the most effective way for the client to manage her increased levels of fear and distress?,Finding meaning and value in life.,Utilizing calming techniques.,Seeking support from family members and friends.,Self-reflection and practicing relaxation techniques when feeling overwhelmed by thoughts.,"(A): Finding meaning and value in life.
(B): Utilizing calming techniques.
(C): Seeking support from family members and friends.
(D): Self-reflection and practicing relaxation techniques when feeling overwhelmed by thoughts.",Self-reflection and practicing relaxation techniques when feeling overwhelmed by thoughts.,D,"Self-reflection helps the client gain perspective on the situation and provides a safe space to pause and consider her thoughts before reacting emotionally. Relaxation techniques help to reduce anxiety and can provide a calming effect. Therefore, the correct answer is (B)",counseling skills and interventions
1440,Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual,"Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.","Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.",,"Based on the Initial Intake, which of the following can be ruled out?",Schizotypal (ability to maintain a relationship),Brief psychotic disorder,Schizophrenia,Schizoaffective disorder,"(A): Schizotypal (ability to maintain a relationship)
(B): Brief psychotic disorder
(C): Schizophrenia
(D): Schizoaffective disorder",Schizotypal (ability to maintain a relationship),A,"The essential feature of schizotypal disorder is ""a pervasive pattern of social and interpersonal deficits marked by and acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior"". It is not likely that he would meet the criteria for schizotypal disorder as he has been able to maintain a stable relationship. From the information provided, Mark's symptoms can be indicative of brief psychotic disorder, schizophrenia and schizoaffective disorder. To rule out any of these, it would be helpful to know the length of time symptoms have occurred. Brief psychotic disorder has a timeframe of less than one month, where in schizophrenia, the disturbance lasts for more than 6 months. Schizoaffective disorder is characterized by one depressive or manic episode. Therefore, the correct answer is (D)",counseling skills and interventions
1441, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.","Using the information you have learned, which of the following should be the first focus of this session?",Ask the client why receiving the books made her panic.,Have the client describe what it feels like to be stressed and overwhelmed.,Ask how did the client manage her concerns with sending her parents money.,Assess the client's past history of panic attacks.,"(A): Ask the client why receiving the books made her panic.
(B): Have the client describe what it feels like to be stressed and overwhelmed.
(C): Ask how did the client manage her concerns with sending her parents money.
(D): Assess the client's past history of panic attacks.",Assess the client's past history of panic attacks.,D,"The client has not mentioned panic attacks previously, so the counselor will need to understand the client's history of panic attacks, including any triggers, symptoms, and how the client has managed her attacks in the past. This will help the counselor and client form a treatment plan to manage the client's stress and any future panic attacks. The counselor should not ask about the client's parents and how she managed that issue. Since the client has not brought it up, the counselor may likely be indulging the counselor's own curiosity, rather than asking for therapeutic reasons. Having the client describe how it feels to be stressed and overwhelmed will be addressed in the session as the counselor and client develop treatment strategies for maintaining the client's well-being. Stress and feeling overwhelmed in the moment when embarking on a new venture, such as graduate school, is not abnormal and should not be pathologized. However, because the client states she had a panic attack and has a history of panic attacks, it will be important to address the panic attacks first and then work backwards to feelings of stress. Asking the client why her books triggered a panic attack will not be a helpful question. Panic attacks are triggered by content that may or may not have connection to the actual panic. Asking why the books were a trigger is not important to understanding the panic attack. Therefore, the correct answer is (C)",counseling skills and interventions
1442,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","   ence. Family History: The client is married and has a 10-year-old daughter from a previous marriage. The client explains that her father was “distant and quiet unless he was drinking.” She remembers hearing that her paternal grandfather declared bankruptcy “at least once” due to gambling losses. The client’s mother has been diagnosed with bipolar disorder, with acute episodes requiring hospitalization. The client indicates that a former therapist also diagnosed her with bipolar disorder, but she rejects the diagnosis stating her symptoms are “nothing like my mother’s",How would you engage the client during the initial phase of treatment?,Encourage her to keep a thought log to track maladaptive cognitions.,Explore factors she believes maintains her depression.,Tell her about your theoretical orientation and experience.,Determine the expectations she has regarding the length of time in treatment.,"(A): Encourage her to keep a thought log to track maladaptive cognitions.
(B): Explore factors she believes maintains her depression.
(C): Tell her about your theoretical orientation and experience.
(D): Determine the expectations she has regarding the length of time in treatment.",Determine the expectations she has regarding the length of time in treatment.,D,"The best way to engage the client during the initial phase of counseling is to determine her expectations regarding the length of treatment. Strengthening the therapeutic alliance helps engage clients in therapy. The therapeutic alliance is enhanced when the client and therapist work collaboratively to determine agreed-upon tasks and treatment plan goals. The length of time in treatment is a part of informed consent and is documented on the client’s treatment plan. Telling the client about your theoretical orientation and experience is incorrect because it does not actively engage the client. Counselors adopting a strengths-based approach are more likely to engage and motivate clients. Answers B and D are incorrect because the focus is on the problem rather than the solution. Therefore, the correct answer is (C)",treatment planning
1443,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",How do you address the issue of confidentiality with your client when she tells you she does not want any of her co-workers to find out she is in therapy?,"You explain that you can only release information to a person who knows her full name and her date of birth, when contacting your office.","You explain that her family may ask you about her care, but you will not confirm or deny she is under your care to anyone else.",You explain the limitations and boundaries of confidentiality and describe the release of information process.,You explain that you cannot release any information under any circumstances to another person while she is in treatment and under your care.,"(A): You explain that you can only release information to a person who knows her full name and her date of birth, when contacting your office.
(B): You explain that her family may ask you about her care, but you will not confirm or deny she is under your care to anyone else.
(C): You explain the limitations and boundaries of confidentiality and describe the release of information process.
(D): You explain that you cannot release any information under any circumstances to another person while she is in treatment and under your care.",You explain the limitations and boundaries of confidentiality and describe the release of information process.,C,"It is important to educate your clients on how confidentiality works in therapy along with the limits and boundaries. Therefore, the correct answer is (C)",professional practice and ethics
1444, Initial Intake: Age: 29  Gender: Female  Sexual Orientation: Heterosexual  Ethnicity: Caucasian  Relationship Status: Engaged  Counseling Setting: Agency - Telehealth  Type of Counseling: Individual,"Client presents as unkempt, hygiene unknown as it is unable to be assessed via telehealth. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is intermittent as she appears to have difficulty focusing both eyes in the same direction (amblyopia or “lazy eye”). She is cooperative and engaged. She admits to having passive suicidal ideation when triggered with distressing emotions and has considered taking pills as a method that would be the most comfortable but declines having intent or plan to collect pills for this purpose. She states her anxiety increases when she takes her children to the grocery store and when she is around crowds, experiencing panic-like symptoms necessitating her to call a friend to calm her down. She reports experiencing flashbacks of sexual trauma and prefers to stay at home as often as possible. She is alert despite being distracted often by her children in the background and is oriented to person, place, time, and situation. She is fidgeting with her hands and speaking circumstantially, often changing topics and going on rants in different directions before returning to her main points. She reports low energy, sleeping too much and weight gain. She adds that she cries every night over losing her paternal grandfather over 10 years ago.","Diagnosis: Anxiety disorder, unspecified (F41.9), Reaction to severe stress, unspecified (F43.9) 
 

You are a new counseling intern in a community agency conducting virtual individual counseling sessions using Telemedicine technology. You were referred a 29-year-old female client by your agency’s Psychiatrist who felt she needed to return to weekly psychotherapy as she had previously been doing two years ago. During your initial assessment session, you learn she has three young children under age 8, lives with her fiancé who is the father of the two youngest children, and that due to medical reasons she is on disability through Medicaid and is unable to work. She tells you she has been depressed and contemplating suicide because she cannot find relief from her anxious thoughts. She wants to be a better mom to her children than her mother was to her and wants help overcoming grief and loss, traumatic memories, panic attacks and irritability.","Family History:
Client has a strained relationship with her mother whom she reports is “always dating an alcoholic” and has been abusive to her growing up. She adds that her mother has “Bipolar depression and ADHD.” She complains often about both her mother and her fiance’s mother mistreating her, making her feel resentful and angry. Client has two sisters, one of which lives with her mother and is mentally challenged. Her other sister has little to no contact with her family. Her father, who has been divorced from her mother for over 20 years, was once accused of child sexual abuse which has alienated him from the rest of their family. The client is the only one who remains in contact with him.","Considering the level of anxiety the client is demonstrating, which of the following interventions would be appropriate to try?",CBT Thought Record,Solution-Focused,Guided Imagery Meditation,Deep breathing,"(A): CBT Thought Record
(B): Solution-Focused
(C): Guided Imagery Meditation
(D): Deep breathing",Deep breathing,D,"Modeling and leading a client through deep breathing is an exercise that will most quickly increase a sense of calm, regulate blood pressure, and ground a client's heightened alert state. Guided imagery and meditation can end up increasing a client's symptoms of traumatic stress as survivors may experience flashbacks or heightened emotional arousal. Given that the client is new to you and is distracted, it might prove too stressful for them to attempt working on the other interventions. Counselors need to consider supporting a client using techniques within the timeline and scope of a situation; a decision that is often made on a moment-by-moment basis. Therefore, the correct answer is (D)",counseling skills and interventions
1445,"Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed","Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc","You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.","The client continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice",What are the ethical guidelines for self-referring clients to private practice?,It is prohibited unless your agency makes explicit provisions.,It is prohibited unless provided pro bono.,It is prohibited for five years following the last professional contact.,It is prohibited under all circumstances.,"(A): It is prohibited unless your agency makes explicit provisions.
(B): It is prohibited unless provided pro bono.
(C): It is prohibited for five years following the last professional contact.
(D): It is prohibited under all circumstances.",It is prohibited unless your agency makes explicit provisions.,A,"The ACA Code of Ethics (2014) states, “Counselors working in an organization (eg, school, agency, institution) that provides counseling services do not refer clients to their private practice unless the policies of a particular organization make explicit provisions for self-referrals. In such instances, the clients must be informed of other options open to them should they seek private counseling services” The 5-year period following the last professional contact refers to the ethical guideline for sexual or romantic relationships with former clients. Pro bono work is encouraged but generally applies to services to the public, such as speaking fees or sharing professional information. Therefore, the correct answer is (C)",professional practice and ethics
1446,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy","All of the following would provide space for client 4 to participate more, EXCEPT:",Active listening,Rounds,Cutting off,Dyads,"(A): Active listening
(B): Rounds
(C): Cutting off
(D): Dyads",Active listening,A,"Active listening, although helpful, is not proactive in helping members participate more when they feel like they cannot get space to speak. Dyads and rounds (enlisting a question to the group and then providing every group member the opportunity to answer) provide an individual with an unobstructed opportunity to speak and participate. Cutting off can be helpful in this situation because cutting off members that are dominating conversation and redirecting questions to client 4 can help her feel that she has an opportunity to speak. Therefore, the correct answer is (C)",counseling skills and interventions
1447,"Initial Intake: Age: 54 Gender: Male Sexual Orientation: Heterosexual Ethnicity: African American Relationship Status: Divorced, In a relationship Counseling Setting: Private Practice Type of Counseling: Individual","John presents as well-groomed with good hygiene and is dressed professionally. Motor movements are slightly fidgety, indicating nervousness or moderate anxiety. Eye contact is intermittent. Denies suicidal or homicidal ideation, no evidence of hallucinations or delusions. John tightens his fists when elaborating on situational issues between him and his ex-wife, with the same controlled expression and tense disposition when sharing about his girlfriend. John mentioned that his girlfriend is also unreasonable for complaining about how often John comes home smelling of alcohol, saying that meeting people for drinks is part of his job. He added the comment “I need to drink to deal with her attitude all the time.”","Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25), provisional
 

John calls your practice asking to speak to a counselor to help him with his relationship. John tells you he’s never been to a counselor before and does not want anyone to know that he is seeing one, mentioning he will pay for sessions privately using cash. John admits to struggling with anger, specifically with his ex-wife of 15 years whom he divorced three years ago. John asks for availability in the evening hours and demonstrates hesitancy and reluctance to commit to more than a handful of sessions. In the initial assessment session, you notice he has difficulty making eye contact and is uncomfortable talking about his situation. After some rapport building, he begins to share that he is only seeing you because his girlfriend Sherry told him she would break up with him if he did not get his “anger issues under control.” John denied physically hitting Sherry, but alluded to several interactions that he stated, “got so heated I lost it on her, and she wouldn’t stop crying.” John complained of women he gets involved with being overly controlling of him and that he doesn’t understand why they are so “needy.” John works a demanding job in the sports marketing industry where he takes frequent trips out of state and spends long nights out, entertaining clients. He wishes he had the freedom to “do what he has to do” without “being treated like a child” by his romantic partners.","Family History:
John tells you he has two children, a 34-year-old son he had with a one-night stand in college and an 18-year-old daughter with his ex-wife the first year they were married. He has a decent relationship with his son and provides him and his family occasional financial support, visiting with his grandchild over social media video once a month. He reports once being close with his daughter but that their relationship became strained as she got older and that now they hardly speak, saying “she took her mother’s side during the divorce, so she doesn’t want anything to do with me right now.” While conducting further interviewing about John’s family health you learn that John’s father passed away at 56 after several heart attacks and his mother died of heart failure and diabetes complications at 49. John has no other living relatives besides an uncle in another state and his cousins who live near him. He tells you growing up he used to go to church with his mother every Sunday until she got sick and has not been to church since.
 
Work History:
John has a master’s degree in Business Marketing and made his connections with his current position through contacts he made while playing on collegiate basketball teams. John has always worked busy jobs with which he becomes heavily engaged in and puts in overtime hours. John prefers work that keeps him on the road and traveling often, as he does not like to engage in the same routine every day. He mentions when he was younger, he could not keep a 9-5 office job or at any place that did not encourage individuality, saying he “butted heads” with all his managers and bosses until he was older.
 
Legal History:
John has had two arrests made for domestic disturbances in his home that his wife called in after heated arguments that left his wife afraid for her life. He was always able to make bail and was never tried or sentenced as charges were usually dropped thereafter. John admits to one drinking and driving accident when he was 19 where he served community service and fines as punishment.",Which of the following is the best short-term objective based on SMART goals?,Eliminate explosive outbursts of anger with loved ones within 4 weeks,"Decrease the number, intensity, and duration of angry outbursts while increasing use of new skills for managing anger within 6 months",Decrease use of alcohol as a means of coping with frustrations and increase healthy habits,Identify underlying triggers associated with anger outbursts,"(A): Eliminate explosive outbursts of anger with loved ones within 4 weeks
(B): Decrease the number, intensity, and duration of angry outbursts while increasing use of new skills for managing anger within 6 months
(C): Decrease use of alcohol as a means of coping with frustrations and increase healthy habits
(D): Identify underlying triggers associated with anger outbursts","Decrease the number, intensity, and duration of angry outbursts while increasing use of new skills for managing anger within 6 months",B,"This objective clearly meets SMART goal criteria (specific, measurable, achievable/attainable, relevant/realistic, and time-bound). Answers a) and b) are not specific, measurable or time bound. Although they are good objectives to start with, they just need some refinement to be SMART. Treatment planning objectives that call to eliminate the symptoms of the proposed diagnosed condition within a short amount of time are not realistic. Treatment planning goals in general do not necessarily have to be SMART depending on your organization's priorities, but it is best practice to consider these criteria when preparing your plans for treating your client. Therefore, the correct answer is (D)",treatment planning
1448,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies.  You would like to measure the effectiveness of the group intervention by administering the same standardized instrument that was used previously to measure social performance and anxiety",You would like to measure the effectiveness of the group intervention by administering the same standardized instrument that was used previously to measure social performance and anxiety. This experimental design is an example of which of the following?,One-group pretest-posttest,One-shot case study,One-group posttest comparison,Two-group nonrandom-selection pretest-posttest,"(A): One-group pretest-posttest
(B): One-shot case study
(C): One-group posttest comparison
(D): Two-group nonrandom-selection pretest-posttest",One-group pretest-posttest,A,"This is an example of a one-group pretest-posttest experimental design. Pretest-posttest experimental designs are conducted using the following steps: (1) a pretest is administered to a group (eg, members participating in group therapy for social anxiety), (2) the intervention (eg, group therapy) is administered, and (3) the same assessment used in the pretest is again administered as a posttest. The purpose of the one-group pretest-posttest design is to determine if the intervention has created a change (ie, did it lessen social anxiety and the related performance avoidance?). This design limits internal validity because of confounding factors, such as history, maturation, instrument decay, and regression toward the mean. It has no external validity. Group posttest comparison does not include a pretest. Group posttests are administered to a group after an intervention. One advantage of group pretests is randomization, which allows the experimenter to control for maturation and history. The “one-shot” case study is a design in which one group is observed on one occasion after the intervention. This design is limited because there is no control group. Two-group nonrandom-selection pre-test-posttest designs consist of an experimental group and a control group. One group is given a pretest, followed by treatment or intervention, and then a posttest is administered. The control group receives a pretest and a posttest only. This design also has limitations related to nonrandomization, such as selection and maturation. Therefore, the correct answer is (A)",treatment planning
1449,Initial Intake: Age: 68 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widow Counseling Setting: Community Agency Type of Counseling: Individual,"The client presents appearing thin for height and older than her stated age. She is dressed in jeans and a shirt, no make-up and appropriate hygiene.  Her mood is identified as euthymic and her affect is congruent. She is talkative and tells stories about herself and others, although she appears very distractible and changes subjects easily. She demonstrates appropriate insight, judgment, memory, and orientation using mental status exam questions. She reports never having considered suicide and never consider harming herself or anyone else.","You are a counselor in a community agency and your client presents voluntarily, though at the request of her family members. She tells you that her stepson and daughter-in-law told her they are concerned about her because she lives alone and they don’t believe that she can take care of herself at her home. She tells you that she is very happy living alone and is never lonely because she has over 20 indoor and outdoor cats that she feeds and they keep her company. During the intake, the client tells you that her husband of 33 years died five years ago from lung cancer. When asked why her family wanted her to come to counseling, your client says that she gets along well on her own; however, she believes that her stepson is looking for ways to take over her property. She tells you she owns a large section of land that includes two trailer homes, one of which is in better shape than the other so that is where she lives; ten or eleven vehicles, some that run and some that do not; and five large carports that hold the items that she and her husband used to sell at the daily flea market before it closed 15 years ago. She tells you that she sometimes finds uses for some of these items around her house but keeps all of them because they may “come in handy” at some point. She currently has no help on her property for mowing or upkeep, unless a neighbor or her son-in-law volunteers to help.","Family History:
The client reports that her parents divorced when she was a young teenager and she did not see her father again after that time. She reports he was an alcoholic as was her mother and they often argued. She relates that her mother did not work and she grew up with government assistance for food and shelter. She tells you that several years after the divorce, her mother’s mobile home was destroyed in a fire and the two of them lived in a friend’s trailer until they were able to buy another one to put on their property. She reports that she quit high school in 10th grade after having trouble reading for many years, married at age 16, had one daughter, and then divorced at 19 due to her husband’s continuing drug use. She tells you that her daughter has not been around for the “past few years” because she lives in another state and has some “mental problems, like bipolar something.” She tells you that she married again at age 20 and remained married to her husband until his death. She tells you her husband was a “good man” though he had many problems related to his military service in Vietnam and health problems due to smoking. She reports he had lung cancer and lived for 20 years although the doctors did not expect him to live so long. This was a second marriage for both of them and she tells you that her husband had one son. The client tells you she has not been close with her stepson because he has never helped them out and it has been worse since she stopped letting him keep his hunting dogs on her property. She tells you that he never took care of them and she had to feed them every day because he did not. The client tells you that she is close to her stepdaughter-in-law and that she trusts her much more than she does her stepson. The client tells you that she and her husband worked at the local flea market for many years selling things they had collected, but since the flea market closed 15 years ago, they lived on Social Security and the money her husband made doing “odd jobs” around town.","Based on the information provided, which of the following cultural factors would be most appropriate to explore first with this client?",How the client views her living situation,"How the client views her family situation, both past and present",How the client views her widowhood,How the client views her ethnicity,"(A): How the client views her living situation
(B): How the client views her family situation, both past and present
(C): How the client views her widowhood
(D): How the client views her ethnicity",How the client views her living situation,A,"The priority to explore would be the client's living situation because it is likely to relate to her socioeconomic status. Culture includes a client's race, ethnicity, socioeconomic style, family structure, and any group membership that the client is or becomes a part of that influences her identity and personality formation. The client's family history includes low socioeconomic conditions and government subsidies, which has helped shape the client's views of the world and how she fits in it. Exploring the client's views on her family situation and widowhood may provide other information for understanding the client's cultural formation, but these are not priority given the reason the client has presented for counseling. The client's ethnicity may be explored as a cultural factor if it is found to be a part of the counseling concerns, although given the current information, it does not present as an issue. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1450,"Name: Tina Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting Type Age: 21 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Italian American Marital Status: Not Married Modality: Individual Therapy Location of Therapy : University counseling center  ","The client presented with a slender physique and was observed wearing conservative, dark-colored attire. Her overall demeanor was reserved, displaying noticeable nervousness and a tendency to withdraw from interactions. Upon conversing with her, it became evident that her train of thought often deviated from the topic at hand, hinting at a tangential pattern. This difficulty in maintaining concentration appears to be a consequence of her heightened anxiety levels. Delving deeper into her thought content, a recurring theme of obsessions surrounding food and body weight emerged. Additionally, a palpable fear of judgment from her peers and the broader society was evident. In terms of her cognitive functioning, she was found to be alert and fully oriented to her personal details, as well as her current location and time. However, a significant concern is her limited insight into her present circumstances and the implications of her behaviors. Throughout the assessment, there were no indications of any memory impairments.","First session You are a mental health therapist working in a university counseling center. The client, a 21-year-old female, presents issues related to anxiety, poor body image, and eating. You begin the session by introducing yourself and explaining your role as a therapist. You also explain how confidentiality is handled and make sure that she understands her rights as a client. After the initial introductions, you ask her to tell you about her current situation and what led her to seek out therapy. She reports that she has been feeling anxious for a while, but it has gotten worse since a basketball game when someone in the audience yelled to the referee ""thunder thighs over there needs to get her act together!"" Even though the comment was not directed at her, she internalized it. She explains that she was already feeling uneasy due to her stepfather's comments about her weight from a few years ago, and the recent insult at the game made it ""all come crashing down"" for her. Now, she cannot stop ruminating about her appearance. She saw a poster in her dorm room promoting counseling services and decided to make an appointment.    You continue your interview by asking about her current eating behaviors. She explains that she avoids carbohydrates, sugar, and most dairy ""since that stuff makes you fat."" When you ask her to describe what she eats during a typical day, she says, ""I usually have a fruit smoothie with almond milk for breakfast, an apple and 12 nuts for lunch, and then some steamed vegetables or a salad for dinner."" When asked about exercise or other physical activity besides basketball, she reports that she runs at least seven miles on a nearby trail every morning and spends two hours swimming laps at the indoor gymnasium pool every evening before bed. She says, ""The pool is pretty quiet at night. I don't like to be around a lot of people when I'm exercising.""    As you continue your dialogue, you ask the client open-ended questions to explore her relationship with her parents, especially her stepfather. She reports that her stepfather has always had negative remarks about her size and shape. She states that she feels like he views her as ""less-than"" because of her weight, which has led to feelings of shame and worthlessness. You explore the dynamic further by inquiring about how these comments have impacted her self-esteem. She reports feeling anxious, embarrassed, and inadequate when her stepfather is critical. You validate her feelings and explain that comments like these can be very damaging to a person's self-image.    You ask the client what she hopes to accomplish in therapy. After some thought, the client says that she wants to learn how to manage her anxiety. She looks at your shyly and says, ""I also want to be able to eat a piece of chocolate. I know that sounds crazy, but I just want to be able to enjoy it, without feeling guilty or like I'm going to get fat."" You affirm her desires and explain that a key part of the therapeutic process will be to help her build self-confidence and develop healthier relationships with food.","The client's parents divorced when she was six years old. Her mother remarried 12 years ago. The client has a younger half-brother who lives with her mother and stepfather. She is close to her mother, but ""my stepfather is a different story."" She reports that he is critical of her and often remarks on how she looks or what she is eating. She states that he has commented on her weight and body shape since middle school. Her mother tries to intervene, but her stepfather continues to be critical. She tells you she couldn't wait to graduate high school and move out of the house. She tells you, ""I remember that when I went home for a visit during winter break during my freshman year, my stepdad had this shocked look on his face when he saw me. He told me I had gained so much weight that I didn't even look like myself anymore. I've never forgotten that. And it's not like he's the picture of health."" Previous Counseling: The client has a history of anxiety. She saw a therapist for a few sessions in high school after being referred by her school counselor, but she did not feel comfortable with the therapist and refused to continue attending sessions. She did not receive a clinical diagnosis related to her anxiety. The client reports that she has been feeling more anxious lately and is struggling to cope with her anxiety. She says that she feels ""on edge,"" and that makes it difficult for her to concentrate. She is interested in exploring therapy to manage her anxiety. Additional Characteristics: The client is currently on the school's basketball team. She was voted most valuable player two years in a row.  ",What short-term goal would be most appropriate to work on during the early stages of therapy?,Find validation and self-worth that is not dependent on physical appearance,"Explore how personal history, familial patterns, and environmental influences have contributed to her eating disorder",Develop a better relationship with her stepfather built on mutual respect and understanding,Increase body acceptance and develop healthier ways of responding to negative body image thoughts and feelings,"(A): Find validation and self-worth that is not dependent on physical appearance
(B): Explore how personal history, familial patterns, and environmental influences have contributed to her eating disorder
(C): Develop a better relationship with her stepfather built on mutual respect and understanding
(D): Increase body acceptance and develop healthier ways of responding to negative body image thoughts and feelings","Explore how personal history, familial patterns, and environmental influences have contributed to her eating disorder",B,"By understanding the origin of her disorder, she can begin to build a foundation of insight that will help support lasting change. With this new awareness, she can also start to cultivate self-compassion and begin to let go of any guilt or shame associated with food or body image issues. Ultimately, this goal will provide her with an understanding and acceptance of herself that she can use as a catalyst for long-term recovery. Therefore, the correct answer is (A)",treatment planning
1451,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)","Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem","You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.","You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client.  The client expresses that she is afraid of termination and concerned that she might “fall back into unhealthy eating behavior",The client expresses that she is afraid of termination and concerned that she might “fall back into unhealthy eating behavior.” Which of the following might be most helpful to provide to the client?,express to the client that you are proud of her accomplishments and that she will do great following termination,provide results of weekly screenings to encourage her because she has made significant progress,provide referrals to support groups so the client is connected to others who experience similar symptoms,reassure the client that you are available to restart sessions if she needs support in managing symptoms,"(A): express to the client that you are proud of her accomplishments and that she will do great following termination
(B): provide results of weekly screenings to encourage her because she has made significant progress
(C): provide referrals to support groups so the client is connected to others who experience similar symptoms
(D): reassure the client that you are available to restart sessions if she needs support in managing symptoms",provide referrals to support groups so the client is connected to others who experience similar symptoms,C,"The client has achieved treatment goals and now social support systems are the most appropriate intervention for maintenance; therefore, support groups would be beneficial by connecting her to others who are experiencing similar struggles. Providing results of screenings does not empower the client to use social support systems, but it may show her that she has been successful and has made progress. You should be careful in showing pride in her success, so that it is clear you are proud of her success, not your own skill as a counselor. It is helpful to let the client know that she should not feel shame in restarting counseling if she needs to, but this does not show her that she has made progress or that you believe that she can manage her emotions on her own. Therefore, the correct answer is (B)",counseling skills and interventions
1452,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ","While clenching her fists, the client says, ""My teacher hates me. She is always taking everybody else's side and lies to my mom about what happens at school."" You respond, ""I hear you saying that you're being singled out and that your mom doesn't believe you, and this makes you angry."" What are you trying to attempt with this response?",Display and empathic response,Form a therapeutic bond wit the client,Show unconditional positive regard,Demonstrate reflection of the client's feelings,"(A): Display and empathic response
(B): Form a therapeutic bond wit the client
(C): Show unconditional positive regard
(D): Demonstrate reflection of the client's feelings",Demonstrate reflection of the client's feelings,D,"Reflection of feelings is used in the therapeutic process to accurately describe the client's state from verbal or non-verbal cues. Therefore, the correct answer is (B)",counseling skills and interventions
1453,Refer to the following to answer the next 10 questions:   7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual,"Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone","Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.","llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.",You have some questions for Millie's father. How should you approach contact?,Ask Millie's permission to speak with her father and then call.,Request that Millie sign a consent for release of information to speak with her father.,It is not advised to speak with her father in this situation.,Call Millie's father and ask him your questions,"(A): Ask Millie's permission to speak with her father and then call.
(B): Request that Millie sign a consent for release of information to speak with her father.
(C): It is not advised to speak with her father in this situation.
(D): Call Millie's father and ask him your questions",Request that Millie sign a consent for release of information to speak with her father.,B,"HIPAA requires written consent to speak with another person regarding a counselee; even if Millie gave resounding verbal permission, she may revoke this agreement later thus leaving you as the counselor in a legally vulnerable position. Millie is 18 years old and does not fall under the status of Minor; therefore, Millie can deny or revoke consent for you to speak with her parents. Therefore, the correct answer is (C)",professional practice and ethics
1454,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness","Regarding the client’s thoughts after the second day of using inhalants in a row, which of the following would be the most appropriate cognitive reframe of this thought?",“I may not be able to improve my relationship with my ex-wife or have the visitation agreement that I want. I just need to keep moving forward.”,"“I got off track, but I can make better choices in order to improve my situation by contacting my sponsor and counselor.”",“I broke my sobriety and need to focus now on how to get back on track.”,“I can contact my lawyer and begin working on the visitation agreement so that I can manage future stress and will be less likely to feel that I need to use inhalants.”,"(A): “I may not be able to improve my relationship with my ex-wife or have the visitation agreement that I want. I just need to keep moving forward.”
(B): “I got off track, but I can make better choices in order to improve my situation by contacting my sponsor and counselor.”
(C): “I broke my sobriety and need to focus now on how to get back on track.”
(D): “I can contact my lawyer and begin working on the visitation agreement so that I can manage future stress and will be less likely to feel that I need to use inhalants.”","“I got off track, but I can make better choices in order to improve my situation by contacting my sponsor and counselor.”",B,"Helping the client identify that he is not where he wants to be (in terms of breaking his sobriety) and then identifying that he can start working with his counselor and sponsor to improve his situation is the most helpful reframe to his cognitive distortion. It is most helpful to be realistic with the presenting problem and to choose a path forward. Although the reframe that he may not be able to improve the relationship or visitation agreement might have some truth to it, improving these situations is important for his relationship with his children and for his own mental health; therefore, these are important to continue to focus improvement efforts on. Contacting the lawyer may be helpful for the visitation agreement, but this will not guarantee that the client is going to be okay moving forward. The client needs to improve his behavior and thought processes to maintain sobriety and therefore improve visitations for the long term. Identifying that the client broke sobriety and needs to get back on track is true, but it does not provide the next steps for improving his situation. Therefore, the correct answer is (B)",core counseling attributes
1455,"Name: Becky Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.1 Conduct Disorder, Childhood-onset Type Age: 10 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : School  ","Appearance: Female with crossed arms, avoiding eye contact, and a blank expression.    Affect: Flat affect.    Speech: Responses are brief and monotone, lacking emotion.    Thought Process: Poor focus, easily distracted, and unable to maintain a cohesive conversation.    Thought Content: Negativity-focused on herself, blaming others for her difficulties; no suicidal or homicidal ideation reported.    Perception: No evidence of hallucinations or delusions.    Cognition: Difficulty with problem solving, difficulty shifting focus between tasks, and poor organization skills.    Insight/Judgment: Poor insight into her situation; judgment impaired due to her inability to see the consequences of her actions.","First session You are a school counselor and often work with families whose children are having behavioral issues. A 10-year-old female student named Becky comes to your office with her parents. Becky's teacher notified you of behavioral problems she noticed in the classroom. You arranged to meet with Becky and her parents to discuss the teacher's concerns and determine how you can best support Becky's needs. You explain your role as a school counselor, providing short-term counseling for students and making referrals if long-term therapy is deemed appropriate. Becky's parents tell you that ""it wasn't a surprise to get your phone call,"" as their daughter's behavior is poor at home, too. They are at their ""wit's end"" due to their daughter's constant ""back talking"" and ""arguing"" with them and any other authority figures in her life. Becky blames others when confronted at school and has become physically aggressive toward her classmates and teacher. You attempt to build rapport with Becky, but this proves challenging as she is not responsive to your efforts.    Becky seemed to be quite guarded and disconnected during the initial assessment. She demonstrated defensive behaviors, such as crossed arms, avoiding eye contact, and evasive responses. She appeared to be dissociated from her current environment and seemingly uninterested in the conversation. However, she did demonstrate a certain level of compliance when her parents attempted to redirect her focus.    Her parents reported that Becky has been displaying these behaviors for months, escalating in intensity as time has passed. She has been increasingly defiant and aggressive both at home and at school. They are concerned that her behavior could pose a risk to her safety and have already attempted different strategies to help her, such as removing privileges and providing additional structure. Still, she continues to be uncooperative and argumentative. Clearly, the family was feeling overwhelmed and needed help managing Becky's behaviors.  Fourth session You have been meeting with Becky for 30-minute sessions once a week for the past three weeks. You have been collaborating with her parents and sharing strategies for how they can support their daughter at home. You have also been communicating with Becky's teacher to monitor Becky's behavior in the classroom. Today is your fourth session with Becky, and she is accompanied by her mother. The mother reveals that her daughter has stolen money from her purse. The mother has also received a call from Becky's teacher informing the parent that Becky was seen removing items from the teacher's desk. When confronted with this information during the session, Becky loudly denies stealing anything, calls her mother a liar, grabs a coffee cup from your desk, and throws it on the floor.    You respond to the situation by remaining calm and utilizing a nonjudgmental approach. You remind Becky and her mother that it was a safe space to discuss their feelings and that it was important to express them appropriately. You then explored Becky's feelings about her mother's accusation to understand her perspective and encourage Becky to take ownership of her behavior. Finally, before Becky and her mother leave, you provide them with tools to practice at home to manage their emotions, suggesting they focus on communication, problem-solving, and finding healthy ways to express their feelings.  Seventh session Today, you meet with Becky and both of her parents. Her father demands to be included in the treatment process. He is adamantly opposed to his daughter being placed in special classes, but the mother expresses her belief that placement in a special class is the best solution. The parents continue to disagree. Finally, Becky screamed out her support for her father's side of the argument.    Becky's reaction in support of her father's position only further escalated the disagreement between her parents. Her mother seemed to be taken aback by Becky's outburst and tried to explain calmly why she believed special classes would be the best solution for their daughter. At this point, the conversation became more heated. Her mother expressed her frustration with her husband, saying he always seemed to take Becky's side regardless of the situation. This further agitated the father, and he began to raise his voice in protest. Sensing the tension in the room, Becky suddenly crossed the room and sat on her father's lap. The parents' discussion escalated into an argument, with Becky's mother finally walking out of the office."," The client is currently failing in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. The client has been referred to you for therapy. She has a history of aggressive behavior toward peers and teachers, including physical attacks and verbal aggression. She has also been observed to demonstrate non-compliant behavior, such as refusing to wear a face mask when interacting with other students.    Additionally, she has been observed to demonstrate oppositional behavior, such as sticking her tongue out at the teacher. These behaviors have been consistently reported by the teacher and other school staff and have been increasing in frequency and intensity. These behaviors have significantly impacted the client's academic performance and have resulted in her current failure in school. Her teacher has called for a conference to begin the process of making an individualized education plan (IEP) to address the client's disruptive behavior. ",In which of the following are you demonstrating conflict tolerance appropriately in a therapy session?,Recognize that clients in therapy should express strong feelings and seek to elicit such responses from the client,"Recognize that conflict is the problem and, as such, steer the discussion to a more rational framework",Recognize that expressing strong feelings during a session provides a window to the client's underlying issues,Recognize that the participant initiating conflict should seek separate individual therapy to cease being a roadblock to progress.,"(A): Recognize that clients in therapy should express strong feelings and seek to elicit such responses from the client
(B): Recognize that conflict is the problem and, as such, steer the discussion to a more rational framework
(C): Recognize that expressing strong feelings during a session provides a window to the client's underlying issues
(D): Recognize that the participant initiating conflict should seek separate individual therapy to cease being a roadblock to progress.",Recognize that expressing strong feelings during a session provides a window to the client's underlying issues,C,"Conflict during a session is expected, and a therapist's ability to manage it is key. Therefore, the correct answer is (C)",counseling skills and interventions
1456,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",What strength does the client possess that will help her achieve her goals in therapy?,Her deep understanding of Columbian culture and its expectations for elders,Her organizational skills and ability to manage multiple responsibilities at once,Her strong understanding of the needs of her family,Her willingness to engage in self-reflection and be open about her feelings,"(A): Her deep understanding of Columbian culture and its expectations for elders
(B): Her organizational skills and ability to manage multiple responsibilities at once
(C): Her strong understanding of the needs of her family
(D): Her willingness to engage in self-reflection and be open about her feelings",Her willingness to engage in self-reflection and be open about her feelings,D,"The client's willingness to engage in self-reflection and be open about her feelings is a strength that will contribute to the client's long-term success in counseling. By being honest with herself and willing to discuss her thoughts and feelings, the client has taken an important step towards gaining greater insight into her situation and developing effective coping strategies. Therefore, the correct answer is (C)",treatment planning
1457, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",Should you tell your supervisor that Bob has confided in you he will be leaving treatment AMA?,No - sharing the information could harm your therapeutic alliance,Yes - so you can rally your entire team to prevent him from leaving AMA,"Yes - confidentiality extends to a ""treatment team"" in an inpatient setting",No - confidentiality laws prohibit you from telling anyone,"(A): No - sharing the information could harm your therapeutic alliance
(B): Yes - so you can rally your entire team to prevent him from leaving AMA
(C): Yes - confidentiality extends to a ""treatment team"" in an inpatient setting
(D): No - confidentiality laws prohibit you from telling anyone","Yes - confidentiality extends to a ""treatment team"" in an inpatient setting",C,"For your client's safety and to protect company liability it is important to inform your supervisor of Bob's intentions. The treatment team can provide additional support for Bob, whether safety planning support, referral recommendations, family phone calls, and especially medical coordination to ensure Bob has the prescriptions and recommendations needed to proceed mindfully. You should not share this information for the sole purpose of getting others to persuade him to stay, despite the health and relapse risks he is undertaking by leaving AMA. Confidentiality prevents you from sharing his information with any party not included in his treatment; this is where private practice and inpatient care can be different, but you should always check first with your institution's HIPAA policies and client's signed confidentiality paperwork. While the therapeutic alliance is important, in an inpatient setting with high-risk clients, it does not take precedence over safety. Therefore, the correct answer is (C)",professional practice and ethics
1458,Initial Intake: Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.  He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.","You are a counselor in a private practice setting.  Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”","Family History:
The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”  He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.",Which of the following interventions would be the least effective in helping the client manage the intense emotions that emerge in trauma treatment?,Teaching and practicing breathing and relaxation exercises,Scheduling shorter sessions to reduce the amount of time the client spends with emotions,"Having the client select a word or motion that means ""I need to stop""","Teaching and practicing a ""container"" exercise","(A): Teaching and practicing breathing and relaxation exercises
(B): Scheduling shorter sessions to reduce the amount of time the client spends with emotions
(C): Having the client select a word or motion that means ""I need to stop""
(D): Teaching and practicing a ""container"" exercise",Scheduling shorter sessions to reduce the amount of time the client spends with emotions,B,"Working with traumatic content often requires a full session or sometimes a 90-minute session so that the counselor and client will have time to work through traumatic material and then help the client regain emotional equilibrium prior to leaving the session. Shorter sessions would not allow the client and counselor to work with disturbing emotional content and still have time to help the client recover from these before the session is over. Container exercises are helpful techniques that allow the client to place their intense emotions in a real or imagined container that will hold these until the next session. Having the client select a word or hand motion that signals the counselor that they need a break because of intense emotions allows the counselor to help the client ground themselves and take time to recover before proceeding again. Teaching and practicing breathing exercises are helpful tools for clients to use when they are overwhelmed with intense emotions. Concentrating on their breathing and relaxing each part of their body distracts the mind from the emotions and allows the client to feel more in control. Therefore, the correct answer is (C)",treatment planning
1459,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","   tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her",Which one of the following specifies the level of severity of depression for this client?,Suicidal ideation,Effects on functioning in multiple settings,Number of criteria met over the minimum criteria for diagnosis,Level of depressed mood reported,"(A): Suicidal ideation
(B): Effects on functioning in multiple settings
(C): Number of criteria met over the minimum criteria for diagnosis
(D): Level of depressed mood reported",Number of criteria met over the minimum criteria for diagnosis,C,"The number of criteria met that is over the minimum criteria for a diagnosis of depression is how a counselor specifies the severity of the depression as mild, moderate, or severe. This client is diagnosed with moderate depression, which is defined as being in between mild and severe depression (in which mild depression meets an amount of criteria just over the minimum requirements and severe depression meets an amount of criteria significantly over the minimum requirements). Suicidal ideation does denote the severity of the depression, but it does not affect the specifier other than being another criterion that is counted. The level of depressed mood is not measured when considering depression other than the state of being in a depressed mood more often than not. The effect of depression on functioning is an important criterion to consider and is also a criterion for the diagnosis of major depressive disorder. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1460, Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual,"Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.","Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.","Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.",Taylor asks if anyone in your family has autism. What is the best response?,"Offer a warm smile and respond asking ""How would it help you to know if I did or not?""",None of these options are appropriate.,Gently point out that personal details about the counselor are not important.,Share about those whom you know with autism to create a therapeutic bond.,"(A): Offer a warm smile and respond asking ""How would it help you to know if I did or not?""
(B): None of these options are appropriate.
(C): Gently point out that personal details about the counselor are not important.
(D): Share about those whom you know with autism to create a therapeutic bond.","Offer a warm smile and respond asking ""How would it help you to know if I did or not?""",A,"Clients are often looking to bond with their counselor to share similar experiences or seeking support from their counselor through advice based on personal experience. While neither is necessary to offer valid clinical feedback, understanding why a client wants to know can be more helpful in therapy than building rapport through sharing a commonality. Self-disclosure is always at the discretion of the counselor but answer a maintains the focus on the client's feelings. Answer b alters the professional relationship by switching focus to the counselor, which again is at the counselor's discretion but is not the best response. Pointing out that details about yourself are not important when a client has specifically asked them of you can be invalidating if you are unaware of the client's reasons for asking. Therefore, the correct answer is (A)",counseling skills and interventions
1461,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.","Based on a psychoanalytic perspective, what is the primary factor contributing to the client's alcohol abuse?",Learned behavior from his parents,Trauma and attachment issues,Parent's divorce,An Oedipal neurosis,"(A): Learned behavior from his parents
(B): Trauma and attachment issues
(C): Parent's divorce
(D): An Oedipal neurosis",Trauma and attachment issues,B,"As a psychoanalytic therapist, you recognize the impact of early childhood experiences in holding future behavior. A potential reason for the client's alcohol abuse from a psychoanalytic standpoint is trauma and attachment issues. His childhood experiences with his enmeshed and alcohol-abusing mother are the most significant factor in his developing an attachment to alcohol as a source of comfort and security. The client's history of trauma and his unresolved issues with his mother can be addressed therapeutically. He needs to develop an understanding that alcohol is not a solution and that the only way to heal from past trauma is through self-awareness and emotional processing. In order to do this, he needs to build more secure attachments with others in order to replace. Therefore, the correct answer is (A)",counseling skills and interventions
1462,Initial Intake: Age: 68 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African-American Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”",Which of the following would be most effective for the client in helping him work through his guilt and anger?,Having the client schedule in-home caregivers despite his wife's objections,Having the client keep a journal of his emotions and thoughts surrounding them,Having the client investigate daily activities for himself in his community,Having the client attend a caregivers' support group in person or virtually,"(A): Having the client schedule in-home caregivers despite his wife's objections
(B): Having the client keep a journal of his emotions and thoughts surrounding them
(C): Having the client investigate daily activities for himself in his community
(D): Having the client attend a caregivers' support group in person or virtually",Having the client attend a caregivers' support group in person or virtually,D,"Having the client attend a caregivers' support group, particularly a virtual one that does not add the stress of leaving his wife unattended will be the most effective for the client as he appears to have little support. Being able to share his feelings with others that are in similar situations will allow him to see that his emotions are normal and he is not alone. Having the client investigate daily activities is most likely to increase his feelings of guilt and anger as he has stated he often has to cancel because of his wife's needs. Scheduling in-home caregivers despite his wife's objections will likely cause more guilt and anger if his wife is not cooperative. Having the client keep a journal of his emotions and thoughts can be helpful for some clients, particularly when clients are trying to identify their emotions. In this client's case, he is aware of his guilt and anger and why he experiences these. Journaling may help him express these ideas but will not be as helpful as normalizing his experiences by talking with other caregivers and receiving support. Therefore, the correct answer is (C)",treatment planning
1463,"Name: Jack and Diane Clinical Issues: Marital/partner communication problems Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 35 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Community-based mental health facility  ","The clients are a couple in their mid-30s. The husband is tall and healthy. The wife is petite and well-groomed. As they enter, you make note that though they came in the same vehicle, they enter with no contact between them. They sit far away from one another and do not look at each other but maintain excellent eye contact with you. The husband's movements seem to be more agitated; the wife appears subdued. He speaks quickly and loudly and often fidgets in his chair, rarely sitting still; in contrast, her speech is low and soft, and she remains still and moves very little. They both seem guarded. They both identify their son's diagnosis of Autism Spectrum as being a significant strssor.","First session Your clients are in their mid-30s and present to the community agency where you are employed as both a licensed mental health therapist and a marriage and family therapist. You begin by introducing yourself and telling the couple about your professional experience and explain the types of therapies that you provide for couples. When asked why the couple made an appointment to meet with you, the husband takes the lead and tells you that he and his wife have been ""serious problems"" with their relationship for a few years. The husband shares that his wife does not trust him since his alcohol use ""got out of control."" Although he has been able to maintain sobriety for two years, he says that his wife is ""paranoid"" that he is using again and insists on knowing where he is ""every minute of the day."" He further reports that his wife is ""too dependent"" on him, and he feels ""suffocated."" He says, ""I just can't keep doing this"" and puts his head in his hands. You thank him for sharing his perspective of the problem and encourage the wife to share her thoughts about what is going on with their relationship. She tells you, ""Truthfully? I'm scared to death that he's going to start drinking again and leave me alone with our children. I don't know what I would do if I lost him."" She wipes a tear away from her face. After taking a deep breath, she says that when she tries to approach him to talk about how she feels, ""he just gets mad and leaves the room.""    Using open-ended questions, you ask about each person's expectations for the counseling process and inquire about past experiences in therapy that may inform the current situation. Both partners look at each other, then back at you and share that they would like to re-establish trust and respect in their marriage. This is their first time seeking counseling. You also invite them to share the story of how they first met each other, memories of their relationship prior to getting married, and how they felt when they became parents. The husband shares that they first met when they were teenagers and have been together ever since. He talks about how their relationship was full of passion, respect, and trust. Even during the difficult times, they felt like nothing could tear them apart. He also shares that when their son was diagnosed with Autism Spectrum Disorder, they felt like the world had come to a standstill, but they were determined to get him the best care possible. He pauses. The husband and wife look at each other before the wife speaks. She explains that after their son's diagnosis, her husband began to drink more heavily as a way of dealing with his own stress and anxiety. He denied it for a long time, but eventually admitted he needed help and sought treatment. Although she was relieved that he got help, she is still struggling to trust him again.  Fourth session Today, the couple arrives for their afternoon appointment ten minutes late. The wife appears to have been crying. Her husband smells like mouthwash, and his movements are slightly slower than normal. You ask if he has been drinking today. He states that he has not had any alcohol today, but his wife says, ""That's not true!"" and proceeds to tell you that she ""caught"" him holding a bottle of liquor in their garage this morning. The husband replies, ""I didn't do anything wrong. This is just another example of you looking for problems where there are none. Why can't you believe me when I tell you that I'm not drinking?"" She replies, ""I really want to believe you, but you make it really hard to do that."" He shakes his head and throws his hands up in the air in frustration. You ask the husband to step out of the room for a few minutes. He agrees and says, ""Fine. You know where to find me."" The wife shares that she feels like her husband is not taking the process seriously, and she questions whether or not counseling will work for them. You thank her for expressing her thoughts and explain that it is very common for couples to have doubts about therapy, especially when there has been a history of substance abuse. You discuss the potential treatment barriers and emphasize that it is important to have insight into these problems in order to create positive outcomes. The wife appears to understand and is reassured by your words.    You invite the husband back into the room and ask him to share his thoughts about the counseling process. He takes a deep breath and says that he still wants to make their marriage work, but he is afraid of failing. He admits that he does not know how to ""make things right"" and this makes him feel helpless. You explain to him that counseling can help them gain insight into their communication patterns, learn new ways to interact with each other, and develop healthier coping strategies. You also discuss a plan for handling escalations in future sessions. You explain to the couple that it is important to have a plan in place whenever they are feeling overwhelmed or angry. Next, you discuss conflict resolution skills, emphasizing the importance of communicating their feelings and needs in an honest, respectful, and non-judgmental way. You also stress the importance of each partner taking responsibility for their own actions. You encourage them to practice these strategies outside of the session in order to improve their communication and relationship.    After the session, you discover that the community-based mental health facility where you work will be closing in six months due to a lack of funding. You view this as a potential barrier that will inhibit mental health treatment access for many clients as this is the only mental health treatment facility in the city.","  The husband used to have severe issues with alcohol. He went to rehab three years ago and has maintained sobriety for two years. He continues to attend weekly meetings. As a result of his alcohol misuse, he has some medical issues with his liver, but they are not currently life-threatening as long as he continues to abstain from alcohol. The husband has worked hard to rebuild his relationships with his family and friends. He is actively trying to repair the damage that was done due to his alcohol misuse. He has been attending AA meetings and is focusing on rebuilding trust and communication. He has also been making an effort to be more present in his family life and to be a better husband and father.",What would have been the most effective method for handling the emotional escalation that occurred during this session?,Ask the husband to stay and explain why he was drinking in the morning.,Ask the couple to take a break for a few minutes and then come back together to discuss the situation.,Ask the husband to leave the session and to only attend therapy sober.,"Engage in a psychoeducational unit on metacommunicative techniques to give the couple the means to examine their communication style,","(A): Ask the husband to stay and explain why he was drinking in the morning.
(B): Ask the couple to take a break for a few minutes and then come back together to discuss the situation.
(C): Ask the husband to leave the session and to only attend therapy sober.
(D): Engage in a psychoeducational unit on metacommunicative techniques to give the couple the means to examine their communication style,",Ask the couple to take a break for a few minutes and then come back together to discuss the situation.,B,"Taking a time out is a healthy way to de-escalate the situation. This allows the couple to take a break, cool down, and then come back together to discuss the situation and work on a solution. Therefore, the correct answer is (D)",counseling skills and interventions
1464,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.",You are a supervised intern in your last few weeks of supervision and assigned to work with a client via Telehealth. The platform you are considering using automatically records the sessions. What should you do first?,Discuss the expectations and goals of Telehealth therapy with the client,Determine if the Telehealth platform is HIPAA compliant,Have your supervisor sit in on the session as you are an intern,Obtain informed consent from the client,"(A): Discuss the expectations and goals of Telehealth therapy with the client
(B): Determine if the Telehealth platform is HIPAA compliant
(C): Have your supervisor sit in on the session as you are an intern
(D): Obtain informed consent from the client",Determine if the Telehealth platform is HIPAA compliant,B,"Before you start therapy with the client, you must know if the platform is HIPAA compliant, as it is your responsibility to ensure that client data is kept secure. Therapists should use a HIPAA-compliant platform to ensure that their clients' protected health information (PHI) is kept secure and confidential. HIPAA (the Health Insurance Portability and Accountability Act) is a federal law that sets standards for protecting PHI. It requires that any platform used to store, transmit, or receive PHI must have certain safeguards to protect the data's privacy and security. Therefore, the correct answer is (B)",professional practice and ethics
1465,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.  Tenth session It's been two and a half months since you first started seeing the client for weekly therapy sessions. Today, your client appears calm and relaxed. You review her progress and highlight her areas of growth since the start of therapy. The client states that she feels more empowered to challenge her negative thoughts and is able to recognize when her anxiety is beginning to spiral. She has been using the coping skills she learned in the previous sessions to manage her stress levels more effectively. The client also reports a weight loss of 5 pounds since beginning therapy, which she is pleased with and attributes to the mindfulness techniques she has been practicing. You discuss her weight loss and the importance of mindful eating practices. You explain to the client that weight loss is a secondary outcome of therapy and that it is more important to focus on living a healthy lifestyle than a number on a scale. The client expresses her understanding and appreciation for the guidance.    When you ask her to rate her level of anxiety, she indicates that she is much less anxious than when she first started therapy. Her preoccupation with illness has decreased, though it has not gone away completely. She reports that her colleagues have noticed the change in her attitude and confidence. She is able to stay present and focus on her job, without constantly worrying about negative judgement from her co-workers. She tells you that she has been keeping up with the journaling homework that you assigned in a previous session and it has been a helpful outlet for her to express her thoughts. She has also been practicing progressive muscle relaxation during her breaks at work and after she gets home in the evenings. The client is still drinking wine to help her relax, but you have determined that her alcohol use does not warrant clinical intervention. You discuss spacing out your sessions and she agrees to try meeting with you twice a month. At the end of the session, she asks if you could email her a copy of her therapy records so that she can refer back to them periodically in order to continue making progress.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",What additional support service would you recommend to the client at this time?,AA meeting,Social support group of women in the healthcare field,Support group for anxiety,Psychiatric evaluation,"(A): AA meeting
(B): Social support group of women in the healthcare field
(C): Support group for anxiety
(D): Psychiatric evaluation",Support group for anxiety,C,"A recommendation to attend group therapy will offer ongoing support for your client to address any issues which she may encounter once she has completed therapy with you. She will be able to share her success and also learn how her peers cope with their symptoms. Of course, you can remind your client she may follow up with therapy in the future, as needed. Therefore, the correct answer is (A)",treatment planning
1466,Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9),"Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam","You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.","The client presents today with a blunted affect and an irritable mood. The daughter accompanies the client and states that the results of the client’s recent PET scan show changes in the brain that may indicate Alzheimer’s disease. You process the results with the client and her daughter and provide psychoeducation on cognitive impairment, including counseling risks, benefits, and limitations. The client would like to focus on improving psychosocial issues associated with her cognitive impairment",Which of the following psychosocial interventions uses tangible memory triggers to prompt discussions of past experiences?,Reality orientation,Reminiscence therapy,Cognitive stimulation therapy,Validation therapy,"(A): Reality orientation
(B): Reminiscence therapy
(C): Cognitive stimulation therapy
(D): Validation therapy",Reminiscence therapy,B,"Reminiscence therapy uses tangible memory triggers (eg, photographs, music, household items) to prompt discussions of past experiences. Reminiscence therapy, validation therapy, cognitive stimulation therapy, and reality orientation are evidence-based psychosocial interventions for persons experiencing cognitive impairment. Reminiscence therapy improves factors associated with an individual’s quality of life, such as depression and apathy. Validation therapy is based on the premise that individuals with cognitive impairment present with confusion to escape reality and do so to avoid loneliness, isolation, and distress. Validation therapy recognizes, respects, and values each individual’s qualities and feelings rather than focusing on their experiences of confusion. Cognitive stimulation therapy typically consists of a variety of activities, puzzles, and games used to improve one’s memory. Cognitive stimulation therapy may also include elements of reality orientation. Reality orientation works by increasing an individual’s awareness of time, location, and surroundings. This is typically done by placing this information on a dry-erase board in an individual’s home or residence. Therefore, the correct answer is (B)",counseling skills and interventions
1467,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","You arrive at the client’s house for the session, and he decides to meet with you in the family office and brings some toys with him. He sits on the floor, and you decide to sit on the floor with him and engage in play to continue building rapport. While playing, you begin to ask the client about what frustrates him about his parents, and, through processing, you identify that he desires some independence. You meet with the parents after the session and encourage them to give him some choices throughout his day so that he can have a sense of control. You state that they can be choices that may not be consequential, such as the order of the bedtime routine, so that the routine still happens but he has some control over the order of the process","When addressing the client’s behavioral response to the denial of a snack, which one of the following would be the most appropriate behavioral intervention?",Maintain boundaries and allow the client time to accept the decision that was made about waiting until the end of the session for the snack.,"Support the client in requesting the snack in a more appropriate manner and when he does, you provide the snack.","The parents set a boundary that the client needs to wait until the session is over, so you support him in coping with the denial of his request.","Support the client in calming down, and when he does, if he requests the snack in an appropriate manner, he may have it.","(A): Maintain boundaries and allow the client time to accept the decision that was made about waiting until the end of the session for the snack.
(B): Support the client in requesting the snack in a more appropriate manner and when he does, you provide the snack.
(C): The parents set a boundary that the client needs to wait until the session is over, so you support him in coping with the denial of his request.
(D): Support the client in calming down, and when he does, if he requests the snack in an appropriate manner, he may have it.","The parents set a boundary that the client needs to wait until the session is over, so you support him in coping with the denial of his request.",C,"The most appropriate behavioral intervention should address the problem behavior, which, in this case, is the reaction to being denied a snack immediately (and not the manner in which he requested the snack). When the client engages in inappropriate behavior in order to gain access to something (in this case, the snack immediately rather than after the session), you should support him in coping with the decision that was made if clear boundaries are set. If the client had inappropriately requested the snack, then you could support the client in requesting the snack more appropriately and provide the snack when he does. Simply allowing the client to accept the decision that was made by his parents is not enough because you want to empower him to cope with his strong emotions. Therefore, the correct answer is (A)",counseling skills and interventions
1468,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.",rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family,"According to Abraham Maslow’s hierarchy of needs, which of the following would be the most appropriate area of clinical focus at the start of therapy?",Begin substance use counseling to support the client in abstaining from fentanyl use.,Assist the client with processing his feelings regarding cessation of fentanyl use.,Encourage the client to reach out to his children to develop a support system.,Support the client by providing referrals to local soup kitchens and processing barriers to housing.,"(A): Begin substance use counseling to support the client in abstaining from fentanyl use.
(B): Assist the client with processing his feelings regarding cessation of fentanyl use.
(C): Encourage the client to reach out to his children to develop a support system.
(D): Support the client by providing referrals to local soup kitchens and processing barriers to housing.",Support the client by providing referrals to local soup kitchens and processing barriers to housing.,D,"Maslow’s hierarchy of needs has five levels that include, in order from bottom to top, physiological, safety, love/belonging, esteem, and, finally, self-actualization. The more basic needs starting with physiological must be met in order for an individual to begin working on the other areas. The client’s housing and food situation are both physiological and safety needs and should be addressed and supported. Although working on cessation from fentanyl use and his feelings regarding stopping its use are important, the client is homeless and does not have resources, so this is the most important. The client’s relationship with his children would be classified under the “love and belonging” level in the hierarchy and would not be the area of initial focus. Therefore, the correct answer is (B)",treatment planning
1469,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",What technique would best help the client remember the event?,Dream analysis,Hypnosis,EMDR,Cognitive-Behavioral Therapy,"(A): Dream analysis
(B): Hypnosis
(C): EMDR
(D): Cognitive-Behavioral Therapy",Hypnosis,B,"Hypnosis will allow the client to recover her lost memory of her friend's shooting. Therefore, the correct answer is (B)",counseling skills and interventions
1470,Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears to be his stated age and overweight for his height. He is dressed professionally and appropriately to the circumstances as he tells you he will see clients after your appointment. The client lays on the office couch with his hands behind his head and his feet on a cushion. He answers questions without pauses and often replies very casually with “sure” or “I don’t know,” demonstrating little insight into his thoughts, behaviors, and emotions. He estimates his mood as dissatisfied and unhappy though his affect suggests ambivalence. He presents with some complaints of forgetfulness but is oriented to time and place, and endorses no delusions or hallucinations. He acknowledges frequently feeling suspicious, especially when he’s feeling really stressed. He says he questions other people’s motives and what they are doing or saying when he’s not present. The client acknowledges using alcohol on weekends, and has used marijuana and cocaine regularly over the past ten years but admits it has increased over the last two years. He assures you he only drinks and uses drugs when not seeing clients. He has a prescription for pain medicine and states he uses it appropriately.","You are a counselor in a private practice setting.  Your client presents with complaints of not meeting his own expectations in his licensed, health care profession, and dealing with the business aspect of his work, difficulty meeting financial obligations, difficulty getting along with others, and problems with his ability to concentrate. He says his business partner used to be his best friend but now he can’t stand him because he sees the clients more often and leaves your client to do all the work. He tells you his concentration issues have always been present but have become progressively worse over the past eighteen months, as have his feelings of irritability, failure, fatigue, and lately he has pains in his chest and shoulder. He tells you that he thinks sometimes about what would happen if he died, but only as far as wondering how others would react. Later in the session, he says he is not suicidal and does not have a plan, but occasionally he just “gets tired of it all.” He tells you that sometimes he feels like “ending it” and has said that to women when the relationship isn’t going well and once or twice during breakups. He asserts that he has not actually tried to kill himself. He summarizes his relationships with others as “if they like me, they lose interest” and says that he finds himself “almost being manipulative” in how he chooses his words in his relationships with women and sometimes takes them on spontaneous “wildly expensive vacations” so they will not lose interest in him. The client tells you he has been in several relationships with women over the years, beginning with his high school sweetheart, then with his college sweetheart, but none of them have “worked out.” He states he was engaged to his college sweetheart at 24 for 6 months and then she married someone else. He tells you that another girlfriend was married and didn’t tell him, one “went crazy and threatened him with a gun,” and one broke up with him saying that he was “too needy” and “almost obsessive” in wanting to see her every day. He tells you that “all in all, I’m unhappy with how things are going and I need to make changes, but I just have no motivation to do it and I don’t know why I should have to.”","Family History:
He states he is close to his sister who has never married but “always likes the deadbeat guys.” He tells you his father and mother never showed affection to him while growing up, were always bickering, and his mother was always obsessive about saving money and always complaining. He acknowledges loving his parents but sometimes getting so angry at them that he wishes he could just ignore them forever. He tells you both his maternal and paternal grandfathers were “mean as snakes,” while his paternal grandmother was a “saint.” He reports that one of his uncles committed suicide several years ago and that his cousin, whom he was very close to, committed suicide last year. He also says his best friend died five years ago due to a drug overdose.","Based on the information provided and your diagnosis, which is the next referral to be made for this client?",Family therapy,Alcoholics Anonymous,A Dialectical Behavioral Therapy group,Narcotics Anonymous,"(A): Family therapy
(B): Alcoholics Anonymous
(C): A Dialectical Behavioral Therapy group
(D): Narcotics Anonymous",A Dialectical Behavioral Therapy group,C,"Dialectical behavioral therapy (DBT) groups are the most widely prescribed treatment for people diagnosed with BPD. The individual and group therapy focuses on managing emotions and building skills for better relationships. This is the appropriate treatment referral for this client. Either AA or NA can be useful for this client if he demonstrates insight that his substance use is a problem for him, personally or professionally. At this time and given the information provided, the client does not yet demonstrate that understanding so he is unlikely to attend or benefit from substance abuse self-help groups. Family therapy is not likely to be helpful at this time for a client with BPD since relationships are often intense and fluctuating depending on the client's level of emotion and stress. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1471,"Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)","Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia","You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.","The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions.  You disagree with the client’s evaluation of her situation and want to support her",You disagree with the client’s evaluation of her situation and want to support her. Which of the following would most support the client’s presenting needs?,Empathize with the client’s thoughts and feelings and encourage cognitive reframing.,Validate the client’s feelings and thoughts in order to continue building rapport.,Encourage cognitive reframing in order to guide the client toward your conclusion about her thoughts and beliefs.,Challenge the client’s thoughts and beliefs.,"(A): Empathize with the client’s thoughts and feelings and encourage cognitive reframing.
(B): Validate the client’s feelings and thoughts in order to continue building rapport.
(C): Encourage cognitive reframing in order to guide the client toward your conclusion about her thoughts and beliefs.
(D): Challenge the client’s thoughts and beliefs.",Empathize with the client’s thoughts and feelings and encourage cognitive reframing.,A,"Providing empathy and encouraging cognitive reframing are helpful because these actions validate the client’s experience, even if you do not think that it is rooted in reality, and it provides an opportunity for her to identify other ways to think about the situation. Simply validating the client’s experience does not provide the client with other options about how to feel or think. Challenging beliefs does not validate the client’s experience and may make the client feel unheard or that you do not think she is being rational. Encouraging reframing on its own may put pressure on the client to feel a certain way. Pairing empathy with cognitive reframing is a more holistic approach to supporting the client. Therefore, the correct answer is (B)",counseling skills and interventions
1472,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","The client attends group therapy and is making therapeutic gains. Her overall anxiety has decreased, and she is engaging in more constructive thinking. Today is week 6 out of the 12 scheduled weekly group sessions. The client continues to work on increasing her assertiveness and has become less tentative with self-disclosures. She is pleasant and cooperative but remains eager to please others. Three group participants have formed a subgroup (i\. e., clique) and have excluded others. The client has begun to take social risks, and today she shares about a time when she felt most anxious. You notice the subgroup whispering and laughing after her disclosure. She nervously turns to you to gauge your response.  You feel protective of the client and find yourself becoming increasingly angry with the subgroup’s negative behavior",You feel protective of the client and find yourself becoming increasingly angry with the subgroup’s negative behavior. What is the likely source of these feelings?,Underdeveloped leadership skills,Countertransference,Unhealthy group dynamics,Transference,"(A): Underdeveloped leadership skills
(B): Countertransference
(C): Unhealthy group dynamics
(D): Transference",Countertransference,B,"The likely source of these feelings is countertransference. Countertransference occurs when the therapist emotionally reacts to transference happening among group members. Countertransference can either be subjective (ie, stemming from unresolved past issues) or objective (ie, stemming from the difficult personalities of group members). Transference involves the unconscious transfer of feelings and reactions to another person or experience encountered in the present moment. Transference occurs in individual and group therapy. When transference happens in group therapy, it can happen with the group leader or other group members. The group is not exhibiting unhealthy dynamics because they are in the middle, or storming, stage of group development, characterized by struggles for power and control. Lastly, because countertransference is a normal experience, it is not caused by underdeveloped leadership skills. However, therapists must be attuned to the present-moment experience required for understanding the subgroup’s behavior. Therefore, the correct answer is (A)",professional practice and ethics
1473,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process.  The client believes he is unworthy of love and destined to fail in intimate relationships",The client believes he is unworthy of love and destined to fail in intimate relationships. This is an example of which one of the following?,Confirmation bias,Overgeneralization,Black-and-white thinking,Personalization,"(A): Confirmation bias
(B): Overgeneralization
(C): Black-and-white thinking
(D): Personalization",Overgeneralization,B,"The client concludes that because he and his girlfriend broke up, he is unworthy of love and is destined to fail romantically; this is an example of overgeneralization, which occurs when broad conclusions are drawn without supporting evidence. Personalization involves a person believing that they are being targeted by someone else’s behavior when it has nothing to do with them. Black-and-white, or polarized, thinking consists of “either/or” statements or beliefs. Confirmation bias is the tendency to seek out and retain information in line with one’s preconceived notions. Therefore, the correct answer is (B)",counseling skills and interventions
1474,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community","Which family systems approach would best help the client’s parents regain control by examining hierarchical positioning, challenge shifting boundaries, assigning tasks, and reframing?",Contextual family therapy,Structural family therapy,Strategic family systems therapy,Multi-generational therapy,"(A): Contextual family therapy
(B): Structural family therapy
(C): Strategic family systems therapy
(D): Multi-generational therapy",Structural family therapy,B,"Structural family therapy’s primary purpose is to strengthen the boundaries within family systems. One objective of structural family therapy is to help parents regain control by assessing the family structure and assisting families with setting appropriate boundaries. Treatment phases include joining the family, reconceptualizing (diagnosing) the family, and applying restructuring techniques. Restructuring techniques include: assigning tasks, reframing, shifting boundaries (unbalancing), escalating stress, psychoeducation, blocking transactional patterns, and developing implicit conflict. Multigenerational (Bowenian or Extended) family therapy focuses on eight interconnected concepts. Bowenian family concepts include differentiation of self, emotional triangles, sibling positions, society emotional process, multigenerational transmission process, nuclear family emotional system, family projection process, and nuclear family emotional system. Strategic family therapy differs from structural family therapy in that strategic family therapy places much less emphasis on boundaries and instead focuses on patterns of communication and interactions. Some techniques of strategic family therapy include positive connotation (similar to reframing), paradoxical intervention, pretend techniques, and hypothesizing. Contextual family therapy emphasizes ethical elements of each family, including loyalty, trust, and relational principles. Therefore, the correct answer is (C)",counseling skills and interventions
1475,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","The client has been free of suicidal ideation for four weeks now. Psychoeducation has helped him gain insight into BDD. Distance counseling has been effective in decreasing ritualistic behaviors, and you provide face-to-face sessions every other week to help decrease avoidance behaviors. The client has benefited from cognitive-behavioral therapy (CBT). He attended two social events this month and has decreased ritualistic “safety behaviors” once used to prevent a feared consequence. He would like to take two college courses in the fall and is nearing the termination stage of therapy","To help with the client’s avoidance of anxiety-provoking situations, you gradually and incrementally expose him to fears previously arranged on a fear hierarchy through a process known as which of the following?",Graded exposure,Systematic desensitization,Flooding,Subjective units of distress,"(A): Graded exposure
(B): Systematic desensitization
(C): Flooding
(D): Subjective units of distress",Graded exposure,A,"Graded exposure is a process that works by incrementally exposing the client to fears previously arranged on a fear hierarchy. Graded exposure is one component of exposure and response prevention (ERP). Graded exposure is used to gradually increase exposure to higher anxiety-provoking situations until the fear naturally subsides without the client performing ritualistic behaviors, such as mirror-checking. Systematic desensitization is a process that combines exposure with relaxation techniques. Flooding involves exposing the client to the highest level of anxiety-provoking stimuli from the beginning, rather than starting with the lower levels and building up. Subjective units of distress (SUD) measure perceived stress. SUDs are generally measured on a 0-100 scale and correspond to the client’s individualized fear hierarchy. Graded exposure involves starting with exposure exercises with the lowest SUD measures first. Therefore, the correct answer is (B)",counseling skills and interventions
1476, Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual,Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.,"Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.",,"At this point in the session, the counselor should not?",Explain to Theodore that the most sensible place to live is with Nate,Obtain more information about the relationship between Nate and Theodore,Explore other resources for places Theodore can live,Make a diagram of Theodore and those who are a support to him,"(A): Explain to Theodore that the most sensible place to live is with Nate
(B): Obtain more information about the relationship between Nate and Theodore
(C): Explore other resources for places Theodore can live
(D): Make a diagram of Theodore and those who are a support to him",Explain to Theodore that the most sensible place to live is with Nate,A,"It is not up to the counselor to verbalize his/her opinion about who Theodore should live with. And it would be judgmental to assume that because of Theodore's age he is not able to live on his own. At this point in the session, the counselor should explore other resources that are available for Theodore. It is also important to better understand the relationship dynamics and history between Nate and Theodore. One way to explore resources and to get a better understanding his relationships and support systems is by drawing a diagram of people he knows and his relationships with them. Therefore, the correct answer is (B)",counseling skills and interventions
1477,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",You notice the client beginning to sob uncontrollably after she describes how her ballet injury is affecting her. What strategy would you use to help the client manage her intense emotional reaction in session?,"Engage her in the present moment using the ""name the story"" technique","Sit with her in silence, allowing her to emote","Utilize the Gestalt technique of ""staying with the feeling""",Validate her emotions and engage her in a guided imagery exercise,"(A): Engage her in the present moment using the ""name the story"" technique
(B): Sit with her in silence, allowing her to emote
(C): Utilize the Gestalt technique of ""staying with the feeling""
(D): Validate her emotions and engage her in a guided imagery exercise",Validate her emotions and engage her in a guided imagery exercise,D,"Validating her emotions can help her feel heard and understood, which can promote trust and rapport between the therapist and client. Engaging her in a guided imagery exercise can help her focus on her breath and body sensations, which can provide a sense of relaxation and grounding during a highly emotional state. This exercise can also help her shift her focus away from her negative thoughts and emotions, allowing her to feel more in control of her feelings and behavior. Therefore, the correct answer is (D)",counseling skills and interventions
1478,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing.  You were approached by a local community college to speak to a therapy group that is provided for students regarding management of ADHD","You were approached by a local community college to speak to a therapy group that is provided for students regarding management of ADHD. All of the following are American Counseling Association (ACA) considerations for media presentations, EXCEPT:","If you do not have training as an educator, you must decline to meet with the group.",Your statements must be based on accepted counseling literature and practice.,It is made clear to the group that you are not establishing a counseling relationship with them.,Your statements align with the ACA Code of Ethics.,"(A): If you do not have training as an educator, you must decline to meet with the group.
(B): Your statements must be based on accepted counseling literature and practice.
(C): It is made clear to the group that you are not establishing a counseling relationship with them.
(D): Your statements align with the ACA Code of Ethics.","If you do not have training as an educator, you must decline to meet with the group.",A,"Training as an educator is not a prerequisite to speaking regarding areas that you specialize in as a counselor, even if it is in an educational setting. The ACA Code of Ethics states that you are within your limits as a counselor if you base your lecture on accepted literature and practices, the group knows that you are not establishing a counseling relationship with them, and your statements align with the ACA Code of Ethics. Therefore, the correct answer is (D)",professional practice and ethics
1479,"Name: Aghama Clinical Issues: Cultural adjustments and sexual identity confusion Diagnostic Category: V-codes Provisional Diagnosis: Z60.3 Acculturation Difficulty Age: 18 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Bisexual Ethnicity: Nigerian Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client comes to your office and sits rigidly and makes little eye contact. She is dressed neatly and appropriately for the weather with overall good hygiene. She appears cooperative and open to the therapeutic process. She expresses a willingness to discuss her experiences, thoughts, and feelings, but show some hesitation due to her unfamiliarity with therapy. The client's mood is depressed. Her affect is congruent with her mood, displaying a flat or subdued demeanor, but shows some variability when discussing her family or life in Nigeria. Her speech is clear, fluent, and coherent. She has no difficulty expressing herself in English and seems to have a good command of the language. Her speech is slightly slow. The client's thought process appears linear and goal-directed. She is able to articulate her concerns and goals; her thoughts seem to be dominated by her feelings of sadness, loneliness, and homesickness. The client demonstrates some insight into her situation and the impact of her homesickness on her overall well-being. She appears to be motivated to seek help and improve her situation. There is no evidence of suicidal ideation or intent. The client does not express any thoughts of self-harm or harm to others. However, her ongoing feelings of sadness and loneliness warrant close monitoring and support during the therapeutic process.","First session You are a licensed mental health counselor working at a university counseling center and take a humanistic approach in your work with clients. Today you are meeting with an 18-year-old student who recently moved to the United States from Nigeria. She tells you that she moved to the United States one month ago after missionaries in Nigeria granted her a scholarship. She feels lonely, misses her family, and is questioning her decision to come to the United States. She indicates she has never been to therapy before but was told by her academic advisor that it might be helpful to make an appointment with a counselor.    You continue the intake session by exploring the client's current psychological functioning. She expresses that she is homesick and is struggling to find her place in a new environment. She describes having difficulty making friends at college and feels isolated. She does not feel comfortable talking about her personal life with people she does not know well, which makes it even more difficult for her. Additionally, she is struggling with the pressure of living up to the expectations of the members of her church that gave her the scholarship to attend the university. She is currently pursuing a nursing degree at the university. You ask her to share some details about her family and cultural background in order to gain a better understanding of the context of her situation. She tells you that her parents are both teachers and she has two siblings. The family is very close-knit and they typically speak in their native language at home. You also ask about how she is managing her academic obligations, any specific challenges or barriers she might be facing, and how she is spending her free time. She says that her courses are challenging, but she is managing them well. In between classes, she spends most of her time in the library studying.    You discuss the therapeutic process and what she hopes to gain from counseling. She expresses that she would like to learn how to better cope with her homesickness and loneliness. She says, ""I'm worried that I'll be a disappointment. It took a lot of money and effort to get me here, and I don't want to let them down. I was so excited when I first got the scholarship, but maybe it would have been better if it went to someone else."" You validate her feelings and explain that it is natural to feel overwhelmed when faced with a new culture and environment. You further explain the importance of focusing on her strengths, as she has already accomplished so much by making the decision to attend college abroad. You describe therapy as an opportunity for her to explore her feelings, develop coping strategies, and adjust to her new environment. At the end of the session, she tells you she is on a ""tight schedule"" and needs to know when she can see you for therapy so she can plan accordingly. You provide her with your availability and suggest that an ideal therapy schedule would involve weekly sessions. You also explain the importance of consistency in order to allow her to make meaningful progress during therapy. You schedule an appointment for the following week.  Fifth session This is your fifth weekly session with the client, and she states that she likes the ""structure"" of seeing you on Wednesday afternoons. The client appears to be doing better since she last saw you. She begins today's session by telling you that she still feels isolated and is having difficulty making friends. You ask her to elaborate on the challenges she has been facing in connecting with students at the university. She tells you that most of the other international students are from countries closer to America like the Caribbean islands, and it is difficult for her to relate to them. She pauses for a moment and asks if she can tell you about something that happened a few days ago that she is feeling nervous about. You respond affirmatively, and she tells you that her roommate invited her to a party and she ended up drinking which is not something she would normally do. When she and her roommate got back to their dorm room later that night, they kissed. She goes on to say that she thinks she has developed romantic feelings for her female roommate. This experience made her feel confused and anxious, and her family's expectations weigh heavily on her mind. You ask her to elaborate on her feelings in order to gain a better understanding of the situation. The client shares that she is unsure what this could mean for her future and worries if her family will be disappointed in her if they find out. She says, ""I am actually engaged to a man in Nigeria. We decided to postpone the wedding until I finished my degree, but now I don't know what to do. My parents were so excited when we announced our engagement, and the thought of breaking it off feels like a betrayal.""    You explain that it is natural to feel confused when faced with new experiences and remind her that she is in control of the decisions she makes about her life. You suggest exploring what a relationship with her roommate might look like, as well as considering the consequences of breaking off her engagement. She says, ""I know I need to stay true to myself. I just don't want anyone hurt in the process. I can't even imagine what it would mean if I told my parents or church family about my roommate. They are not as conservative as other people in the town where I grew up, but I don't think they know many, if any, people who are in same-sex relationships."" You discuss with the client how her religious and cultural beliefs may affect her sexual identity and contribute to feelings of guilt and fear of disappointing her family.    During the next few weeks following today's session, the client cancels twice without proper notice and later tells you that she ""had other stuff going on.""",,What is the best way to initially approach the client's repeated cancellations?,Express concern for the client's well-being and discuss the importance of regular attendance,Explain the potential consequences of repeatedly canceling sessions,Plan to educate the client about time management strategies during the next session,Begin a discussion about termination,"(A): Express concern for the client's well-being and discuss the importance of regular attendance
(B): Explain the potential consequences of repeatedly canceling sessions
(C): Plan to educate the client about time management strategies during the next session
(D): Begin a discussion about termination",Express concern for the client's well-being and discuss the importance of regular attendance,A,"This is the best way to approach the client's repeated cancellations because it shows that you are invested in her well-being and want to ensure that she gets the most out of her therapy sessions. Expressing your concern in a non-judgmental manner will help create an open dialogue with the client, allowing her to share any issues she may be facing and work together to come up with a plan that works for both of you. Therefore, the correct answer is (B)",professional practice and ethics
1480, Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual,"Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.
","Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.",,Which of the following situations would possibly hinder the creation of a therapeutic alliance with Carl?,Ask Carl what qualities he likes in a counselor,"Sit with Carl in the center of the room, in an L shape",Sit with Carl on one side of a desk and you on the other,Ask Carl about his expectations for counseling,"(A): Ask Carl what qualities he likes in a counselor
(B): Sit with Carl in the center of the room, in an L shape
(C): Sit with Carl on one side of a desk and you on the other
(D): Ask Carl about his expectations for counseling",Sit with Carl on one side of a desk and you on the other,C,"Body posture and the physical space of the counseling office is important to keep in mind to create an environment conducive to the counseling process. Placing a structure, such as a desk, between a client and counselor can serve as a barrier to openness. Ideally, the counselor and client should be sitting with no objects between them. This can be face to face, or in an L shape. Due to Carl's history of assaulting a counselor, it would be advisable for the counselor to sit near an exit. Other ways to help build a therapeutic alliance would be to ask Carl about his expectations of counseling in order to provide structure and allow for a conversation about informed consent. Also, by asking Carl what he likes in a counselor, the counselor can see what has worked for Carl in the past. Therefore, the correct answer is (A)",counseling skills and interventions
1481,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.  Third session You are in your office waiting for the client to arrive for her weekly session when suddenly you hear screaming. You run out into the hallway and see the client crying hysterically. After guiding her into your office, she lies on the couch, crying. She begins to punch the pillows on the sofa. You indicate you are here to listen when she is ready to talk. The client is in a heightened emotional state and says, ""He. Left. Me."" You maintain a calm demeanor and encourage the client to tell you what happened. She said she arrived home after work and noticed her husband's car was gone. He had left her a note indicating he was leaving and wanted a divorce.    The client expresses feelings of shock and betrayal as she discusses how she had been blindsided by her husband's sudden decision to end the marriage. She reports feeling overwhelmed by a range of emotions, including fear, anger, sadness, and confusion. The client expresses hopelessness and despair, believing her situation is beyond repair. She ruminates on the idea that her marriage is irrevocably broken and that her life will never be the same. She expresses feelings of helplessness and fear of the unknown, feeling overwhelmed by the magnitude of the situation. The client struggles to make sense of her husband's decision and appears overwhelmed by the potential consequences. She is particularly concerned about how her husband's decision will affect their children and their family's future. The client stares at you with a blank expression and states, ""I might as well give up. There's no point anymore.""    You further assess her current mental health state and determine that she is suffering from an acute stress reaction. You provide empathy and validation while creating a safe space for the client to process her thoughts and feelings. You encourage her to talk openly and honestly about her experience, allowing her to express her emotions without judgment.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ","Based on the client's reaction in session, how would you prioritize your next step in treatment?",Take steps to have the client involuntarily committed for her safety,Refer to a psychiatrist for medication evaluation,Explore the safety plan and make adjustments where necessary,Use grounding techniques to stablize intense emotions,"(A): Take steps to have the client involuntarily committed for her safety
(B): Refer to a psychiatrist for medication evaluation
(C): Explore the safety plan and make adjustments where necessary
(D): Use grounding techniques to stablize intense emotions",Use grounding techniques to stablize intense emotions,D,"In this situation, your priority would be to help the client stabilize and manage her intense emotions, providing immediate emotional support and ensuring her safety. You can use grounding techniques and coping strategies to help her regain a sense of calm and control, allowing her to better process her feelings and discuss her concerns. This would create a safe and supportive environment for her to begin addressing the emotional impact of her husband's decision and to explore potential next steps for coping with the situation. Therefore, the correct answer is (C)",treatment planning
1482,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","The client reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him. The client says he has attended Metropolitan Community Church (MCC) with his boyfriend and was surprised to hear their messages of acceptance and inclusion. He has stopped going to bars and nightclubs since dating and reports less substance and alcohol misuse. The client states it has been quite some time since he felt like he had no purpose in life.  When the client shares recent developments, you find yourself tearing up as you tell him you are happy that he is starting to experience a level of peace in his life","When the client shares recent developments, you find yourself tearing up as you tell him you are happy that he is starting to experience a level of peace in his life. Which core counseling attribute does this represent?",Cultural attunement,Empathetic responding,Metacommunication,Genuineness,"(A): Cultural attunement
(B): Empathetic responding
(C): Metacommunication
(D): Genuineness",Genuineness,D,"Counselors show genuineness by responding in a manner that is consistent with the client’s and their own internal emotional experiences. Genuineness is about responding authentically, in the present moment, in a way that is verbally and emotionally congruent; ie, there is consistency between the counselor’s words and non-verbal behaviors. Empathetic responding occurs when counselors convey an understanding and non-judgmental acceptance of a client’s expressed and underlying feelings. It consists of perceiving, understanding, experiencing, and responding. Empathetic responding differs from genuineness in that it refers to the counselor’s response to the client’s, not the counselor’s, emotional expression. Metacommunication refers to the counseling process as it is unfolding. It is communication about communication, including verbal or non-verbal cues, that carry depth and meaning. Counselors who show cultural attunement skillfully communicate that they both know and do not know the cultural realities of those we treat. Cultural attunement is about remaining teachable and having the desire, humility, and curiosity to acknowledge things such as privilege and oppression, for example. Therefore, the correct answer is (A)",counseling skills and interventions
1483,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","You meet with the client during your regularly scheduled session. The client says that the manic behavior has stopped and that she is starting to enter a depressive episode. The client identified mild depressive symptoms including a down mood, difficulty enjoying activities, and fatigue. The client states that she still has not contacted the psychiatrist because she does not know if she is ready for medication. You process this thought with the client and identify that she is worried about the side effects of the medication. You encourage the client to meet with the psychiatrist and be open about her worries in order to get more information on the medication options. The client expresses worry that her academic success has been affected by cycling moods. The client’s grades are currently dropping, and she says that she does not have control over them. You empathize with the client and begin to talk about behavioral and cognitive interventions to improve functioning",All of the following demonstrate an open counseling stance EXCEPT:,Mirroring,Smiling,Arms are not crossed,Leaning forward,"(A): Mirroring
(B): Smiling
(C): Arms are not crossed
(D): Leaning forward",Leaning forward,D,"Leaning forward can come across as aggressive or argumentative behavior if not reciprocated or as part of mirroring the client. It is best to sit back in the chair or, if standing, to lean on a wall. Smiling and keeping your arms open show that you are relaxed and not closed off to the client. Mirroring is helpful because it is about matching the emotions of the client and their posture, which shows attunement to the client’s mental state. Therefore, the correct answer is (C)",counseling skills and interventions
1484,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","  You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown",Which one of the following is more indicative of suicidal self-injury than nonsuicidal self-injury (NSSI)?,"A desire to cause harm, to feel better, or to end distressing feelings permanently",A persistent urge to cause harm that is often difficult to resist,Difficulty coping with negative emotions and poor self-worth immediately before the injurious act,The constant need to regulate persistent emotional pain and self-critical thoughts,"(A): A desire to cause harm, to feel better, or to end distressing feelings permanently
(B): A persistent urge to cause harm that is often difficult to resist
(C): Difficulty coping with negative emotions and poor self-worth immediately before the injurious act
(D): The constant need to regulate persistent emotional pain and self-critical thoughts","A desire to cause harm, to feel better, or to end distressing feelings permanently",A,"The desire to cause harm, feel better, or end distressing feelings permanently is more indicative of suicidal self-injury than NSSI. Suicidality differs from NSSI in that there is a desire to permanently end feelings. In contrast, with NSSI, there is a chronic or persistent urge to cause harm to oneself to regulate or detach from distressing emotions. The DSM-5-TR discusses NSSI not as a mental disorder, but as a symptom or consequence that may be confronted when supporting individuals with mental disorders. With NSSI, there is no suicidal intent. Instead, there is the expectation that the self-inflicted damage relieves a negative feeling or cognitive state. NSSI may also include intentional injury associated with feeling distressed, anxious, sad, or tense. Feelings immediately before the act may also be coupled with self-criticism. Finally, NSSI is associated with the persistent urge to cause harm that is often difficult to resist. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1485,Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual,"Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.","Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.",,"A few days later, after Harold informs the counselor he no longer wants her as a counselor, Harold came to the counselor's office with a small, wrapped box. Harold stated that it was just a small token to say thank you. Under ethics rules, the counselor should?","Thank Harold and wish him the best, opening the gift later.",Tell Harold she needs to speak to her supervisor first and then will get back to him,Thank Harold but tell him that she cannot accept any gifts,Open the box in front of Harold and give it back to him if it seems expensive,"(A): Thank Harold and wish him the best, opening the gift later.
(B): Tell Harold she needs to speak to her supervisor first and then will get back to him
(C): Thank Harold but tell him that she cannot accept any gifts
(D): Open the box in front of Harold and give it back to him if it seems expensive","Thank Harold and wish him the best, opening the gift later.",A,"In most cases, a is the best choice since Harold is no longer a client. Counselors should be aware of the code of ethics which state that ""Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to take gift from a client, counselors consider the therapeutic relationship, the monetary value of the gift, the client's motivation for giving the gift and the counselor's motivation for wanting to accept or decline the gift"". In this scenario, the client and counselor have terminated their relationship and the gift is a token to say thank you. By telling Harold she cannot take any gifts, Harold may be offended. This may cause undo harm, which goes against ethical standards. Opening the gift in front of him and then possibly giving it back can be uncomfortable for both parties. Choice d leaves the situation in a limbo and the counselor should be aware of the code of ethics when presented with a gift. Therefore, the correct answer is (A)",counseling skills and interventions
1486,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.  Fifth session The client missed last week's appointment and rescheduled to see you today. Before she sits down in the chair, she hands you a file with her medical records and blood work. She explains that she made copies for you to review. You discuss how she has felt since meeting with you. She uses various clinical terminology when describing her feelings and reports ""battling anhedonia."" It is difficult for her to enjoy going anywhere as she is constantly worried that she will contract a disease. She states that her anxiety has caused her to make some mistakes at work which she is very upset about. You notice that the client is wringing her hands together and biting her lips.    You state to the client, ""It sounds like you're really struggling with your anxiety. I noticed that you were talking about some of the mistakes you feel like you make at work because of your anxiety. Can you tell me more about that?"" The client replies, ""Yeah, it's so embarrassing and frustrating. Whenever I go out, and especially when I'm at work, I feel like everyone is judging me for my weight. It's like they think I'm not good enough because of it. I start to question myself and mess something up."" You ask the client, ""Have people actually said anything to you about your weight?"" She responds, ""No, but I can tell they're thinking it."" As the therapist, you are able to observe how the client's cognitive biases may be contributing to her distress. You acknowledge her emotions, while also highlighting that she is facing challenges associated with being in a demanding role at work. You utilize cognitive-behavioral strategies with an emphasis on mindfulness practices to help her manage her feelings. You also discuss possible coping mechanisms that could help her manage the stress of her job. At the end of the session, you summarize what you have worked on and schedule her next appointment.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ","Using a cognitive-behavioral approach, how would you help your client practice decentering from her thoughts?","""We can't control what other people think about us, but we can control how we think about ourselves.""","""I'd like for you to try to have a dialogue with the part of you that feels judged and 'not good enough.' What would you say to that part of yourself?""","""When you start to feel like you're being judged and aren't good enough, try to replace those negative thoughts with a positive affirmation.""","""Let's take a step back and observe these thoughts and feelings, as if they are coming from someone else. This can help you recognize that they don't have to define you or your worth.""","(A): ""We can't control what other people think about us, but we can control how we think about ourselves.""
(B): ""I'd like for you to try to have a dialogue with the part of you that feels judged and 'not good enough.' What would you say to that part of yourself?""
(C): ""When you start to feel like you're being judged and aren't good enough, try to replace those negative thoughts with a positive affirmation.""
(D): ""Let's take a step back and observe these thoughts and feelings, as if they are coming from someone else. This can help you recognize that they don't have to define you or your worth.""","""Let's take a step back and observe these thoughts and feelings, as if they are coming from someone else. This can help you recognize that they don't have to define you or your worth.""",D,"Decentering can help people step back and observe their thoughts, feelings, and bodily sensations from a distance. It encourages people to observe experiences as if they are happening to someone else, rather than taking them on directly. This helps reduce the intensity of these experiences and create some psychological distance between them and their thoughts. Decentering can help people gain insight into how their beliefs and opinions influence their feelings, and can help them better manage their emotions. It also encourages self-compassion by allowing people to be kind and understanding towards themselves in difficult situations. Therefore, the correct answer is (A)",counseling skills and interventions
1487, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",What is the best response for how to guide this parent while building the therapeutic alliance?,"""Don't worry, you're doing a great job and he will grow out of this phase eventually.""","""I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together.""","""Use negative reinforcement to deter his behavior and CBT for addressing negative patterns.""","""You have to implement stronger boundaries in order for my interventions to be effective.""","(A): ""Don't worry, you're doing a great job and he will grow out of this phase eventually.""
(B): ""I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together.""
(C): ""Use negative reinforcement to deter his behavior and CBT for addressing negative patterns.""
(D): ""You have to implement stronger boundaries in order for my interventions to be effective.""","""I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together.""",B,"Parent behavior management training is an evidence-based treatment teaching parents how to manage difficult childhood behaviors (defiance, outbursts, noncompliance). Validating and encouraging a parent like in answer a) is positive, a positive attitude to have however dismissing the behavior or the parent's role in reinforcing the behavior is not clinically best practice when you are responsible for treating the child conducting those behaviors. Answer b) is an aggressive response to a parent who is actively seeking advice and support, however the need for stricter boundaries may be something the parent should consider. Negative reinforcement and CBT (cognitive behavioral therapy) techniques are also appropriate to teach the parent, but this response assumes the parent understands these terms. It is also best practice to collaborate with the parent on what interventions they have already tried already, and work towards empowering them to select their own options as this approach tends to be the most effective. Therefore, the correct answer is (D)",counseling skills and interventions
1488,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ","You tell the client, ""What we talk about stays between you and me. You can trust me, but I may have to talk to your mom if you are in danger or others are in danger. Do you understand what I am saying?"" What are you doing here?",Appealing to the client's desire for community.,Forming rapport and trust,Explaining confidentiality in terms he can understand,Assessing for homicidal ideation,"(A): Appealing to the client's desire for community.
(B): Forming rapport and trust
(C): Explaining confidentiality in terms he can understand
(D): Assessing for homicidal ideation",Explaining confidentiality in terms he can understand,C,"This is the correct answer because the client is 11 years old. Using terms he can relate to will make it easier for him to comprehend. Therefore, the correct answer is (D)",professional practice and ethics
1489, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.",Maria's expression of emotion is a relief to you. How do you tell her this?,"""If you had shared sooner, you could be farther along in the healing process.""","""Your expression of emotion means you are finally facing your reality.""","""I am proud of you for being brave by admitting all of this, you are amazing!""","""So frustrating! I am so grateful you can share this with me. I'm here for you.""","(A): ""If you had shared sooner, you could be farther along in the healing process.""
(B): ""Your expression of emotion means you are finally facing your reality.""
(C): ""I am proud of you for being brave by admitting all of this, you are amazing!""
(D): ""So frustrating! I am so grateful you can share this with me. I'm here for you.""","""So frustrating! I am so grateful you can share this with me. I'm here for you.""",D,"This is the most empathic answer without causing shame as in answer a), reversing the focus to your own reaction and opinion of her like in answer b), or pointing out her process for her like in answer c). Therefore, the correct answer is (D)",counseling skills and interventions
1490,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","You have attempted to arrange a family session with the mother, but she is unable to take off work to attend. The client arrives for his second session eager to share that he is “on green” this morning, which means the client’s behavior for the day has been good. You praise him for staying in his seat and keeping his hands and feet to himself. The client responds well to your praise. When engaging in a feelings identification activity, the client identifies feeling unhappy and worried when his father doesn’t show up for scheduled visitation. The client explains that his parents frequently argue about “how to take care of me” and “sometimes push each other.” He quickly abandons the feelings activity and asks if he can go back to class. You deny the client’s request to leave and instead give him the option of selecting another activity. The client refuses to do so and begins to kick your file cabinet repeatedly. He proceeds to knock papers off your desk. When redirected, the client’s behavior escalates. He quickly becomes inconsolable as he cries and yells, “I hate counseling, this school, and everyone in it!”  During the feelings identification activity, you respond to your client’s disclosure by stating, “You’re feeling sad and miss your dad. And on top of worrying about him, it sounds like you feel responsible for some of your parents’ grown-up problems","During the feelings identification activity, you respond to your client’s disclosure by stating, “You’re feeling sad and miss your dad. And on top of worrying about him, it sounds like you feel responsible for some of your parents’ grown-up problems. Am I getting this right?” This is an example of a(n):",Additive encourager,Advanced paraphrase,Clarification,Complex reflection,"(A): Additive encourager
(B): Advanced paraphrase
(C): Clarification
(D): Complex reflection",Complex reflection,D,"Complex reflections go beyond simple reflections and paraphrasing by addressing the client’s underlying or implicit thoughts, feelings, and experiences. In this response, you validate the client’s feelings (sad and worried), allude to additional feelings of being overwhelmed (and on top of worrying), and attempt to counter any personal responsibility for “grown-up problems” Since the client is still in the early stages of therapy, it is often helpful to ask if your interpretation is correct. (“Am I getting this right?”) This response helps subtly shift the power dynamic from that of an authoritative adult to one who understands the child and the world around them. An encourager or lead is a prompt used to help the client continue expressing themselves. Encouragers can be both verbal (“Please, go on”) or non-verbal (head nodding) and are used to convey interest in what the client is expressing. Additive empathy is a core counseling attribute (rather than an additive encourager). Clarification is used when the client’s statement is vague or confusing. (Client: “I’m just done” Therapist: “Can you tell me what it means for you to be done?”) Paraphrasing selectively focuses on the client’s intended message or meaning. Paraphrases are different from reflections in that paraphrases solely concentrate on the content of the client’s statement. Paraphrases do not involve reflecting the client’s feelings. Therefore, the correct answer is (A)",counseling skills and interventions
1491,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","    History of Condition: The client’s milestones were all developmentally appropriate; he was walking at ten months, toilet trained by 24 months, and speaking in complete sentences at almost 30 months. The mother describes the client as “moody” beginning in kindergarten. His temper outbursts began to escalate in intensity and duration within the last few years. During this time, there were no known associated stressors. The mother reports that the client has always had a hard time following directions and difficulty complying with authority figures. Family History: The client has two maternal half-brothers, ages 18 and 20, and has positive relationships with both of them. His parents divorced when the client was three years old, and the mother has physical custody of the child\. Before the divorce, the client witnessed verbal and physical altercations between his parents. The client’s father visits periodically, and he has been in and out of substance abuse treatment centers for most of the client’s life. When angry with his mother, the client tells her he wishes he could live with his father. The client’s maternal grandmother is diagnosed with bipolar disorder, and the client’s mother states she struggles “off and on” with depression. Aside from the father’s substance use disorder, a paternal history of mental illness is unknown","In addition to severe temper outbursts, which information is most indicative of the diagnosis of Disruptive Mood Dysregulation Disorder (DMDD)?",Defiance towards authority,Social-emotional difficulties,Irritability,Impulsivity,"(A): Defiance towards authority
(B): Social-emotional difficulties
(C): Irritability
(D): Impulsivity",Irritability,C,"Disruptive Mood Dysregulation Disorder (DMDD) is characterized by severe and recurrent temper outbursts (at least three times per week) and irritability. According to the DSM-5-TR, irritability must be chronic and persistent (nearly every day, most of the day). Defiance to authority, a characteristic of Oppositional Defiant Disorder, is not a manifestation of DMDD. Socio-emotional difficulties characterize Autism Spectrum Disorder, and impulsivity is a symptom of ADHD, making both answer options incorrect. Further, if a client meets the criteria for both DMDD and ODD, they should be assigned the diagnosis of DMDD. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1492,Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22),"Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor","You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.","The client reports that her husband’s patience continues to wear thin, so she has explored the possibility of alternate employment. She states that she applied for a position as a curriculum sales representative but did not get an interview. The client reports that the company used a personality inventory to prescreen job applicants. She says that someone in human resources told her she was not selected for an interview because the company was looking for someone who was more extraverted and a “thinker” rather than a “feeler.” The client explains that she was under the impression that they were looking for a male. She expresses an interest in using personality inventories to help identify employment that would be a good fit for her.  You administer the Self-Directed Search (SDS) career assessment tool to determine the client’s three-point Holland code","You administer the Self-Directed Search (SDS) career assessment tool to determine the client’s three-point Holland code. If the client’s code is SAE, which occupation would give her the highest job satisfaction?",Systems analyst,Veterinarian,Interior decorator,Accountant,"(A): Systems analyst
(B): Veterinarian
(C): Interior decorator
(D): Accountant",Interior decorator,C,"An interior decorator would give the client the highest job satisfaction of the careers listed if her code is SAE (social, artistic, enterprising). John Holland conceptualized six occupational and personality categories: realistic (R), investigative (I), artistic (A), social (S), enterprising (E), and conventional (C), or RIASEC. Holland used a hexagon to illustrate the positioning of each occupational category, with each point representing one of the Holland types. Work environments and personalities that are most similar are adjacent to one another. For example, the client is a teacher, which puts her in the social category. The social category includes career environments and personality types described as humanistic and responsible (eg, teachers, nurses, social workers). Categories adjacent to social (ie, artistic and enterprising) are more likely to include careers that would also be a good fit for the client. For example, interior design is grouped with the artistic category. Accountants are included in the conventional category, which is nonadjacent to social. Another nonadjacent category is the realistic category, which includes careers such as veterinarian. Lastly, systems analyst is included in the investigative category, which is also nonadjacent to the social category. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1493,"Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)","Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa","You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.","Third Session, 3 Weeks After the Initial Intake The couple comes into the session and sits down. Their body language does not appear as uncomfortable as it has in previous sessions because they are sitting a little closer together. You ask both individuals what they need to work on. The wife says that she knows that she needs to rebuild trust, and the husband says that he wants to know more about what happened in the affair before they move forward. The couple report that they tried to engage in sex, but that the husband stopped during intercourse. The husband states that he could not get the idea out of his mind that his wife does not find him attractive because she was with a woman. You ask the husband what it means for their marriage if his wife does not find him attractive, and he states that it means he will not be able to please her. You then ask him what it means for the relationship if he cannot please her, and he responds that it means he cannot be a good husband. You follow up asking what it means if he cannot be a good husband, and he says that they will have a miserable marriage. You support effective communication strategies and empathize with the couple. After the session, the wife comes back to get her coffee that she left and says that she knows that she hurt her husband and is in the wrong, so she will do whatever her husband needs to rebuild trust.  You are using narrative therapy with the couple",You are using narrative therapy with the couple. Which one of the following actions is an example of narrative therapy?,"In a therapy session, each individual tells the story of their relationship from the view of a narrator in order to see things more objectively.",Prompt the couple to read therapeutic books related to their problem areas.,"Each individual writes a narrative of the story of their problem and then is guided in rewriting the story from a different, more positive, perspective.",Provide homework for the couple to write a story together in order to work on collaborating and considering each other’s viewpoints.,"(A): In a therapy session, each individual tells the story of their relationship from the view of a narrator in order to see things more objectively.
(B): Prompt the couple to read therapeutic books related to their problem areas.
(C): Each individual writes a narrative of the story of their problem and then is guided in rewriting the story from a different, more positive, perspective.
(D): Provide homework for the couple to write a story together in order to work on collaborating and considering each other’s viewpoints.","Each individual writes a narrative of the story of their problem and then is guided in rewriting the story from a different, more positive, perspective.",C,"Narrative couples therapy involves having each individual write a narrative of their own story and then guiding them to rewrite the story from a new, more positive, perspective. This process assists the couple with externalizing the problem and also with understanding that there are two sides to a conflict, which helps individuals take responsibility for their own part. By then rewriting the story, the couple is given the opportunity to rework how they will reflect on their past as they move into the future, ideally seeing their relationship more positively. Reading specific therapeutic books related to the problem areas would fall under bibliotherapy. Writing a story together and telling their story as a narrator are not defined clinical interventions specific to narrative therapy. Therefore, the correct answer is (C)",counseling skills and interventions
1494,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",You are considering transferring your client to a colleague. What information would be the most important to include in a discharge summary?,Recommendations for stabilization with sobriety and medication management,Recommendations for enhanced self-care and better coping skills,Recommendations for marital and vocational counseling,Recommendations to develop more effective emotional regulation.,"(A): Recommendations for stabilization with sobriety and medication management
(B): Recommendations for enhanced self-care and better coping skills
(C): Recommendations for marital and vocational counseling
(D): Recommendations to develop more effective emotional regulation.",Recommendations for stabilization with sobriety and medication management,A,"Facilitating the client's stabilization initially will be critical to providing an opportunity for success with treatment. Getting the client involved in motivational interviewing and some form of recovery will be essential while at the same time proper medication management appropriate for the bipolar condition is vital. Therefore, the correct answer is (B)",treatment planning
1495,"Name: Ella Clinical Issues: Seeking help after experiencing a trauma Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.0 Acute Stress Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is a 35-year-old white female with a slender build. She is wearing jeans and a t-shirt and appears to be clean and well groomed. Her posture is slumped, her facial expression is flat, her eyes are downcast, and she has been displaying signs of crying. She speaks softly in a monotone voice. The client appears depressed and anxious, with tearfulness and trembling. She seems overwhelmed by her current situation and is unable to control her emotions. She reports difficulty concentrating on day-to-day activities. Her thoughts are logical and organized with tangential moments. She reports feeling as if she is living in a dream-like state since the trauma occurred. She experiences frequent nightmares about people she loves being killed. She is able to recall her personal history accurately. She is able to understand and follow your instructions and questions. She recognizes that she needs help. She denies suicidal ideation or intent.","First session You are a mental health counselor working in a private practice setting while under supervision. The client is a 35-year-old white female who presents for therapy following a trauma. When you ask the client why she made an appointment to see you, she begins to cry and shake uncontrollably. She tells you that her friend was shot two weeks ago and the client saw it happen. Her friend is in the intensive care unit at the hospital. She cannot consciously recall the actual shooting. Since the assault, she cannot concentrate and feels anxious all the time. She does not want to talk to her friends, and she has been withdrawing from her family. The client tearfully tells you that ""life has no meaning."" She is seeking your help to find some relief.    You validate the client's emotions and begin processing her subjective experience. You help her to understand that witnessing such a traumatic event can lead to the physical and emotional symptoms that she is experiencing. She appears receptive to what you are saying and nods her head. You emphasize that she has taken a courageous step by seeking professional help. As you continue with the initial session, you focus on providing an empathetic space where she can explore her feelings without fear of being judged. You provide her with information about resources she can access for further help. You also discuss the principles of cognitive-behavioral therapy as a method to begin to process her traumatic experience. Before the session ends, you present relaxation exercises that she can practice at home in order to reduce distress and tell her that learning healthy coping skills will be an important part of her recovery.    Following the session with your client, your supervisor tells you that she has worked extensively with the client’s parents in the past and offers to give you their files so that you can understand more of the client's family history.  Second session After meeting with the client for the initial session, you thought it would be beneficial to meet with her again in a few days. She scheduled an appointment to meet with you via telehealth three days after her initial visit. You begin today's session by discussing potential avenues of treatment. The client reports not sleeping well because of vivid nightmares. She excessively worries about losing her parents but does not want to concern them. Since the assault, she has withdrawn from her family. She reports becoming angry when they suggest that she go for a walk outside to ""get some fresh air"". She now believes they do not care that she feels unsafe. The client denies suicidal ideation but sometimes feels she would be better off not waking up in the morning. During the first 10 minutes of the session, the client's two pet dogs continually draw her attention away from the session. You notice the distraction and acknowledge it. You ask the client if she would like to take a break and play with her dogs for a few minutes. The client agrees and takes a few minutes to interact with her animals. When she is finished, she escorts the dogs out into the hallway and returns to her room, closing the door behind her.    You sit with the client and share a compassionate space together, allowing her to share her vulnerable feelings. You notice that, as you talk, her two pet dogs are still being disruptive, barking in the hallway, and distracting her from the conversation. You bring her attention back to the session by reiterating your understanding of how she has been feeling since the assault. You then explain that these feelings may be compounded by the disruption caused by her pets during their sessions. You offer suggestions on ways to create a better environment for therapy such as having another family member manage the pets while they work together, or setting up a comfortable area in another room where she can work with you away from distractions. The client is appreciative of your suggestion and agrees to put some of these ideas into practice for their next session. From here, you move onto discussing potential treatment options for her recovery. You explain the benefits of cognitive behavioral therapy and how it can help her in managing her feelings more effectively. Additionally, you share relaxation techniques with the client to help reduce her physical symptoms of distress. Finally, you work collaboratively with your client on developing coping skills and increasing self-care practices in an effort to improve her overall well-being. You end the session feeling that progress has been made, both in terms of providing an understanding environment and suggesting ways to further address the trauma she experienced.  Eighth session It has been one month since your initial counseling session with the client. You have been meeting with her twice a week. Today, you take time to review the progress she has made in therapy. She has utilized several calming techniques while demonstrating a willingness to discuss the traumatic event with you. She is experiencing fewer nightmares, and her mood has improved. She is once again finding some meaning and value in life. You have established excellent rapport with the client, and she has been reestablishing supportive relationships with her family. She still experiences high anxiety, however, when worrying, particularly when passing the store where her friend was shot. Your client reveals that the shooter she witnessed during the robbery was Irish American. She now has a feeling of genuine fear toward all Irish Americans. She uses several derogatory slurs during the session and reveals she hates all Irish men due to her experience.    You empathize with the client's feelings and explain how post-trauma symptoms can lead to increased levels of fear and distress in certain situations. You discuss with her the importance of understanding that trauma can cause us to make generalizations about people or groups who we associate with the traumatic event, but these are not necessarily accurate or fair assessments. You encourage your client to practice self-reflection when feeling overwhelmed by similar thoughts in order to gain perspective. Additionally, you introduce exercises which promote relaxation and offer a safe space for her to pause and consider her thoughts before reacting emotionally.","The client's family has a long history of living in the Bronx, New York, as her great-great-grandparents immigrated from Italy. She currently lives with her parents in a house that has been in her family for generations. Her entire life she has always felt safe and secure living in her Italian neighborhood. The client has one older brother who is married and works as a paramedic. She is close to her parents and describes them as supportive, hardworking, and loving. Her father was diagnosed with cancer several years ago and she has tried to be there for him in every way possible. Stressors & Trauma: The client witnessed her friend being shot during a robbery. Since then, she cannot stop thinking about the event. As a result, she has insomnia and frequent nightmares about people she loves being killed. She is unable to stop shaking and crying when discussing the nightmares. In addition, the event has left the client feeling angry, confused, ashamed, depressed, and highly anxious in her day-to-day activities.  ",What is the best way to address the client's self-reported fear and negative statements about Irish Americans?,Address the client’s prejudice and challenge her new assumptions about this population,Terminate the client due to her prejudiced tendencies and your inability to control her constant use of derogatory slurs,"Allow the client to continue expressing derogatory slurs, as this has not been identified as an issue in the treatment plan",Use therapeutic silence to allow the client to recognize your unacceptance of her derogatory slurs,"(A): Address the client’s prejudice and challenge her new assumptions about this population
(B): Terminate the client due to her prejudiced tendencies and your inability to control her constant use of derogatory slurs
(C): Allow the client to continue expressing derogatory slurs, as this has not been identified as an issue in the treatment plan
(D): Use therapeutic silence to allow the client to recognize your unacceptance of her derogatory slurs",Address the client’s prejudice and challenge her new assumptions about this population,A,"You need to address these issues directly and challenge the client’s worldviews in relation to her anxieties and fears. Therefore, the correct answer is (B)",counseling skills and interventions
1496,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","   age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement",What is the primary ethical risk of allowing the client to interpret for his family?,It might cause the client to experience secondary trauma when discussing his parent’s torture.,It might violate the principles of self-determination and autonomy inherent in informed consent.,It might reinforce unhealthy boundaries and contribute to parental inadequacy.,There is the potential for misdiagnosis if the client chooses to interpret selectively.,"(A): It might cause the client to experience secondary trauma when discussing his parent’s torture.
(B): It might violate the principles of self-determination and autonomy inherent in informed consent.
(C): It might reinforce unhealthy boundaries and contribute to parental inadequacy.
(D): There is the potential for misdiagnosis if the client chooses to interpret selectively.",It might violate the principles of self-determination and autonomy inherent in informed consent.,B,"The primary risk for allowing the client to interpret for his family is that it calls into question the validity of informed consent. The principles of self-determination and autonomy govern informed consent. While the adolescent is the identified client, he does not have the legal right to provide consent for treatment. According to the ACA Code of Ethics (2014), “Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. […] Counselors communicate information in ways that are both developmentally and culturally appropriate. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (eg, arranging for a qualified interpreter or translator) to ensure comprehension by clients” If counselors do not have immediate access to interpreters, remote options are available via phone or video. In certain instances, in some states, using nonprofessional interpreters is against the law. Experiencing secondary trauma is unlikely because there is an increased probability that the client is already aware of the torture or that the parents do not discuss it with anyone. Additional considerations include perpetuating the client’s role as chief decision-maker, selective messaging, and intentional or unintentional miscommunication; however, these issues do not supersede the need to adhere to the principles of self-determination and autonomy. Therefore, the correct answer is (D)",professional practice and ethics
1497,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.  Ninth session You have seen the client weekly, and she is progressing. She arrives at today's session on time. She appears calm, alert and focused. She states that she has been actively journaling her thoughts and feelings. This has been helpful for her in identifying themes in her faulty cognitions. She tells you that she is surprised by how much she is learning about herself, including how much her past has influenced her current beliefs.    She showed some psychomotor agitation by pulling on the strings of her blouse. The client expressed that she and her husband have been trying to implement a date night which has helped their relationship and for him to better understand what Panic Disorder is. She said that having meaningful conversations with him and having his support in times of panic has helped reduce the attack's length. However, the client did express that she cannot shake the fear of dying and leaving her children. You discuss with her the potential triggers of these panic attacks and discuss ways to manage them.    As she leaves, you see that she has bruises on her arms as she is getting ready to leave and says she was ""roughhousing"" with her husband. You are unsure if she is telling the truth, making you wonder about everything she has been saying about her husband. You discuss with her the option of attending couples therapy to help them work through any issues they may face. She says she is open to it but worried about bringing up deeper issues surrounding their relationship. You reassure her that she and her husband will have a safe space to discuss any topics and remind her about the counseling.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","You, as a therapist, mention to your spouse that you have a client from Latin America suffering from Panic Attacks. Your spouse tells you that she has a cousin from Latin America with the same problem. When your spouse mentions the cousin's name, you realize this is your client. Have you violated confidentiality, and how should you proceed?","You have not violated confidentiality, and you must explain the situation to your client and ask if she wants to continue therapy.","You have violated confidentiality, and you need to refer the client to another therapist.","You have violated confidentiality, and you need to continue seeing the client.","You have not violated confidentiality, and you need to refer the client to another therapist.","(A): You have not violated confidentiality, and you must explain the situation to your client and ask if she wants to continue therapy.
(B): You have violated confidentiality, and you need to refer the client to another therapist.
(C): You have violated confidentiality, and you need to continue seeing the client.
(D): You have not violated confidentiality, and you need to refer the client to another therapist.","You have not violated confidentiality, and you need to refer the client to another therapist.",D,"Since you did not reveal the client's name, you have not broken confidentiality. You should, however, not continue therapy with your client, given that the client is your significant other's relative. It would be a conflict of interest and could potentially damage the trust between you and your client. It is best to refer the client to a different therapist to ensure the best possible care and to maintain the integrity of the therapeutic relationship. Therefore, the correct answer is (C)",professional practice and ethics
1498,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","The client comes into the session and looks tired, as evidenced by the darkness under his eyes and he is walking slowly. The client starts talking immediately about 2 days prior when he went to his ex-wife’s house to pick up his kids for a visit and she told him that although she cannot stop this visit, due to recent inhalant use a few weeks ago, she talked with her lawyer about changing the status of his future visits to supervised visits, and she will be returning to court to do so. The client says that he spent time with his kids and that when he left, he stopped by a store to get acetone and that he used this substance that night. The client expresses guilt and shame surrounding using, which led to him using the acetone the next day. The day after he used inhalants, the client stated that he was thinking, “I already broke my sobriety; I may as well huff so that I can feel better.” You empathize with the client regarding the situation because you can see how this would be distressing for him. The client says that his children seem bored when they are with him, as if they want to go home, which induces feelings of shame and sadness","All of the following are possible symptoms of inhalant use, EXCEPT:",Euphoria,Insomnia,Muscle weakness,Nystagmus,"(A): Euphoria
(B): Insomnia
(C): Muscle weakness
(D): Nystagmus",Insomnia,B,"Insomnia is not typically associated with inhalants. Rather, inhalants generally slow down the body’s movement, slow reflexes, and cause a stupor, likely leading to sleepiness. Nystagmus (uncontrollable eye movement), euphoria (feelings of great happiness or excitement), and muscle weakness are common symptoms of inhalant intoxication. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1499,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.",ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report,"When the client leaves the room, which of the following is the most important to consider for an effective counseling intervention with your client?",Encouraging the client to return to the office with the foster parents,The manner in which you enter the lobby and approach the client,Discussing the need for safety and refraining from hitting,Confidentiality when leaving the foster parents in your office,"(A): Encouraging the client to return to the office with the foster parents
(B): The manner in which you enter the lobby and approach the client
(C): Discussing the need for safety and refraining from hitting
(D): Confidentiality when leaving the foster parents in your office",The manner in which you enter the lobby and approach the client,B,"When considering effective counseling interventions for this client, you must first identify the underlying purpose of the behavior that must be addressed. In this case, while hitting is not an appropriate behavior, it was the client’s method of communicating a feeling of insecurity. Effective counseling to address the feeling of insecurity must start with creating an environment that is comfortable and secure for the client, which is first communicated through the manner in which you enter the lobby and approach the client. Doing so calmly and without judgment will ensure that you are not there to reprimand, but to support. Only if the client feels secure, would discussing the need for safety and refraining from hitting be received and the possibility of the client returning to the office with her foster parents be realistic. Confidentiality when leaving the office is important (and can be enforced by locking your computer and/or taking your notebook so that neither are available to the parents), but this does not directly address an effective counseling intervention with the client. Therefore, the correct answer is (B)",counseling skills and interventions
1500,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Using the provided information, which of the following would not be useful to understand the client's current presentation?",Beck's Anxiety Inventory-II (BAI-II),Family Genogram,Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),Connors Behavioral Rating Scale (CBRS),"(A): Beck's Anxiety Inventory-II (BAI-II)
(B): Family Genogram
(C): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(D): Connors Behavioral Rating Scale (CBRS)",Connors Behavioral Rating Scale (CBRS),D,"The CBRS is a widely-used assessment for ADHD in children and adolescents. Due to the client's age, this would not be an assessment to use. Because he takes Concerta, the counselor may choose to use an inventory developed for adults. The MMPI-2 is used to assess personality traits and psychopathology. This may help the counselor determine a client's psychological state or a diagnosis, and in this client's case, may help explain some of the patterns that the client exhibits that are not easily fit into a diagnostic category, such as his forgetting, tuning out, and being seen as thinking he is better than others when he does not believe this. Completing and evaluating a family genogram will help the counselor and client identify patterns and interactional dynamics that have become unhealthy ways of thinking and behaving that may have served the client well in childhood with his family of origin but have become problematic in his adult life in his family and other relationships. The BAI-II measures the client's current level of anxiety. The client presents with an anxious mood and takes Pristiq, which is both an antidepressant, and an anti-anxiety medication that works on neurotransmitters that impact the fight-or-flight response. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1501,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.","You meet with the client and review a log that he brings in that documents how often he masturbated over the past week. The client’s log showed that he masturbates about three to four times per day. The client appears to masturbate more when his roommates are not in the apartment and late at night when his time is less structured. The client reports that he has a job interview in a few days at a nonprofit agency that works with children to ensure that they have clothing. He feels that this will be meaningful work and is encouraged because he knows the supervisor there from a previous job, and he thinks that the supervisor is a respectful person. The client expresses worry that he will not be competent at the job based on how he is doing at his current place of employment. You support the client with reframing his anxious thoughts about the interview.  You complete a mental status exam during every session",You complete a mental status exam during every session. Which one of the following domains would most likely be affected by the client’s presenting diagnoses?,Mood,Eye contact,Orientation,Suicidality,"(A): Mood
(B): Eye contact
(C): Orientation
(D): Suicidality",Mood,A,"Mood is the most likely element of the mental status exam to be affected during this client’s sessions because he has verbalized feelings of anxiety, guilt, and shame in discussing his struggles, all of which may impact his mood. Eye contact may have been difficult during the early sessions for this client because he was still in the process of building rapport; however, this is your fourth session and the client is less likely to be experiencing social anxiety and discomfort with the therapeutic relationship. Suicidality is not a reported or observed concern due to the client’s diagnoses or reports. Orientation does not appear to be affected because the client is alert and oriented to time, location, self, and situation. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1502,Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th","You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.","   e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family.  The client shares her worries about her less-than-perfect performance on the tennis court",The client shares her worries about her less-than-perfect performance on the tennis court. This is an example of which of the following?,Black-and-white thinking,Emotional reasoning,Disqualifying the positive,Mind reading,"(A): Black-and-white thinking
(B): Emotional reasoning
(C): Disqualifying the positive
(D): Mind reading",Disqualifying the positive,C,"Disqualifying or discounting the positive is a cognitive distortion associated with the client’s worry. Disqualifying the positive is the belief that one’s accomplishments don’t count. For example, the client is the number-one ranked player on her high school varsity tennis team, yet she is dissatisfied with her less-than-perfect performance on the tennis court. Mind reading is a cognitive distortion that happens when one claims, without evidence, that other people’s reactions to them are negative. Emotional reasoning is also a cognitive distortion; it occurs when one engages in self-judgment based on emotional reactions. It is the belief that negative emotions define an individual as a person (eg, “I’m experiencing anxiety; therefore, I am in danger”). Black-and-white, or all-or-nothing, thinking happens when there is no acknowledgment of any “shades of gray” (eg, “Either I fail or I succeed”). Therefore, the correct answer is (B)",counseling skills and interventions
1503,"Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)","Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation","You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.","You meet with the client, and she reports that she started dating someone. You and the client spend some time talking about the man who she is dating and agree that he sounds like a nice person that is not taking advantage of her personality. You and the client discuss her having an increased awareness of the behaviors that she has engaged in in the past that she did not like. The client identifies that she has engaged in behavior that worries her with this boyfriend. She went out for lunch and felt compelled to buy him lunch also, even though he was not there. After exploring why the client feels an obligation to buy her boyfriend lunch when he is not present with her, it becomes clear that it is motivated by the fear that he will be offended that she bought herself lunch without thinking of him. You support the client in identifying more helpful thoughts related to this and ask her to complete a behavioral experiment regarding this situation. The client becomes frustrated that she is still struggling with relationships and says, “I think I’ll just date who I want and how I want from here on out. It’s definitely the easiest choice instead of doing all of this.” You remind the client that therapy takes some time but can be really beneficial and you praise her for engaging fully so far",Which of the following would be an appropriate behavioral experiment regarding the client’s fear of offending the man who she is dating by not buying him lunch?,The client will buy herself lunch this week and use thought processing techniques to manage her own anxiety.,The client will ask her boyfriend about whether or not it offends him when she does not buy him lunch.,The client will buy herself lunch this week and use coping skills to show herself that she can be okay if she does not buy him lunch.,The client will buy herself lunch this week and not buy her boyfriend lunch to see if her assumption is true.,"(A): The client will buy herself lunch this week and use thought processing techniques to manage her own anxiety.
(B): The client will ask her boyfriend about whether or not it offends him when she does not buy him lunch.
(C): The client will buy herself lunch this week and use coping skills to show herself that she can be okay if she does not buy him lunch.
(D): The client will buy herself lunch this week and not buy her boyfriend lunch to see if her assumption is true.",The client will buy herself lunch this week and not buy her boyfriend lunch to see if her assumption is true.,D,"The behavioral experiment that addresses the client’s root concern is to buy herself lunch and see if her boyfriend gets offended if she does not buy him lunch, too. He likely will not get offended if she is buying herself lunch when he is not around, and this will provide evidence for the client to use in the future to challenge these intrusive thoughts. It is important for the client to see that she can manage her own anxiety because this builds confidence, but this does not directly confront the source of the anxiety, which is related to offending her boyfriend. The client could simply ask her boyfriend if it would offend him if she did not buy him lunch, but hearing something and experiencing something are different, and she may not believe him based on her past experiences. Therefore, the correct answer is (D)",counseling skills and interventions
1504,Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3),"Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio","You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.","The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss",Ethical guidelines for the counseling profession state that counselors must refrain from terminating or referring clients based solely on which of the following conditions?,The client’s failure to pay agreed-upon fees,The determination that the client is no longer benefiting from services,The lack of competence required to provide professional assistance,"Adherence to personal values, attitudes, beliefs, and behavior","(A): The client’s failure to pay agreed-upon fees
(B): The determination that the client is no longer benefiting from services
(C): The lack of competence required to provide professional assistance
(D): Adherence to personal values, attitudes, beliefs, and behavior","Adherence to personal values, attitudes, beliefs, and behavior",D,"Counselors are instructed to “refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature” (ACA, 2014). The ACA Code of Ethics specifies that the client’s failure to pay agreed-upon fees justifies appropriate termination. Counselors review policies and procedures associated with nonpayment as part of informed consent. In terms of counselor competence, the ACA Code of Ethics states, “If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship” (ACA, 2014). Lastly, counselors are ethically obligated to end professional counseling relationships when the client no longer benefits from counseling. Therefore, the correct answer is (C)",professional practice and ethics
1505,"Name: Candy Clinical Issues: Anxiety and relationship distress Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.03 Borderline Personality Disorder Age: 29 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client presented as a well-groomed female who appeared her stated age. She was appropriately dressed in casual attire. Her speech was marked by a slow rate and low volume overall, though, at times, her rate and loudness increased spontaneously. Her tone was muffled and difficult to hear clearly at times. The client's mood appeared depressed and confused. She displayed emotional lability during the evaluation, with shifts between expressing elation, fear, and distrust of this clinician and the treatment environment. Despite her affective instability, she was oriented to person, place, and time. Her attention and concentration waxed and waned throughout the session, with some difficulty tracking questions and sustaining focus on topics. She denied current homicidal ideation or intent. However, the client endorsed chronic passive suicidal ideation that intensifies during times of high personal stress. She also reported a remote history of hospitalization due to engaging in self-injurious cutting behaviors when feeling extremely distressed.","First session You are a clinical mental health counselor working in a private practice setting. The client, a 29-year-old female, presents to the intake session expressing that she has trouble controlling impulsive acts and is constantly worried. She speaks about her marriage, describing it as up and down. She looks down tearfully and says, ""I keep hurting him. One day I love him, and the next day I can't look at him."" She pauses and asks, ""What if he leaves me? I can't deal with that."" She further reveals that after she fights with her husband, she goes into their bedroom and cuts her thighs. At first, she feels relief, but this is followed by profound sadness and a feeling of worthlessness.    The client's lack of a stable parental figure resulted in her having difficulty forming healthy attachments with others. She feels isolated and disconnected from the world around her and has difficulty appropriately expressing her emotions. Her relationships are often strained, and she finds it difficult to trust others or herself. She has difficulty setting healthy boundaries and repeatedly emotionally abuses herself and others.    She reports feeling overwhelmed by her emotions and finds it difficult to regulate them. She states that she experiences intense guilt and shame following her impulsive acts and is often worried that her husband may leave her due to her behaviors. The client has struggled to control her emotions, which has been a source of significant distress in her life.    The client's self-destructive behavior has become increasingly frequent and intense. She has been unable to find a way to cope with her emotions and has resorted to self-harm as a way to manage her distress. She has become increasingly isolated and withdrawn, and her relationships have suffered as a result. She has become increasingly dependent on her husband, and her fear of abandonment has become a source of significant distress.","The client's father died when she was very young. She describes her mother as having a ""difficult time raising me and my brother as a single mother."" The client's mother worked three jobs and could not spend much time with her children. The client remembers having several babysitters as a child, but they never lasted long. Currently, the only relative the client speaks with is her mother. She lists her husband and mother as her emergency contacts on the intake form. The client reports feeling isolated and alone, especially since her father's death. Personal/Social Relationships: The client has a long history of attempting suicide. She has been in and out of emergency rooms nearly every week. She is persistently angry, needs attention and recognition, and has difficulty trusting others. She has had numerous affairs in an attempt to feel worthy. The client compensates for her guilt by buying her husband expensive gifts. She grapples with maintaining healthy relationships and controlling her rage and violent behaviors when she feels threatened. She has struggled to form meaningful relationships with her peers and has few friends. Although she does not lack socialization skills, the client finds it difficult to get close to people. Previous Counseling: The client is currently taking Paxil for her underlying depressive symptoms. She has expressed concern about her ability to manage her mental health with her current treatment. She worries that her erratic adherence to her medication regimen and lack of follow-up with her psychiatrist could lead to a termination of services. She has reported increased anxiety and stress as a result of this fear. She reports that her mood swings are more extreme, and she is having difficulty concentrating and staying focused. She reports that her friends and family have noticed her behavior change and expressed concern.  ",Which therapeutic intervention would have the most efficacy in addressing the client's self-harming behaviors?,Solution-focused therapy,Filial therapy,Psychodynamic therapy,Dialectical behavior therapy,"(A): Solution-focused therapy
(B): Filial therapy
(C): Psychodynamic therapy
(D): Dialectical behavior therapy",Dialectical behavior therapy,D,"Dr Marsha Linehan originally designed dialectical behavior therapy (DBT) to treat Borderline Personality Disorder. DBT is a combination of individual and group therapy sessions. During the individual sessions, the client and therapist work collaboratively to address issues that have come up for the client, focusing on self-harm or self-destructive behaviors. There is also an emphasis on improving social skills and healthy coping skills. During the group sessions, the focus is on developing skills in four areas: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Therefore, the correct answer is (D)",treatment planning
1506,"Name: Jeff Clinical Issues: Referral following hospitalization for suicidal ideation Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F31.32 Bipolar I Disorder, Moderate, Most Recent Episode Depressed Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's overall presentation during the examination is disheveled. He is thin, taller than average, and hunches over in his chair. He appears tired and exhibits low energy. Several times during the examination, he massages his neck and shoulders. He has inconsistent eye contact and often looks down at the floor. Speech is quiet and slow. You have to wait several seconds for him to answer questions. Thought content reveals negative themes. At various times he appears numb and indifferent but then shifts to tearfulness. Memory is slightly impaired, and he has difficulty staying focused. He denies homicidal ideations but states having past suicidal ideations.","First session You are a clinical mental health therapist working in a private practice setting. The client is a 33-year-old male referred to you by an ER physician as a follow-up after being hospitalized due to suicidal ideation. This is not the first time the client has been hospitalized. During the initial counseling session, the client discloses, ""I don't know why I'm here. No one can help me. My sister made this appointment for me because I got this referral when I left the hospital. She drove me here and is sitting out in the waiting room."" He continues with a tearful eye, ""I'm a total failure. No one cares about. My sister looks after me, but I think it's because she feels sorry for me.""    You continue with your assessment to gain a more thorough understanding of his current situation. He tells you that there are times when he feels ""really low"" and his mind tells him that he would be better off dead. Other times, he feels ""pretty good"" with a lot of energy, a positive self-image, and motivation to complete various projects. You ask about his relationships with friends and family, and the client reveals that he has lost contact with most of his close friends due to a ""series of negative events"" in his life. He further discloses that he has difficulty maintaining relationships. He expresses feelings of loneliness and disconnection from the world. He is worried that his sister will eventually ""give up"" on him. When asked about his parents, he softly laughs and says, ""They took the easy way out and died. Mom in a car crash and Dad from cancer. They are the ones who deserve to suffer and instead, they've got it easy.""    You discuss your role as a therapist and what the client can expect from the counseling process. You also review the parameters of confidentiality involved in therapy. He tells you that he would like to ""give counseling a try"" and see you for another session. You schedule an appointment to see him the following week.","The client's parents divorced when he was ten years old. He has an older sister who he currently lives with. He recalls his childhood memories as traumatic and reports experiencing verbal and physical abuse by both parents. The client states that he lived with his dad after his mom died when he was 14 years old. He explains that living with his dad was difficult, saying, ""Being around my dad was like being around a ticking time bomb. There were times when he was calm and seemed interested in what I was doing, but there were other times when he would become very angry and I was never sure what might set him off."" The client works in a local pizza shop. He says he is written up weekly for being late to work. He reports verbal altercations with his coworkers because they will not listen to him. In his teen years, the client used alcohol to cope with his family situation. Since that time, he only drinks socially.",Which pair of topics are least likely to be discussed in-depth during the intake process?,Fees/financial expectations and short-term goals,Confidentiality and diagnosis,Informed consent and agency policies,Short-term goals and diagnosis,"(A): Fees/financial expectations and short-term goals
(B): Confidentiality and diagnosis
(C): Informed consent and agency policies
(D): Short-term goals and diagnosis",Short-term goals and diagnosis,D,"During client intake, the main objective is to gather information. The therapist and the client need to understand what goals can be established but have a lower priority than informed consent, fee/financial expectations, and confidentiality. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1507,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ","At this point in treatment, which intervention would you consider useful for this couple?",Bringing the ex-husband in with the client to have a formal discussion to abstain from future relationships,Having the couple identify each other's weaknesses by creating a list and reading it aloud during the session,Helping the couple formulate their ideal relationship rather than explore their past relationship failures,Holding a safe therapeutic place for confrontation,"(A): Bringing the ex-husband in with the client to have a formal discussion to abstain from future relationships
(B): Having the couple identify each other's weaknesses by creating a list and reading it aloud during the session
(C): Helping the couple formulate their ideal relationship rather than explore their past relationship failures
(D): Holding a safe therapeutic place for confrontation",Holding a safe therapeutic place for confrontation,D,"As a therapist, consider this intervention as a goal. Its use is necessary for productive work in the session. Therefore, the correct answer is (A)",counseling skills and interventions
1508,"Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)","Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c","You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.","The client continues to be compliant with therapy but is having difficulty discontinuing his drug use. He states he uses because it changes his mood and helps him forget about not fitting in at home or school. He explains that when he speaks English or dresses in non-traditional clothing, his family says they feel like, “I’ll forget where I came from. But when I leave the house, all I hear is, ‘Go back to where you came from.’” The client states he began using at the end of 7th grade and started using daily approximately four months ago. He admits to feeling guilty about how his use affects his family but claims, “It’s not like I’m an addict or anything.” His parents arrive today with an interpreter and attend a concurrent parenting group with a psychoeducational component that addresses adolescent substance abuse","According to the DSM-5-TR, what aspects of the client’s clinical presentation qualifies as “acculturation difficulty”?","Rejection, exclusion, and discrimination by those who hold social power in the dominant culture","Rejection, exclusion, and discrimination by those lacking social power in the minority culture",Difficulty adapting to cultural expectations due to demands from the dominant culture impacting treatment or prognosis,Difficulty adapting to cultural expectations due to an inability to balance demands from the dominant culture with the demands from the minority culture,"(A): Rejection, exclusion, and discrimination by those who hold social power in the dominant culture
(B): Rejection, exclusion, and discrimination by those lacking social power in the minority culture
(C): Difficulty adapting to cultural expectations due to demands from the dominant culture impacting treatment or prognosis
(D): Difficulty adapting to cultural expectations due to an inability to balance demands from the dominant culture with the demands from the minority culture",Difficulty adapting to cultural expectations due to demands from the dominant culture impacting treatment or prognosis,C,"According to the DSM-5-TR, acculturation difficulty is a category that “should be used when difficulty in adjusting to a new culture (eg, following migration) is the focus of clinical attention or has an impact on the individual’s treatment or prognosis” Difficulty adapting to cultural expectations due to an inability to balance demands from the dominant culture with the demands from the minority culture does not fit the definition of acculturation difficulty. The category of Social Exclusion or Rejection V624 (Z604) should be used “when there is an imbalance of social power such that there is recurrent social exclusion or rejection by others”(APA, 2022). Therefore, the correct answer is (A)",counseling skills and interventions
1509,"Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)","Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso","You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.","   mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic",What would be the most appropriate short-term goal for management of depression symptoms?,Improve happiness,Improve hygiene,Improve self-talk,Change careers,"(A): Improve happiness
(B): Improve hygiene
(C): Improve self-talk
(D): Change careers",Improve hygiene,B,"Improving hygiene is a good first step in managing depressive symptoms because it helps the patient show himself that he has value and promotes general well-being. Improving happiness and self-talk are usually more long term in nature because they require many things to change including behavior and cognition. Changing careers is a decision that the client will need to process and move toward, but it likely will not happen in the short term unless it is already in progress. Therefore, the correct answer is (B)",treatment planning
1510,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","    book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends.  You want to confirm the psychologist’s diagnosis of autism spectrum disorder (ASD); therefore, you explore differential diagnoses","You want to confirm the psychologist’s diagnosis of autism spectrum disorder (ASD); therefore, you explore differential diagnoses. All of the following are differential diagnoses for ASD, EXCEPT:",Intellectual disability (ID),Reactive attachment disorder,Attention-deficit hyperactivity disorder (ADHD),Schizophrenia,"(A): Intellectual disability (ID)
(B): Reactive attachment disorder
(C): Attention-deficit hyperactivity disorder (ADHD)
(D): Schizophrenia",Reactive attachment disorder,B,"Reactive attachment disorder is not a differential diagnosis for ASD. Reactive attachment disorder is often caused by insufficient care from a primary caregiver and is characterized by limited seeking of comfort or wants when distressed, limited positive affect, and unexplained irritability, sadness, or fearfulness. ID, ADHD, and schizophrenia are all appropriate differential diagnoses for ASD. ID can also present as a delay in development; however, it differentiates itself in older children because social skills are not as impacted as they are with ASD. ADHD can be similar to ASD due to attention difficulties, but these difficulties are secondary to the child’s hyperactivity. Schizophrenia with childhood onset can present similarly to ASD because social skills can be impacted in the early phases of this condition. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1511,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",You discuss various experiments with Shawn for increasing his exposure to anxiety-provoking situations. What is the purpose of this exercise?,To work on minimizing his safety-seeking behaviors,To collect data for future treatment planning considerations,To demonstrate to him his clinical level of severity,Behavioral activation instead of cognitive restructuring,"(A): To work on minimizing his safety-seeking behaviors
(B): To collect data for future treatment planning considerations
(C): To demonstrate to him his clinical level of severity
(D): Behavioral activation instead of cognitive restructuring",To work on minimizing his safety-seeking behaviors,A,"A key strategy for overcoming social anxiety is through exposure therapy to practice minimizing safety-seeking behaviors and to test and change thoughts about underlying fears associated with the anxiety-provoking stimuli. Using experimentation solely to highlight a client's clinical severity or to collect research information is unethical and unnecessary for increasing insight. Behavioral activation is an intervention useful for clients with clinical depression but is not a sufficient replacement in this case to cognitive restructuring. Therefore, the correct answer is (A)",counseling skills and interventions
1512,"Name: Dana Clinical Issues: Relationship distress with mother during divorce Diagnostic Category: Depressive Disorders;V-codes Provisional Diagnosis: F33.1 Major Depressive Disorder, Moderate, Recurrent Episodes; Z62.820 Parent-Child Relational Problem Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Multiracial Marital Status: Never married Modality: Individual Therapy Location of Therapy : Under Supervision  ","The client is dressed in black attire. She sits with her hands folded and slumped over in the chair. She makes little eye contact and seems to distrust you. Her mood seems flat. During the intake, the mother complains about how her daughter ""does not listen,"" ""acts out all the time,"" and ""picks fights with her sister."" The client is reticent and shrugs her shoulders.    The client reported several other symptoms indicative of a depressive episode, including feelings of worthlessness, anhedonia, and lethargy. She also said having recurrent thoughts of self-harm that had become pervasive throughout her day-to-day life. On objective examination, the patient demonstrated psychomotor retardation, appearing to move and speak in a lethargic and sluggish manner. Cognitively, the patient's attention span was limited, and her concentration was impaired. She could not sustain her train of thought and had difficulty forming coherent sentences. Her mood was notably depressed, and her affect was constricted. This suggests a severe depressive episode, and these symptoms will likely require aggressive treatment.","First session You are a limited permit holder under direct supervision. The client is a 15-year-old multiracial female who presents to the first counseling session with her mother. The session begins with the client's mother monopolizing the conversation, and it is difficult for the client to get a word in edgewise. The client's mother continually brings up her husband as a source of her daughter's problems. The mother says, """"Our daughter is not doing well in school and has been talking back to her teacher. I think it comes from the relationship she's had with her father."" The client interrupts and says, ""It's not Dad's fault! You're the one who abuses me!"" The mother is incredulous and begins to yell, saying that she would never hit her daughter and that the client is lying. The mother tells you that her daughter is a ""liar, a thief, and creates problems."" She reports that Child Protective Services (CPS) has been to their house several times, and she believes that these visits are her husband's fault.    The client is visibly upset, and her mother continues to berate her. You intervene and explain that the client's disclosure is serious and should be taken seriously. You explain that you must speak to the client alone before deciding the best course of action. While speaking alone with the client, you notice that she is shaking and close to tears. You encourage her to take deep breaths and explain that she can take some time to regroup before continuing. After a few minutes, she appears calmer and begins to describe her home situation. It becomes clear that the client's home life is chaotic and that she is being subjected to verbal and emotional abuse from her mother. She tells you that she wants to live with her father. The client also states that she has been bullied in school, and this has been going on for some time. You explain to the client that she has a right to feel safe and that you will do everything in your power to ensure her safety. You continue asking question to assess her level of distress, and you note the client's self-reported symptoms consistent with depression, including insomnia, fatigue, and a significant decrease in her appetite. She is also alienating herself from her peers and family.    After completing the initial session, you schedule an appointment to see the client and her mother next week to continue your assessment to determine the best course of action.  Third session During last week's session, the client's mother accompanied her to the session. Throughout that session, the mother continued to talk about her own personal issues, and you could not gather information from her daughter's point of view. The client's mother presents with her daughter again to today's session. After a few minutes, you realize that the mother is monopolizing the counseling session by talking about her personal life and making snide comments aimed at her daughter. You suggest that it might be better for the client's mother to wait outside while you talk alone with the client.    When the mother leaves, the client immediately relaxes and opens up about some of the struggles she has been going through. She shares that life at home has been difficult. She describes her mother as being ""very mean"" to her, and her grandmother makes fun of her. On the other hand, both adults are nice to her younger sister. The client states that she wishes she had never been adopted and that her life is ""miserable."" She expresses a desire to live with her father. Her behavior toward her parents has changed drastically since they started fighting in front of her, but she is not sure how to deal with their constant bickering. She has not told anyone at school about living in a ""broken home"" because she does not want any extra attention from her classmates. However, she has opened up more during therapy sessions, like today's meeting, telling you that music makes her feel better when upset. As homework, you ask the client to put together a playlist of music that is meaningful to her and bring it with her to the next session. Following today's session, the client's father calls you during off-hours to complain about his soon-to-be ex-wife.","The client has experienced a great deal of distress due to the chaotic environment of her home life. Her adoptive parents are in the middle of a ""messy divorce,"" and it has been difficult for her to process, as she has had to witness her parents' arguments and the shifting dynamics of her family. This strain has been further compounded by her mother and grandmother's favoritism towards her younger sister, leading to the client feeling neglected and overlooked. In addition, her attempts to connect with her mother and sister have often been met with hostility, leading to frequent arguments and further exacerbating her feelings of alienation and loneliness.    The client has also expressed feelings of anxiety and depression due to her current living situation. She has expressed a strong desire to live with her father and escape the hostile environment of her mother's home, yet her mother has continuously denied this request. This has resulted in the client feeling trapped and powerless to alter her current situation, leading to a sense of hopelessness.    The client's relationship with her mother is strained, and she has difficulty trusting her. As a result, she is often guarded around her mother and expresses her distrust and resentment, resulting in further conflict and tension between them. The client's school environment has affected her mental health. She is constantly subjected to verbal and physical bullying from her peers, leading to feelings of worthlessness and insecurity. Her academic performance is suffering, and she cannot concentrate in class, leading to further isolation from her classmates. Previous Counseling: The client has been in and out of therapy with many different professionals. She has been diagnosed with Major Depressive Disorder. Her mother is also in therapy and believes her daughter needs ""help."" The client states that her mother has abused her before, and Child Protective Service (CPS) has been to the house numerous times but has not found any evidence of abuse. ","You notice the client seems to favor one parent over the other. In order to gain more insight into the family's interactional dynamics, what action would you consider at this time?",Ask the client's mother and father to attend.,Conduct an empty chair exercise imagining the client's father.,Complete a genogram with the client.,Invite the client's father to the session.,"(A): Ask the client's mother and father to attend.
(B): Conduct an empty chair exercise imagining the client's father.
(C): Complete a genogram with the client.
(D): Invite the client's father to the session.",Invite the client's father to the session.,D,"This would be beneficial to see the interaction between the father and the client. You have seen the interaction between the mother and the client. Knowing how the father interacts with the daughter to gain more insight into the family dynamics. Therefore, the correct answer is (A)",counseling skills and interventions
1513,"Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)","Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are","You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.","The client comes to the counseling center during walk-in hours. The client is continuing to experience a manic episode. She reports that she went out to dance with friends the previous evening and ended up buying a gram of cocaine for $100 and reported doing several lines throughout the night. The client says that she has never used any drugs before and that it scared her that she would spend that much money on drugs and that she used drugs at all. You empathize with the client’s frustration with her behavior and provide psychoeducation on impulse control to support her. The client appears tired as evidenced by her affect and slow movements, and she also appears to have poor hygiene because her clothes have visible stains and she has a slight body odor.  As an individual, you value hard work and were focused solely on school when you were in college; you think that the client is not prioritizing what is important for her","As an individual, you value hard work and were focused solely on school when you were in college; you think that the client is not prioritizing what is important for her. How can you balance your own values and support the client in working toward goals without letting your personal values affect treatment in a negative manner?","Self-disclosure can be beneficial, so you choose to share your own tactics in working toward goals.",You support the client’s reflection on how her behavior is keeping her from her goals.,You are honest with the client about where your values lie in order to foster open discussion and create awareness of how personal biases affect the counseling process.,"You ignore your own values because they should not have an impact on therapy, and you focus exclusively on the client’s needs.","(A): Self-disclosure can be beneficial, so you choose to share your own tactics in working toward goals.
(B): You support the client’s reflection on how her behavior is keeping her from her goals.
(C): You are honest with the client about where your values lie in order to foster open discussion and create awareness of how personal biases affect the counseling process.
(D): You ignore your own values because they should not have an impact on therapy, and you focus exclusively on the client’s needs.",You support the client’s reflection on how her behavior is keeping her from her goals.,B,"It is important to consider your own views and how they affect the counseling process with the client. With this client, it would benefit the therapeutic process to focus on assisting her with seeing how her behavior is keeping her from reaching her own goals. It may be helpful to share tactics that work for you, but self-disclosure should only be used if it will meaningfully impact the counseling process. Honesty about differences between the therapist and client is important at times, but in this case, it can be helpful for the client to see how her own behavior affects her progress. You should not ignore your own values, because they do impact therapy and the goal is to minimize the impact that they have. Therefore, the correct answer is (B)",counseling skills and interventions
1514,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",What is the most important step to take given the new information in this session?,Refer the mother to a parenting support group,Assess for suicidal ideation,Use punishment techniques to extinguish detrimental behaviors,Assess for possible dangerous drug use,"(A): Refer the mother to a parenting support group
(B): Assess for suicidal ideation
(C): Use punishment techniques to extinguish detrimental behaviors
(D): Assess for possible dangerous drug use",Assess for possible dangerous drug use,D,"You do not know what drug(s) the client is vaping. It could be nicotine, marijuana, or something more dangerous like ketamine or LSD. You need to assess his drug use further. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1515,"Name: Michael Clinical Issues: Separation from primary care givers Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F93.0 Separation Anxiety Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Guatemalan American Marital Status: Not Applicable Modality: Family Therapy Location of Therapy : Agency  ","Michael appears clean and dressed in appropriate clothing. He often fidgets with his hands and insists on sitting next to his father during the session. Speech volume is low, and pace is fast. He has a slightly flattened affect. He exhibits minimal insight consistent with his age.","First session You are a licensed mental health counselor at a pediatric behavioral health center. Michael, a 10-year-old male, presents along with his father. You conduct a thorough psychological exam, including a mental status examination. During the initial interview, you take note of Michael's behavior. He sits very close to his father and looks fearfully around the room. The father tells you Michael has been having trouble at school and home for the past few months and it has been getting worse. When you ask how Michael is doing in school, the father tells you there have been several incidents, including difficulty waking up for school, crying in the morning, and refusal to get dressed and ready. The father also tells you that Michael has been showing signs of frustration with his teachers and classmates. On the home front, the father mentions that his son has become ""a nuisance for his babysitter, especially during bedtime."" Both parents are paramedics on a 24-on/48-off shift rotation. Michael often calls his parents while at work, complaining that he feels sick and cannot fall asleep. He worries that someone might break into the house or that ""something bad will happen"" to his parents. The father reports that he and his wife have tried to reassure Michael, but their efforts have been unsuccessful. They are perplexed as to what is causing Michael's distress. The father tells you that Michael has always been a bright and energetic child, but now he seems overwhelmed and anxious.    You conduct a more detailed interview with Michael alone, focusing on his current environment and daily routines. You ask him how he feels about school, and Michael denies having any issues. He tells you that he does not want to go because his new school is ""boring."" However, when you probe further, he admits to feeling scared and alone. He does not want to be away from his parents, and he imagines ""all the ways they could be hurt"" while they are not with him. You say, ""I can understand why you might be feeling scared and anxious, Michael. It sounds like a lot has been going on recently. I'm here to help you and your parents understand what's causing your worries so you can start to feel better.""    You reconvene with Michael's father and provide a brief summary of your findings. You explain that you suspect Michael's anxiety is likely due to the family's recent relocation and having to adjust to a new school. His fears are also likely rooted in his parents' profession, which may lead him to worry about their safety while they are away from home. You have personal experience in dealing with pediatric anxiety and consider briefly sharing your story with Michael and his parents as you believe it may help them to feel supported and less alone in their struggles, while also providing a practical example of how to work through difficult times. You suggest developing an intervention plan to address Michael's distress and recommend meeting with Michael and his parents for weekly sessions.","Michael's parents have been married for nine years and both are dedicated to the well-being of their children. The father reports that he and his wife communicate openly with each other and make joint decisions about parenting issues. They also model healthy family dynamics, such as expressing affection and respect towards one another, being honest with one another, and sharing responsibilities. Michael has a five-year-old sister. His father characterizes the family as very close; they do everything together. The father says that he and his wife go to their children's sporting events and school meetings. Every weekend, the four of them are together doing family activities. Except when required to be away due to their work schedules as paramedics, the parents are home with the children at night. Prior to the family's move to a new state 6 months ago, Michael had been a successful student at school, typically performing at or above grade level. He was an active participant in the classroom, often volunteering to answer questions or participate in class discussions. Since the move, however, getting ready for school has been a struggle each day. He is struggling academically; while his grades haven't dropped drastically, he appears to be having trouble focusing and understanding the material. His parents have attended parent-teacher conferences and Michael's teachers have also reported that he seems distracted and uninterested in class. His parents also report that they are having difficulty getting him to stay on task when doing his homework at home. ","As the session begins, you take note of the client's behavior. As he and his father enter your office, the client stays near his father and looks anxiously around as he sits down. What does this suggest about how you should structure the session?","The father should be asked to stay, and to sit quietly to the side, to help the client transition.",The father should be asked to excuse himself to help the client deal with his anxiety.,The father should be asked to sit outside of your office as a form of exposure therapy.,The father should stay with the client to foster comfort and avoid anxiety to build rapport.,"(A): The father should be asked to stay, and to sit quietly to the side, to help the client transition.
(B): The father should be asked to excuse himself to help the client deal with his anxiety.
(C): The father should be asked to sit outside of your office as a form of exposure therapy.
(D): The father should stay with the client to foster comfort and avoid anxiety to build rapport.",The father should stay with the client to foster comfort and avoid anxiety to build rapport.,D,"The client's behavior suggests that he is anxious. Advising the father to stay with the client during the early stage of therapy will help the client trust the therapist. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1516,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”",Which of the following would provide the counselor with the most effective means of determining this client's diagnosis and subsequent treatment plan?,Mann-Whitney U Test (MWW),Trauma Symptom Inventory 2 (TSI-2),Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),Myers-Briggs Type Indicator (MBTI),"(A): Mann-Whitney U Test (MWW)
(B): Trauma Symptom Inventory 2 (TSI-2)
(C): Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
(D): Myers-Briggs Type Indicator (MBTI)",Minnesota-Multiphasic Personality Inventory-2 (MMPI-2),C,"The client demonstrates characteristics of several disorders including bipolar and related disorders, trauma disorders, substance disorders, and personality disorders. Due to the client's history of difficulties since childhood, an assessment such as the MMPI-2 will evaluate multiple disorders and provide the clinician with information about the client's personality and psychopathology. Briere's TSI-2 assesses for the presence of trauma symptomatology but does not assess other diagnoses. The MBTI could be helpful in understanding how the client views the world and makes decisions, but is not indicated for determining diagnosis or psychopathology. The MWW is a statistical test of probability, not a clinical test. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1517,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","Since the fourth session, child protective services investigated the client’s abuse allegations and determined that they were unfounded. You discuss this with the client and he says he was lying because he was mad at his parents that day. You praise the client for being forthright today regarding the allegations and discuss how false allegations can be incredibly harmful to others and can strain his relationship with his parents further. You and the client process several situations similar to this in which he avoided responsibility. You empathize with the client and support his reflection on his behavior",Which of the following cognitive distortions is often associated with anger?,Catastrophizing,Personalization,“Should” statements,Disqualifying the positive,"(A): Catastrophizing
(B): Personalization
(C): “Should” statements
(D): Disqualifying the positive",“Should” statements,C,"“Should” statements occur when your expectations for how something should be is incongruent with what actually happened. This often incites anger because you expect someone to act a certain way, such as being kind to you, and variations on that expectation are disruptive. Personalization is when an individual thinks that they are responsible for things outside of their control, and this usually leads to the individual thinking that they can make things better even when they are likely not able to. Disqualifying the positive occurs when the client ignores all positives and focuses only on negative events. Catastrophizing is when the client sees only the worst possible outcome even when it is not the most likely outcome. Although anger may result from personalization, disqualification, and catastrophizing, these are more likely to result in disappointment, shame, anxiety, and/or negativity. Therefore, the correct answer is (B)",counseling skills and interventions
1518,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","You and the client develop a clear and explicit treatment contract to provide a foundation for informed consent. Through this collaborative process, you establish an agreement outlining treatment roles, responsibilities, and expectations for you and the client. The client agrees with your suggested goals but does not want to include safety issues as part of her treatment plan. You provide psychoeducation on BPD, and she relates to experiences of abandonment. She would like to learn how to navigate romantic relationships and requests interventions targeting this area",Which ethical principle would best guide your response to the client’s request to exclude safety issues from her treatment plan?,Veracity,Autonomy,Beneficence,Justice,"(A): Veracity
(B): Autonomy
(C): Beneficence
(D): Justice",Autonomy,B,"The ethical principle that would best guide your response to the client’s request to exclude safety issues from her treatment plan is autonomy. The ACA Code of Ethics includes ethical principles fundamental to ethical decision making. Autonomy is defined as “fostering the right to control the direction of one’s life” (ACA, 2014). In this situation, it is appropriate to consider the client’s autonomy by deciding which items go on her treatment plan. Clients have a right to accept or deny treatment. This does not mean that you do not assess and document the client’s safety issues each session. It would be unethical not to assess the client’s safety and provide safety-related interventions as needed. This topic can also be revisited in future sessions after trust has been established. Veracity is an ethical principle that calls for counselors to be truthful in their professional communication. Justice is honored when counselors stand up for equality and promote equity. Lastly, beneficence is achieved when counselors work for the well-being of clients and society at large. Therefore, the correct answer is (C)",professional practice and ethics
1519, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”","While Bob shared the reason that he believes he started drinking, he does not demonstrate insight into other reasons he continued drinking or why his dependency increased. This may be due to a lack of knowledge in what topic of information?",anxiety,ASAM definition of addiction,drug interactions,complex trauma,"(A): anxiety
(B): ASAM definition of addiction
(C): drug interactions
(D): complex trauma",ASAM definition of addiction,B,"The American Society of Addiction Medicine (ASAM) defines addiction as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. It also defines addiction as a primary, chronic disease of brain reward, motivation, memory, and related circuitry. If Bob understood that addiction does not have a single cause or trigger but is a combination of contributing biological, psychological, social, and spiritual factors, he may be more willing to consider treatment recommendations. Understanding the implications that anxiety or trauma has on his drinking would still only point to Bob blaming specific triggers or feelings, and not fully contemplating the role his own biology, choices, and other life experiences have had on his alcohol problem. Drug interactions are not applicable in Bob's case but may play some role if certain medications or other medical conditions were present. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1520,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment.  The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation","The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation. Using a constructionist approach, how would you assist the client with these feelings?",Construct an authentic sense of self by examining the consequences of overgeneralization.,Improve the client’s sense of self-worth by showing unconditional positive regard.,Create a strengths-based narrative emphasizing affirming community experiences.,Teach new skills by increasing environmental rewards and positive reinforcement to mitigate avoidance and shame.,"(A): Construct an authentic sense of self by examining the consequences of overgeneralization.
(B): Improve the client’s sense of self-worth by showing unconditional positive regard.
(C): Create a strengths-based narrative emphasizing affirming community experiences.
(D): Teach new skills by increasing environmental rewards and positive reinforcement to mitigate avoidance and shame.",Create a strengths-based narrative emphasizing affirming community experiences.,C,"A constructionist approach would assist with creating a strengths-based narrative emphasizing affirming community experiences. Constructionists believe that individuals create personal meaning in their lives through social constructs (ie, relationships with others). Theories that use a constructionist approach include object-relations theory, solution-focused therapy, emotionally focused therapy, and narrative therapy. Narrative therapy uses a strengths-based approach to help clients retell their stories and reauthor their lives. The client attests to finding acceptance in the LGBTQ community, which may help guide the client to an affirming sense of self. Showing unconditional positive regard is a person-centered technique rather than a constructivist approach. CBT would emphasize that the client is engaging in overgeneralization, a cognitive distortion used when taking one incident and using it as the only source of evidence for a general conclusion. Finally, behavioral therapists would teach new skills by increasing environmental rewards and positive reinforcement. Therefore, the correct answer is (C)",counseling skills and interventions
1521,"Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)","Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta","You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.","   Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e\. g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication",Which of the following conditions is more likely to co-occur with ADHD?,Major depressive disorder,Oppositional defiant disorder,Social anxiety disorder,Intermittent explosive disorder,"(A): Major depressive disorder
(B): Oppositional defiant disorder
(C): Social anxiety disorder
(D): Intermittent explosive disorder",Oppositional defiant disorder,B,"According to the DSM-5-TR, “In the general population, oppositional defiant disorder co-occurs with ADHD in approximately half of children with the combined presentation and about a quarter with the predominantly inattentive presentation. Anxiety disorders, major depressive disorder, obsessive-compulsive disorder, and intermittent explosive disorder occur in a minority of individuals with ADHD but more often than in the general population” (APA, 2022). Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1522,"Name: Ethan & Cindy Clinical Issues: Sexual functioning concerns Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse Age: 69 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Private Practice  ","The husband appears to be of average build. His dress is appropriate for the occasion, but his facial expression is blank and he keeps staring off into space. He has difficulty maintaining eye contact and speaks in an aimless monotone. His affect is blunted, and he appears to be emotionally detached from the situation. He reports feelings of worthlessness and emptiness that have been ongoing for many years. He has had recurrent suicidal ideations but is not currently making any plans to act on them. His thought process is disorganized, concrete and circumstantial in nature.    The wife is slightly overweight and dressed in loose clothing. She appears agitated and tense but is able to maintain good eye contact throughout the conversation. She speaks in a clear, consistent manner and expresses her thoughts in an organized fashion. Her thought content is focused on her current difficulties with her husband, and she expresses feelings of disappointment, rejection, and anger. She acknowledges feeling a sense of hopelessness in the situation and shares concerns about her future. Her mood reflects her thoughts and is generally pessimistic. Insight is intact as she is able to recognize the impact of her own actions on the current state of affairs. Her judgment is also intact as she recognizes that her current behavior and attitude are not helping the situation.","First session You are a mental health therapist in a private practice setting. A couple, a 69-year-old male and a 65-year-old female, enters your office together. The couple has been married for over 40 years and have two grown children. Their second child age 31 is currently living at home. When you ask what brings them to therapy, the wife immediately states that her husband is not attracted to her anymore. She tells you that he never wants to be in a situation where they are romantic together. She is feeling unwanted, unattractive, and as if they are ""roommates"" who just cohabitate together. When you ask the husband how feels, he says that he has a sense of disgust toward his wife when he thinks of having an intimate encounter with her. The wife believes that her husband is repulsed by her physical appearance as she is overweight. The husband confesses to feeling guilty for his lack of interest in his wife, but he is unable to pinpoint why he feels this way or understand why it has become an issue now after 40 years of marriage. Exploring further, you ask the couple about their family of origin. The wife states that her parents were highly critical and demanding, while the husband's parents were more passive and removed when it came to expressing affection or showing disapproval. She also expresses concern over possible sexual abuse in the husband's past, though he is not sure if anything happened or simply cannot remember due to its traumatic nature. With these additional pieces of information, you begin to develop a comprehensive picture of their situation and focus on working with the couple towards a positive outcome.  Fourth session You have seen the couple for three therapy sessions so far. Today is your fourth session with the couple. The wife tells you that she is ""officially sleeping in the spare bedroom"" and is considering a trial separation. Last week she bought lingerie to entice her husband, and he responded by ridiculing her, then turning away from her and going to sleep. The wife begins to cry as she says, ""We don't talk anymore. He just berates me all the time, and that hurts a lot."" As the wife tells you about the incident, the husband sighs audibly and shakes his head. He looks at you and states, ""She's a mess. I don't know what to say.""    You empathize with the couple's emotional struggles, and you acknowledge their pain. You explain to them that it can be helpful for couples to explore personal issues in an individual therapy setting before coming together as a couple to make progress on their relationship challenges. You let them know that they may find it easier to express themselves when one partner is not present, and that individual counseling can give them each the space to address their own personal issues in a safe environment. You encourage them to take some time to reflect further on whether they believe individual therapy would be useful for them at this time, and you offer to provide further information about the process if needed.    Finally, you let them know that you are here to support them as they make decisions about how best to move forward. You assure them that while their relationship may be in a difficult place right now, it is possible to heal and strengthen their connection with one another. You remind them that relationship issues are often complex and that it is important to be patient with each other as they work together to find solutions. You encourage them to stay committed to the process, even when things feel difficult, and you offer your ongoing support in helping them build a more fulfilling relationship.","The wife states that she had an emotionally distant relationship with her parents growing up and never felt truly accepted by them. She also reveals that her father was often angry and verbally abusive, which left her feeling anxious and fearful in his presence. When asked about his family of origin, the husband speaks of his parents as being cold and unapproachable; they showed acceptance or rejection based on whether he met their expectations. He expresses difficulty in determining how he is supposed to act around them. Stressors & Trauma: When asked about how the family of origin showed acceptance or rejection, the husband states, “My parents ignored me when they were displeased. I got to sleep in their bed when they were pleased with the way I acted.” When asked about sexual abuse, the client states, “I'm not sure. It seems like something bad happened with my mother and uncle. There might be something more than that, too. I can't really remember.” Previous Counseling: The husband has been struggling with depression for the past few months after he lost his job in an economic downturn. He has been struggling with feelings of worthlessness and emptiness for many years, even when he was employed. He has had multiple periods of suicidal ideation, but never acted on them. The client also states that it is difficult for him to focus and stay motivated. He is currently taking Wellbutrin that was prescribed by his primary care physician and states that it helps ""take the edge off."" The client states he would rather deal with the pain than be emotionally blunted.  ",What would you include as a short-term treatment goal to work on first with this couple?,Explore methods to reconnect with each other,Educate the couple about sexual behavior,Build communication skills,Create a satisfying relationship,"(A): Explore methods to reconnect with each other
(B): Educate the couple about sexual behavior
(C): Build communication skills
(D): Create a satisfying relationship",Build communication skills,C,"In this case, it is apparent that the husband and wife are having issues with communication. The wife has stated that she and her husband ""don't talk anymore,"" and the husband ""doesn't know what to say"". Working on communication skills is a good place to start. Therefore, the correct answer is (A)",treatment planning
1523,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,"If the counselor acknowledges she has her own biases regarding Shar's issue, she should?","Do not refer out, no matter what.",Refer the client to someone who specializes with this issue.,Self-disclose this conflict in session.,Try to understand where the biases are stemming from.,"(A): Do not refer out, no matter what.
(B): Refer the client to someone who specializes with this issue.
(C): Self-disclose this conflict in session.
(D): Try to understand where the biases are stemming from.",Try to understand where the biases are stemming from.,D,"Biases will come up, but it is important for the counselor to first acknowledge them and figure out where they are coming from. If the counselor can do this, it is not necessary for the counselor to refer out. If the counselor cannot do this, it would be beneficial to the client to refer out, especially to someone who specializes in similar issues. It would not be appropriate to share this bias in session, as sharing would make the session about the counselor and not the client. Therefore, the correct answer is (B)",professional practice and ethics
1524,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","   tion. Family History: The client has been married for 25 years. He has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together",,Informed consent includes a discussion of the risks of counseling.,"Informed consent includes a discussion of copays, fees, and legal processes for nonpayment.",The client has the right to engage in or refuse counseling services.,Informed consent only occurs during the intake session.,"(A): Informed consent includes a discussion of the risks of counseling.
(B): Informed consent includes a discussion of copays, fees, and legal processes for nonpayment.
(C): The client has the right to engage in or refuse counseling services.
(D): Informed consent only occurs during the intake session.",Informed consent only occurs during the intake session.,D,"Informed consent occurs throughout the counseling relationship, not solely during the intake session, because you need to explain the changes in treatment and the risks involved throughout the counseling process. The risks of counseling, copays/fees, and the counselor’s and client’s rights and responsibilities are covered as part of this process. Therefore, the correct answer is (C)",professional practice and ethics
1525,"Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)","Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.","You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.","The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest","Which assessment tool should you use to evaluate the client’s executive functioning, attention, and cognitive processing?",The NEO-Personality Inventory (NEO-3),Denver Developmental Screening Test II (DDST-II),Cognitive Assessment System (CAS2),The Children’s Systemizing Quotient (SQ-C),"(A): The NEO-Personality Inventory (NEO-3)
(B): Denver Developmental Screening Test II (DDST-II)
(C): Cognitive Assessment System (CAS2)
(D): The Children’s Systemizing Quotient (SQ-C)",Cognitive Assessment System (CAS2),C,"This question tests your knowledge of developmentally appropriate assessment instruments. The Cognitive Assessment System (CAS2) is based on the PASS (planning, attention, simultaneous processing, and sequential processing) model of intelligence and can be administered to children between the ages of 5 and 18. Testing results provide information on specific learning and intellectual disabilities. The CAS2 also provides insight into symptoms of ADHD, which is a comorbid condition of DMDD. The Developmental Screening Test II (DDST-II) is a screening tool used with children aged 1 month to 6 years of age, therefore is not indicated. The NEO-Personality Inventory measures personality traits of adults ages 21-91 (with an additional revised version for adolescents). The Children’s Systemizing Quotient (SQ-C) is an assessment instrument for Autism Spectrum Disorder and is used with children ages 4-11. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1526,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week.  The parents are using punishment to alter behavior, and you want to educate them on positive reinforcement","The parents are using punishment to alter behavior, and you want to educate them on positive reinforcement. Which would be an example of positive reinforcement to encourage appropriate behavior when the client is cursing?",The parents encourage him to request what he wants or needs in a more appropriate manner.,The parents walk away to demonstrate that they will not communicate with him when he curses at them.,The parents wait until the client calmly and quietly requests what he needs and they praise him for appropriate communication.,The parents provide a time-out in the client’s room to encourage more positive behavior.,"(A): The parents encourage him to request what he wants or needs in a more appropriate manner.
(B): The parents walk away to demonstrate that they will not communicate with him when he curses at them.
(C): The parents wait until the client calmly and quietly requests what he needs and they praise him for appropriate communication.
(D): The parents provide a time-out in the client’s room to encourage more positive behavior.",The parents wait until the client calmly and quietly requests what he needs and they praise him for appropriate communication.,C,"The parents praising appropriate behavior is positive reinforcement. Positive reinforcement involves adding something to increase desired behavior. The client desires attention from his parents, so providing positive praise would increase the likelihood of more appropriate communication. A time-out would be considered a punishment, which would focus on providing an adverse consequence to decrease a behavior. The parents walking away to demonstrate they do not approve of his behavior would not be positive reinforcement because they are not adding something to increase the target behavior. The parents’ encouragement to request what he wants or needs is helpful, but it is not positive reinforcement. Therefore, the correct answer is (B)",counseling skills and interventions
1527,"Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)","Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f","You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.",rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family,,Provide a referral for another counselor who specializes in opioid addiction counseling.,Refer the client to a Narcotics Anonymous group.,Pursue further education on opioid addiction counseling.,Use motivational interviewing techniques because these are effective with substance use disorders.,"(A): Provide a referral for another counselor who specializes in opioid addiction counseling.
(B): Refer the client to a Narcotics Anonymous group.
(C): Pursue further education on opioid addiction counseling.
(D): Use motivational interviewing techniques because these are effective with substance use disorders.",Provide a referral for another counselor who specializes in opioid addiction counseling.,A,"If a counselor does not have experience and education in providing counseling for certain diagnoses, then it is most ethical to refer the client to another counselor that specializes in that diagnosis (ACA Governing Council, 2014). It is also important to seek education on certain diagnoses prior to providing services (ACA Governing Council, 2014), although a referral would be more indicated in this scenario. Motivational interviewing is commonly viewed as beneficial for substance use disorders, but if the counselor is not competent in counseling these populations, then this would not be appropriate. Support groups can be helpful in working through a substance use disorder, but they are not a clinical service that can treat substance use disorders. Therefore, the correct answer is (B)",professional practice and ethics
1528,"Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)","Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la","You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.","You meet with the client alone, and he appears to be more comfortable with you because he comes in and starts talking about a video game that he plays. You share that you have played that video game before. During the session, the client mentions that his parents got his first report card of the year and found out that he was failing most of his classes. He started to say that he was worried that his dad was going to hit him because of his grades. You ask if his father hits him often, and he replies that he does several times a week. You try to inquire about the manner of hitting his father uses because a certain level of corporal punishment is legal in the state that you work in. The client says that he is not going to talk any more about this. You remind the client that you likely will need to report this to child protective services and he says, “I don’t care” in response. You spend the rest of this session processing his relationship with his parents, and he discloses that he does love them, but that they are not his real parents. You meet with the client’s parents near the end of the session, and, while talking with them, they report that he was neglected while in foster care because the foster parent was “just in it for the money.”  In structural family therapy, there are subsystems within the family system","In structural family therapy, there are subsystems within the family system. All of the following are subsystems, EXCEPT:",Social family members,The parents,The younger siblings,The client,"(A): Social family members
(B): The parents
(C): The younger siblings
(D): The client",The client,D,"The family system has smaller systems within it that are created, often naturally, based on many different categories, such as gender, age, hierarchy (parent/child), function (who is responsible for what in the home), common interests, or common characteristics. These subsystems generally consist of two to three people who establish roles between them and within the system. The client is an individual and therefore would not be considered a subsystem. The parents are a hierarchical and a generational subsystem. The siblings are another subsystem based on ages/interests and likely have established certain roles that the client may feel ostracized from. The social family members are a subsystem with similar characteristics, and they are bonded over enjoying similar activities. Therefore, the correct answer is (B)",counseling skills and interventions
1529,"Name: Barry Allen Clinical Issues: Behavioral problems Diagnostic Category: V-codes Provisional Diagnosis: Z62.898 Child Affected by Parental Relationship Distress Age: 13 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Agency  ",The client is dressed in DC Comic attire and lives for cosplay. He is well groomed and sensitive to his appearance. Eye contact is minimal. His behavior is tense and purposeful. He demonstrates a limited affect and is minimally responsive. The client denies any current suicidal or homicidal ideation.,"First session The client and his father present at the community counseling center where you practice as a marriage and family therapist. The father reports that his son has not been doing his homework or contributing to family chores. The client's mother is ""at her wit's end"" and told her ex-husband to get their son help. The school has called several times out of concern for the client's withdrawn behavior. He is not paying attention, is sleeping in class, and appears sad and irritable. You notice that he is disinterested, withdrawn, and does not want to be involved in therapy. The father minimizes his son's behavior and does not want any responsibility related to therapy. At the same time, he wants you to improve his son's attitude.    Through open-ended questions and careful exploration, it is revealed that the client has been having difficulty establishing relationships with peers and adults. He has been feeling overwhelmed by his parents' relationship distress and his mother's new family dynamics. Furthermore, he has been struggling to manage the transition of living in two different homes between his parents. His father reports that his son appears to be increasingly isolated and has difficulty regulating his emotions. The client reveals that he is feeling lonely, depressed, and anxious due to the stress and uncertainty of his parents' relationship issues. He feels as though he is caught in the middle of his parents’ conflict and unable to meet their expectations. It appears that the distress caused by his parents’ relationship is affecting the client's overall wellbeing. You explain to the client and his father that therapy can help him process his feelings, build healthy coping strategies, and develop better communication skills with both of his parents.","The client's parents have been divorced for five years. The client's father shares parenting responsibilities of his only son, age 13, with the client's mother. The father, who is not currently in a relationship, ""tries to get along"" with his ex-wife but finds this challenging. The client's mother is living with her new fiancé. The fiancé is twice divorced and has three children from previous marriages. Both sets of the client's maternal and paternal grandparents have passed away.  ","The mother agrees to sign the consent form, but the father refuses. How do you proceed?",Inform the father he cannot be involved in any of the services and proceed with care for the mother and minor.,You have a signed consent form from the mother and can legally proceed with treatment.,Obtain a copy of the custody agreement to determine if there is joint or separate custody.,"Due to the parent's unwillingness to cooperate, you are not obligated to take on this case.","(A): Inform the father he cannot be involved in any of the services and proceed with care for the mother and minor.
(B): You have a signed consent form from the mother and can legally proceed with treatment.
(C): Obtain a copy of the custody agreement to determine if there is joint or separate custody.
(D): Due to the parent's unwillingness to cooperate, you are not obligated to take on this case.",Obtain a copy of the custody agreement to determine if there is joint or separate custody.,C,"If there is joint custody, you will need both consent signatures. If the mother has custody, her signature will suffice. Therefore, the correct answer is (C)",professional practice and ethics
1530,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.  Eighth session It has been seven weeks since the client presented for the initial interview. Today, the client returns to your office for his weekly session. He admits that he has not been following through with any of the activities you have assigned as part of his systematic desensitization plan, and he continues to feels overwhelmed by anxiety. His facial expressions reveal a sense of defeat and disappointment as he shares his struggles with making progress. He says, ""I just want to be a normal guy. What's wrong with me?"" The client expresses feeling overwhelmed with fear and shame at being unable to make any changes. He asks if you know of anyone else who has experienced social anxiety before and if there is any hope for him to get better. You normalize his experience and briefly share a story about being afraid to wear glasses in high school out of fear that your classmates would make fun of you. You then explain to him that even though it may feel like he is alone in his experience and feels discouraged, recovery is possible. You emphasize the importance of being patient with himself and expressing self-compassion as he works through the process.    During the session, the client also mentions that his parents are having a difficult time in their relationship which has been causing additional distress for him. You explain that this could cause extra feelings of worry and insecurity, even when he is away from them. He acknowledges the connection between his parents’ relationship dynamics and his own struggles with anxiety. In order to address the additional stressors created by the distress in the client's parents' relationship, you explore ways he can work on managing his own emotions and reactions. You explain that building self-awareness of his feelings and responses may help empower him to have greater control over his anxiety symptoms. You discuss mindful breathing and visualization techniques. Afterwards, you provide examples of cognitive reappraisal strategies that can be used to challenge any irrational beliefs related to fear of failure or embarrassment that might be driving his avoidance behaviors. You explain the importance of consistently doing the practice in order for it to be effective and positive changes can be expected with consistent effort. You also give the client a homework assignment to read about social anxiety.    Toward the end of the session, you summarize what you have discussed during today's session, and you address his feelings of disappointment in his perceived lack of progress by saying, ""I understand your frustration. It can seem like things are not changing but in reality, even small changes are a sign of progress. The most important thing for you to remember is that it takes time and effort to learn how to manage your anxiety and make meaningful change in your life. As you continue working on the strategies we have discussed, I want you to recognize any successes or moments of improvement as they occur; no matter how small they may be. This will help keep you motivated and encourage further growth.""","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",What is the primary reason you would give the client a homework assignment to read about his diagnosis?,To help him deal with his anxiety,To educate him about self-help strategies that can help him manage his symptoms,To recognize that social anxiety disorder is a common disorder and nothing to be embarrassed about,To convince him that he has mental health issues,"(A): To help him deal with his anxiety
(B): To educate him about self-help strategies that can help him manage his symptoms
(C): To recognize that social anxiety disorder is a common disorder and nothing to be embarrassed about
(D): To convince him that he has mental health issues",To educate him about self-help strategies that can help him manage his symptoms,B,"Psychoeducation is very beneficial when clients are aware of the issues at hand. It can help them better understand what to do and how to cope. Therefore, the correct answer is (D)",counseling skills and interventions
1531,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",What recommendation are you least likely to make during the intake process?,Suggest that Ruth and her husband attend a support group for parents of children who have behavioral problems,Psychological and behavioral evaluation for the family's five-year-old,Refer Ruth and Dale to a psychiatrist for additional support,Suggest attending a parenting course to learn strategies to help with the family's teenager's issues and the child who is acting out,"(A): Suggest that Ruth and her husband attend a support group for parents of children who have behavioral problems
(B): Psychological and behavioral evaluation for the family's five-year-old
(C): Refer Ruth and Dale to a psychiatrist for additional support
(D): Suggest attending a parenting course to learn strategies to help with the family's teenager's issues and the child who is acting out",Refer Ruth and Dale to a psychiatrist for additional support,C,"The couple has not presented with any symptoms that would warrant this referral. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1532,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","The couple acknowledge some improvement with communication, but they continue to feel significant levels of relationship distress. The client has been asking for what she needs, mainly when she is in pain and functionally limited, but she reports that the husband continues to do little to support her. The husband reiterates that he has a demanding job that depletes his energy and that he has little to give when he gets home at night. The husband’s child has been verbally abusive to the client, and her husband minimizes her concern. The client feels “stuck in the middle” when determining her stepson’s schedule and activities. The client states that her husband’s bitter ex-wife makes her new role as stepparent “nearly impossible.” To help with the postdivorce adjustment and lessen conflict, you provide information on local support groups, parent education programs through family court, and additional educational resources.  You provide educational resources outlining your parenting recommendations",You provide educational resources outlining your parenting recommendations. Which of the following would most benefit all involved parties?,Collaborative parenting,Authoritative parenting,Cooperative parenting,Parallel parenting,"(A): Collaborative parenting
(B): Authoritative parenting
(C): Cooperative parenting
(D): Parallel parenting",Parallel parenting,D,"Parallel parenting is effective for divorced parents who have low degrees of cooperation and high degrees of conflict. Parallel parenting allows parents to disengage from one another but remain engaged in their children’s lives. After disengagement, plans are made that determine who is responsible for various parenting domains, such as medical and educational care. Parents form independent relationships with teachers, doctors, and coaches, and communication between the parents is generally conducted via email or through a neutral third party. This approach would benefit the primary client because she would feel less of the burden in raising her husband’s son, in addition to benefiting her husband and her husband’s ex-wife, therefore relieving stress on the entire unit. Cooperative parenting works best with high-cooperation and low-conflict parents. Parents who engage in cooperative parenting effectively communicate with one another and agree on shared responsibilities. Collaborative parenting is used interchangeably with cooperative parenting, making it the preferred approach for couples who communicate effectively and engage in mutual decision making. Parents who use an authoritarian approach emphasize strict obedience and inflict harsh punishments when rules are broken. Using this approach as a form of “tough love” for the husband’s child is ill advised and could be detrimental to the child’s overall well-being. Therefore, the correct answer is (B)",counseling skills and interventions
1533,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",What will best determine the validity of the client's threat to come to school with a gun and cause harm?,A Mental Status Exam,A biopsychosocial assessment,A referral to law enforcement.,A thorough risk assessment,"(A): A Mental Status Exam
(B): A biopsychosocial assessment
(C): A referral to law enforcement.
(D): A thorough risk assessment",A thorough risk assessment,D,"The client has made a serious threat. He needs to be monitored consistently using appropriate risk assessments. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1534,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","The client has expressed exasperation and feelings of depression in having to deal with the consequences of her episode of driving while intoxicated, but you feel that she would benefit from evaluative data that could frame her disorder in clearer terms. Which of the following methods of assessment would provide the most comprehensive information in the most concise manner to assess the client's level of alcohol use?",A thorough Biopsychosocial Assessment,Michigan Alcohol Screening Test (MAST),The use of a Reality Therapy technique encouraging total transparency,Personality Diagnostic Questionnaire (PDQ-4),"(A): A thorough Biopsychosocial Assessment
(B): Michigan Alcohol Screening Test (MAST)
(C): The use of a Reality Therapy technique encouraging total transparency
(D): Personality Diagnostic Questionnaire (PDQ-4)",Michigan Alcohol Screening Test (MAST),B,"The MAST is designed to assess for alcohol problems. Test questions relate to the individual's social, vocational, and family problems associated with heavy alcohol consumption. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1535,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment","Which are the most effective means for understanding the client’s experiences of prejudice, discrimination, and inclusion?",Examine the client’s contextual manifestations through the lens of intersectionality.,"Understand the complexity of the client’s gender identity, sexual orientation, and gender expression.","Address misinformation and disinformation surrounding issues of diversity, sexuality, and cultural sensitivity.","Explore one’s own internalized biases regarding sex, sexual orientation, gender, and related behavioral and cultural norms.","(A): Examine the client’s contextual manifestations through the lens of intersectionality.
(B): Understand the complexity of the client’s gender identity, sexual orientation, and gender expression.
(C): Address misinformation and disinformation surrounding issues of diversity, sexuality, and cultural sensitivity.
(D): Explore one’s own internalized biases regarding sex, sexual orientation, gender, and related behavioral and cultural norms.",Examine the client’s contextual manifestations through the lens of intersectionality.,A,"The most effective means for understanding this client’s experiences of prejudice, discrimination, and inclusion is to examine the client’s contextual manifestations through the lens of intersectionality. Intersectionality considers each individual’s privileged and marginalized status in terms of all intersecting contexts. This client is a young, Catholic, Latino American who self-identifies as a gay male. Each construct serves as a foundation for his identity. The client’s identity influences how he relates to the world and how he is affected by sociocultural values and norms. Since the client identifies as a gay male, his gender identity is not in question. Gender expression refers to how an individual’s dress, behavior, or haircut reflects one’s gender identity, making answer B incorrect. Culturally sensitive therapy involves recognizing one’s personal biases; this is not an effective means for understanding this client’s specific experiences of prejudice, discrimination, and inclusion. Counselors are ethically responsible for addressing misinformation and disinformation on an individual and institutionalized level. However, this alone will not assist you with understanding the client’s marginalized experiences. Therefore, the correct answer is (A)",counseling skills and interventions
1536,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice",Which of the following cognitive distortions operates from the husband’s premise that his “wife is always going to do what benefits her and not us because she is incapable of doing positive things for the relationship”?,Jumping to conclusions,Mental filter,“Should” statements,Catastrophizing,"(A): Jumping to conclusions
(B): Mental filter
(C): “Should” statements
(D): Catastrophizing",Mental filter,B,"The client is focusing only on the negatives and ignoring positive interactions (such as when the wife tries to engage the husband in quality time and attempts to improve their relationship). This is an example of the cognitive distortion called mental filter, which is filtering out positive interactions and focusing on negative interactions. Catastrophizing is assuming that the worst will happen, which is not the focus of his thoughts. Jumping to conclusions involves coming to a conclusion without evidence. This client is not jumping to conclusions because his assumptions contradict the available evidence (assuming that his wife does not put her relationship first even with evidence that she is attempting to improve her relationship). “Should” statements involve expectations that are not met, but this does not apply because the client is not expressing an expectation of what the wife should do to alleviate the problem. Therefore, the correct answer is (B)",counseling skills and interventions
1537,Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual,"Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.","Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”",,"At the conclusion of the second session, the counselor asks Shar and Nadia to complete a satisfaction survey. This request is?",Unnecessary paperwork.,Not common in counseling practice.,A practice that can empower families.,Foreshadowing the desire for termination.,"(A): Unnecessary paperwork.
(B): Not common in counseling practice.
(C): A practice that can empower families.
(D): Foreshadowing the desire for termination.",Foreshadowing the desire for termination.,D,"Satisfaction surveys are useful in providing counselors with necessary feedback while showing families the importance of their input in the counseling process and is common in counseling. Although some clinicians may use this type of survey during discharge, it is important to constantly assess satisfaction throughout the therapeutic relationship. It is also important that the feedback is taken into consideration and changes are implemented when possible. In a value-based system of care, client satisfaction is a priority. Therefore, the correct answer is (A)",professional practice and ethics
1538,"Name: Marta Clinical Issues: Caregiving concerns Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder, with Mixed Anxiety and Depressed Mood Age: 55 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Colombian American Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears older than her stated age. She is disheveled, poorly groomed, and has a strong body odor. She is cooperative but demonstrates a high level of distress manifested as restlessness, being easily distracted, and consistently rubbing her hands. Her speech is initially slow and halted but later becomes elevated and loud. She is oriented X3. Her affect is characterized by anxiety and depression, as she is having difficulty answering your questions. The client indicates that she has thoughts about putting a pillow over her mother's face or taking an overdose of sleeping pills so that she does not have to deal with her family or her mother's demands anymore.","First session You are a counseling intern for a mental health agency. A 55-year-old Colombian American female presents to therapy with tears in her eyes. She appears distraught, anxious, and despondent. She describes feeling guilty about wanting to put her mother in an assisted living facility. Although the client knows that putting her mother in an assisted living facility is probably the best decision, she feels guilty because it goes against the values of her culture. She explains that in traditional Colombian culture, elders are revered, and it is the responsibility of the oldest child to take care of them. The client's siblings have been ""critical of me even talking about moving her into an assisted living facility"" and are pressuring her to keep their mother at home.    The client starts to cry and covers her face. Finally, she looks up and says, ""I feel torn. There are these cultural expectations that I look after my mother, but she never even liked me and made my life miserable when I was growing up."" The client does not have any nearby family who can help support her or assist in the care of her elderly mother. Her brothers live in different states, and her husband is an only child whose parents both passed away a few years ago. The client has expressed feeling overwhelmed by the responsibility of taking care of her mother and running her own household. She says, ""I feel like I just can't keep up with everything. My kids need me, my husband needs me, and now I have to take care of my mother, too. And as for having any time to myself, that's a dream that's never going to happen."" She further explains that her current circumstances remind her of what it felt like growing up in a chaotic household and feeling the pressure of having to take care of her younger siblings. She states, ""It's like history is just repeating itself."" She reports feeling ""like a failure at being a wife, mother, sister, and daughter."" As you listen to the client's story, you sense her feelings of guilt, frustration, and overwhelm about not being able to meet all the demands placed on her. You empathize with the client and validate her feelings. You compliment her on the strength it took for her to take on an additional responsibility despite the hardships that come with it.    When asked what she hopes to gain from therapy, the client tells you that she wants to figure out how to balance her responsibilities. She expresses wanting to find a way to care for her family members without ""losing myself and my sanity in the process."" You suggest meeting with the client for weekly sessions as a place to begin, and you walk the client through what she can expect from therapy.  Fourth session During a previous session, the client expressed an interest in bringing her husband to a therapy session to discuss her feelings and how to best manage their respective responsibilities. The client arrives to today's session with her husband, but he appears disengaged as you begin the session. You notice that the client is on edge, and she avoids looking at her husband. You start out by addressing both of them and asking how they are doing. The client responds first, saying that things have been difficult for her lately due to all the pressure she has been under from taking care of her mother in addition to managing her own household. She expresses feeling overwhelmed and anxious about not being able to meet everyone's needs perfectly.    The husband remains silent, so you ask him specifically what he thinks about his wife's concerns. He replies that he feels frustrated because he believes that she is being ""too sensitive"" and should focus on fulfilling her obligations as a wife and mother instead of worrying about how others think she should do things. Feeling defensive, the client interjects and tells her husband that he does not understand what it feels like to be in her position. He replies, ""You're right. I don't get it. Look, I don't want to be the 'bad guy' here, but you're obsessed with what your brothers think. They don't have to live with your mother. We do. We should be thinking about what's best for our family, not your siblings."" The client says, ""I'm trying my best, but I feel like I'm alone in this. When you get home from work, instead of helping around the house, you just binge watch cartoons and ignore everything. It's like I don't have a husband - I have an extra child!"" The husband appears angry and tenses up, and you notice that the client is equally upset. You acknowledge their feelings of frustration, disappointment, and overwhelm and reiterate that it is understandable to feel this way given the amount of pressure they are both under.    You take this moment to help both the client and her husband understand each other's perspectives in a supportive way. As you discuss their different points of view, it becomes clear that both the client and her husband are feeling overwhelmed by having to balance the demands of caring for an elderly family member. You explain the importance of being able to express their feelings and work together when making decisions about how to manage the family's needs. Next, you suggest that the client and her husband take some time to reflect on their feelings and experiences. You educate them about strategies they can use at home to express their feelings in a supportive way.  10th session During the last few counseling sessions, you and the client explored ways that she and her husband could better collaborate and communicate in order to manage their respective responsibilities. You worked with the client to develop coping skills to manage her anxiety, including deep breathing exercises and visualization techniques. You also engaged the client in a discussion about how her beliefs and values were influencing her reactions to her family's needs and strategized how to set boundaries and make decisions that honor her values without feeling guilty or overwhelmed. She has been actively using these coping strategies to better manage her emotions and has been more successful in communicating her needs to her husband.    When you meet for today's session, the client appears to be in a positive mood. After a long discussion with her husband and her brothers, everyone finally agreed it would be best to move her mother into an assisted living facility. She says, ""I had the most trouble convincing my youngest brother that assisted living was the best option. I think my sister-in-law was the one who finally helped him to understand why making the switch would give my mother the best chance for a better quality of life."" She goes on to describe it as ""one of the most difficult decisions I've ever made."" You ask her how she is feeling now that the decision has been made, and she tells you, ""a little bit guilty, but mostly relieved."" You affirm her courage and ability to handle such a challenging situation. She tells you that she ""can finally breathe again."" She also believes that she might be able to have a better relationship with her mother with her being in an assisted living facility. The client does not want to resent her mother every day and expresses a desire to try to make the most of the time they have left together. She tells you that she has been going through some old family photo albums and came across a picture of her mother when she was newly married. She says, ""She and my dad looked so happy together. There was a time when she wasn't so critical and demanding."" The client tells you that she has been reflecting on her own experiences as a mother lately and thinking about ""the courage my mother must have had to leave everything that was familiar to her and move to a new country with four kids in tow."" She remarks that this newfound awareness has helped her understand why her mother was so demanding and strong-willed; she now sees that all of these qualities stem from a desire to provide for their family and give them the best possible life.    Toward the end of the session, the client says, “I’m so grateful for everything you have done. You have been a great listener and given me the tools to cope with everything in a healthier way."" You acknowledge her progress and remind her that she has come a long way since the beginning of your counseling sessions.","The client is the oldest child in her family. She has 3 younger brothers, all of whom are separated in age by one year. She was born and raised in Colombia. When she was in middle school, her family immigrated to the United States in search of better opportunities. Her father worked long hours as a taxi driver while her mother worked as a nanny taking care of other people's children. The client stated that she often felt like she had no parents because they were always working. The client stated that when they moved, her mother asked her to help out more at home with the cooking, cleaning, and taking care of her siblings. She often felt overwhelmed and guilty because she wanted to spend time with friends or focus on her studies rather than watching her brothers. The client revealed that she often feel a deep sense of resentment knowing that while other girls were able to go outside and play, she had responsibilities to take care of. Personal/Social Relationships: The client's father passed away four months ago and her 76-year-old mother has been living with the client since then. The mother does not speak English and requires assistance with medical appointments, financial dealings, and daily care. She constantly ""nags"" the client about how she is raising her children and often complains about her cooking. The client's husband, who is second-generation Irish American and grew up in Boston, is becoming increasingly irritated with his mother-in-law. He complains to his wife about her mother, which puts a ""massive strain"" on the couple's relationship.  ",How would you affirm the client's ability to handle the decision for her mother's long-term care?,"""It takes a lot of strength and courage to make difficult decisions, especially those that involve the wellbeing of your loved ones. I'm proud of you for taking this big step.""","""It must have been tough having to make such a difficult decision.""","""You should feel proud at showing the strength and courage to make a hard decision in the face of opposition from your family. That was a big step.""","""You've made a lot of progress since we started counseling and I'm impressed with how far you've come.""","(A): ""It takes a lot of strength and courage to make difficult decisions, especially those that involve the wellbeing of your loved ones. I'm proud of you for taking this big step.""
(B): ""It must have been tough having to make such a difficult decision.""
(C): ""You should feel proud at showing the strength and courage to make a hard decision in the face of opposition from your family. That was a big step.""
(D): ""You've made a lot of progress since we started counseling and I'm impressed with how far you've come.""","""It takes a lot of strength and courage to make difficult decisions, especially those that involve the wellbeing of your loved ones. I'm proud of you for taking this big step.""",A,"This response is validating and affirming, acknowledging the client's courage in making a difficult decision while still honoring their autonomy. It also reinforces the idea that the client has made progress since they started counseling. Therefore, the correct answer is (A)",counseling skills and interventions
1539,"Name: Andie Clinical Issues: Gender identity development Diagnostic Category: Gender Dysphoria Provisional Diagnosis: F64.1 Gender Dysphoria Age: 12 Sex Assigned at Birth: Male Gender and Sexual Orientation: Female, Questioning Ethnicity: Caucasian Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is quiet in the session and clingy toward his mother. His head is bent down, and he refuses to make any eye contact. When an attempt is made to engage the client in conversation, he responds with short statements such as, ""I guess; I don't know.""","First session You are a mental health therapist for an agency where two parents and their 12-year-old child named Andie present for their first counseling session with you. The father looks irritated, and the mother seems depressed. She expresses that they have been concerned for some years regarding their son's confusion around his gender identity. They feel he is too young to make any decisions that will affect the rest of his life. The father speaks up, saying, ""He's getting all of this nonsense from school just to fit in, and it needs to stop."" The mother expresses that Andie always likes to dress up in his sister's clothes and believes that one day he will become a girl. Andie appears anxious and is afraid of the father as evidenced by his withdrawing behavior. You discuss your role as therapist and tell Andie that your job is to help make people feel better. You also provide the parents with your initial observations and make a recommendation to start therapy with weekly appointments.  Fourth session During the previous two sessions, you focused on making Andie feel comfortable and spent time learning about his interests and strengths. You have established a strong rapport with Andie. Today, he is quiet and reluctant to speak. He tells you about his family and that his dad is always yelling at him and calling him a ""sissy boy."" He states feeling sad and does not understand why his dad will not love him if he wants to be a girl. he also states that he feels confused by his mother's seeming acceptance of him, but her unwillingness or inability to ""be on his side"" when his father berates him.  He admits that he feels happy when he thinks of himself as a girl, especially when he is free to express himself in that way. He said all the boys at school are mean to him and call him names. he feels most at ease with the girls in his class, or with the teacher. You work with the client on how to express his thoughts and feelings appropriately to his father rather than holding them in.  Tenth session The family arrives to today's session to review Andie's progress. The mother states that she is happy to see that the conflict between her husband and son is decreasing. She states that they are all utilizing ""I statements"" in order to express their feelings. The father states that he is trying to just let him go through this ""phase"" and find himself. You continue to explore with the family any other contributing factors that could be hindering family dynamics. You also explore an array of interventions that would be appropriate when behavior disturbances occur.","The client has three sisters, loves his mother but has difficulties with his father. His parents differ in child-rearing styles. The client is the youngest and has three older sisters and wishes that he had been born a girl. He acts out at home when he feels that he's not being ""understood"" by his parents. He withdraws from his family quite often (will not leave his room) and usually has ""screaming matches"" with his father in regard to his expression of his preferred gender. The client does not get along with the other boys in his class but relates to the girls without difficulty. Before the initial interview with the client, his father related that he is concerned about his son's long-standing ""girlish ways."" His son avoids contact sports but has expressed an interest in ballet. ","When preparing for termination for this client, what would be beneficial for continuous support?",Refer the family to family therapy,Encourage the family to continue therapy,Provide a referral to a family support group,Ask the family if they need more support before offering it to them,"(A): Refer the family to family therapy
(B): Encourage the family to continue therapy
(C): Provide a referral to a family support group
(D): Ask the family if they need more support before offering it to them",Provide a referral to a family support group,C,"An important goal when terminating clients is adding in a further layer of support as they close out therapy. Referrals and school-based supports are the most appropriate choices in this case. Therefore, the correct answer is (A)",treatment planning
1540,"Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)","Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.","You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”","    History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork.  The client is resistant to engage in the self-affirmation exercise, exclaiming that “It just seems silly","The client is resistant to engage in the self-affirmation exercise, exclaiming that “It just seems silly.” Using motivational interviewing, which response would best increase her compliance with this activity?",“There are now studies showing that positive affirmations activate neural reward pathways in the brain.”,“This way of decreasing anxiety seems foreign to you.”,"“Change is really hard for you, but I think you’ll be pleased with the results.”",“You feel like I don’t understand you or can’t help you.”,"(A): “There are now studies showing that positive affirmations activate neural reward pathways in the brain.”
(B): “This way of decreasing anxiety seems foreign to you.”
(C): “Change is really hard for you, but I think you’ll be pleased with the results.”
(D): “You feel like I don’t understand you or can’t help you.”",“This way of decreasing anxiety seems foreign to you.”,B,"Stating “This way of decreasing anxiety seems foreign to you” would best increase compliance with engaging in the self-affirmation exercise. Rolling with resistance is a motivational interviewing strategy used to improve a client’s desire to change. Statements that focus on the problem and not the person are used when rolling with resistance. The counselor’s statement is a simple reflection. The statement “Change is really hard for you, but I think you’ll be pleased with the results” focuses on the person rather than the problem and uses persuasion, which motivational interviewing discourages. The statement “There are now studies showing that positive affirmations activate neural reward pathways in the brain” is also an attempt at persuasion. Finally, the statement “You feel as if I don’t understand you or can’t help you” is a failed attempt at providing empathy because it does not accurately reflect the client’s underlying feelings or beliefs. Therefore, the correct answer is (D)",counseling skills and interventions
1541, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”","Learning about Bob's trauma that apparently initiated his drinking, which intervention should you add to a new trauma goal?",Help Bob to process the traumatic event and consider steps towards resolution,Ensure Bob receives EMDR before leaving treatment facility,Use Empty Chair for Bob to unburden his feelings,Refer Bob to trauma specialist following treatment,"(A): Help Bob to process the traumatic event and consider steps towards resolution
(B): Ensure Bob receives EMDR before leaving treatment facility
(C): Use Empty Chair for Bob to unburden his feelings
(D): Refer Bob to trauma specialist following treatment",Help Bob to process the traumatic event and consider steps towards resolution,A,"Since Bob has presented his underlying reason for drinking through discussion, he is more likely to continue using a discussion method. You now have a little over two weeks to assist Bob in addressing what happened in his past through discussion and help Bob consider what steps he can take to gain more permanent healing. Perhaps Bob can be referred after treatment or can undergo EMDR later when he is stable and in remission from alcohol use, however he has just made clear he will be going home to repeat the same behaviors. Neglecting to further this discussion in the amount of time available would be irresponsible as you may still have a chance at increasing his motivation for change. Answers b) and c) might trigger Bob and counteract the goal of motivating him. Therefore, the correct answer is (A)",treatment planning
1542,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.  Sixth session Rick has been attending group therapy weekly. He continues to wear long sleeves to the session but appears engaged and involved in the group process. The group exhibits high cohesion, and all members participate in group activities. The focus is on continued productivity and problem-solving. You ask the members to reflect on the skills they have been practicing in the group and share an experience in which they have applied those skills outside the session.    Rick's experience in the group has further helped him to identify and understand his feelings. He has been able to recognize his anger and express it in a healthier way. He has also been able to recognize his need for connection. He says he recently called his ex-girlfriend to apologize for being angry about his parents and ""taking it out on her"" by withdrawing from her. This has enabled him to develop a more constructive approach to conflict.    The group members have provided Rick with a safe space to practice his new skills, giving him the confidence to try them in his real-life relationships. The other members have shown Rick support and encouraged him to take risks and to be open to opportunities for growth.    Rick's active engagement in the group has been instrumental in his progress. He has become more aware of his emotions, and he can express himself in a way that is respectful and appropriate. His newfound ability to communicate effectively has been a significant step towards strengthening his relationships both inside and outside of the group.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ",Under what condition are you able to ethically terminate therapy?,If his parents refuse to pay the fees that were agreed upon during informed consent,If the client becomes intransigent regarding personal disclosure.,For any extended absence such as family vacation or while conducting research,"When your life circumstances dictate, such as the event of illness","(A): If his parents refuse to pay the fees that were agreed upon during informed consent
(B): If the client becomes intransigent regarding personal disclosure.
(C): For any extended absence such as family vacation or while conducting research
(D): When your life circumstances dictate, such as the event of illness",If his parents refuse to pay the fees that were agreed upon during informed consent,A,"This is the correct answer. During intake, you review what to expect from therapy, roles, confidentiality, informed consent, fees and payments, cost of sessions, and so on. You are ethically allowed to terminate if a client violates this agreement and does not pay for services. Therefore, the correct answer is (D)",professional practice and ethics
1543,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","You and the client develop a clear and explicit treatment contract to provide a foundation for informed consent. Through this collaborative process, you establish an agreement outlining treatment roles, responsibilities, and expectations for you and the client. The client agrees with your suggested goals but does not want to include safety issues as part of her treatment plan. You provide psychoeducation on BPD, and she relates to experiences of abandonment. She would like to learn how to navigate romantic relationships and requests interventions targeting this area",What is the primary purpose for engaging the client in the process of contract setting?,To eliminate client “splitting” and manipulation,To provide legal protection in the event of a boundary violation,To establish trust and build a working alliance,To give grounds for termination if the client does not uphold her portion of the agreement,"(A): To eliminate client “splitting” and manipulation
(B): To provide legal protection in the event of a boundary violation
(C): To establish trust and build a working alliance
(D): To give grounds for termination if the client does not uphold her portion of the agreement",To establish trust and build a working alliance,C,"You engage in contract setting to help establish trust and build a working alliance. When you work with the client to establish trust and a collaborative working alliance, there is an increased likelihood of the client engaging in and benefiting from therapy. Although contract setting is helpful for addressing other issues, answer A is the best response. Eliminating client splitting and eliminating manipulation are not collaborative goals, making answer option B incorrect. Client contracts do not provide legal protection in the event of a boundary violation. It is the counselor’s responsibility rather than the client’s to ensure that boundaries are clearly defined and kept intact. Lastly, using contracts to give grounds for termination is not the primary purpose of contract setting. Therefore, the correct answer is (A)",counseling skills and interventions
1544,Initial Intake:  Age: 32 Gender: Female Sexual Orientation: Bisexual Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Community mental health agency Type of Counseling: Individual via Telehealth,"Melanie is unkempt, looks tired and is casually dressed. Motor movements are within normal limits, eye contact is appropriate. Melanie reported passive suicidal ideation intermittently throughout her depressive episode as a means for escaping her feelings but has no plan or intent. Melanie reluctantly admits to several instances of past trauma which include losing her son’s father to a tragic car accident four years ago where her son witnessed him die, as well as having three other older children, all with separate fathers, with whom she has no contact. Her only support system is her boyfriend who takes great care of her and her son’s school, which provides help with his Individualized Education Plan.","Diagnosis: Dysthymic disorder (F34.1), provisional, Anxiety disorder, unspecified (F41.9), Post-traumatic stress disorder (PTSD) (F43.1)
 

Melanie has been in mental health counseling for several years through your agency and was referred to you by her last counselor who obtained a position with a local University and was leaving your company. Melanie is a 32-year-old Caucasian female who lives in a house with her boyfriend and her 9-year-old son, Gus, who suffers from ADHD, anxiety, and PTSD. Melanie is receiving psychiatric medication from your agency’s Psychiatrist, another Psychiatric practice by a Nurse Practitioner in a different city and is being treated medically by a Gastroenterologist who has also prescribed medications. Melanie is complaining of ongoing depression caused by her chronic nausea and a cyclic vomiting syndrome and does not want to leave her bed out of helplessness and hopelessness that nothing will ever change. She also reports experiencing anxiety and panic-like attacks when she is around others which causes her to socially isolate for sometimes days at a time. She is upset she cannot care for her son the way she desires and wants to continue counseling to help her feel better.","Family History:
Melanie has what she states is a “complicated” relationship with her family, including her mother, whom she believes wants no involvement with her or her son, and has no contact with anyone else. Melanie states her falling out with her mother began when she was just a child. She comments that her father and her were “very close”, but his new wife makes it “challenging to communicate with him.” Melanie has lived on her own for much of her life and has not engaged in or sustained any relationship with her first three children. She adds that in each instance they were either unfairly taken away by the father or the state and that she has tried to initiate contact, but it has not been successful. Melanie continues to deflect from discussing family dynamics, causing gaps in your initial interviewing process.
 
Work History:
Melanie reports never having an “official” job but always being able to make money “somehow.” She has been on Medicaid for most of her life and continues to survive off government support and the charity of others. She tells you she has dreams of writing a book or even owning her own bakery but does not demonstrate willingness to take the steps at achieving those goals.
 
Legal History:
Melanie has incurred a criminal record for failing to pay child support several times over the past nine years and continues to receive notices and warnings to ensure she is making her payments on time.","After the second session, what is the best intervention to conduct with her at this time?",Prepare her for termination as she needs to be engaged with her program therapists,Redirect her to focusing on what she must do each day to complete treatment,Teach coping skills for managing anxiety,Explain that now is the time to invest in EMDR to address those traumatic memories,"(A): Prepare her for termination as she needs to be engaged with her program therapists
(B): Redirect her to focusing on what she must do each day to complete treatment
(C): Teach coping skills for managing anxiety
(D): Explain that now is the time to invest in EMDR to address those traumatic memories",Teach coping skills for managing anxiety,C,"At this time, preparing Melanie for ending your therapeutic relationship is not appropriate and can exacerbate her emotional condition. Redirection would only be effective if Melanie had the ability to focus; however, it is her chief complaint that she does not have the skills to refocus and is beginning to convince herself she does not need to complete treatment. It is also advisable to directly address her trauma using the therapeutic modality you assessed would be useful from the initial intake, but this is not recommended for a client in early addiction treatment who has not yet demonstrated effective use of coping skills for stress. There are advanced technologies available in some treatment centers that provide Neurofeedback services which have been proven effective in addressing treatment of trauma on a neurochemical level concurrent with talk therapy services, but this is not the same as EMDR and either way it is safest for a client to have learned coping skills prior to any experimental or evidence-based treatments. Teaching or reviewing coping skills for managing Melanie's anxiety would best help her in the moment while addressing all her concerns. Therefore, the correct answer is (D)",counseling skills and interventions
1545,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",What characteristics of this client best support your provisional diagnosis?,The client is slightly overweight for his age and wears clothes that appear too small for his physique.,The client receives frequent but inconsistent physical punishment from his mother.,"The client cannot make friends his age in the neighborhood, and other parents do not want their children playing with him.","The client is sitting with his arms crossed in the chair, refusing to make eye contact with you, and his attitude is disrespectful.","(A): The client is slightly overweight for his age and wears clothes that appear too small for his physique.
(B): The client receives frequent but inconsistent physical punishment from his mother.
(C): The client cannot make friends his age in the neighborhood, and other parents do not want their children playing with him.
(D): The client is sitting with his arms crossed in the chair, refusing to make eye contact with you, and his attitude is disrespectful.","The client is sitting with his arms crossed in the chair, refusing to make eye contact with you, and his attitude is disrespectful.",D,"Negative affect, argumentative, and defiant behavior are the feature characteristics of Oppositional Defiant Disorder. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1546,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","The client comes into the session and reports that he and his wife have been getting along better since the last session following some conversations about what they can do to get through this situation together. The client says that he wants to work on figuring out what he is going to do for work next. You and the client discuss possible options, and he says a friend offered him a job at his restaurant. The client says that he is considering it just for the money but that he has never been a server before and has some reservations. You conduct a career interest assessment and discuss the results.  The client expresses worry about being a server in a restaurant because he has never done it before",The client expresses worry about being a server in a restaurant because he has never done it before. Which one of the following responses would be most helpful?,Encourage the client to take the position due to his financial needs.,Encourage the client to continue looking for a position that more closely relates to his experience.,Process the client’s experience in the automobile plant and compare it to being a server to demonstrate the overlap of skills between the two positions.,Use your assessments to determine other positions that he might be a good match for.,"(A): Encourage the client to take the position due to his financial needs.
(B): Encourage the client to continue looking for a position that more closely relates to his experience.
(C): Process the client’s experience in the automobile plant and compare it to being a server to demonstrate the overlap of skills between the two positions.
(D): Use your assessments to determine other positions that he might be a good match for.",Process the client’s experience in the automobile plant and compare it to being a server to demonstrate the overlap of skills between the two positions.,C,"Many job experiences have some level of overlap, with the skills required being applicable in other positions. Because the client has an immediate financial need to be employed, he should be supported in considering this position. His experience as a supervisor lends itself to helpful social skills, and his work in the automobile plant was hard labor. You should emphasize that these skills are relatable to being a server. Meanwhile, the client can continue to look for positions that might meet his financial needs better and/or interest him more; however, the client’s financial needs are more urgent, and both of these things can be done while accepting the job that provides immediate work. It is not typically a therapeutic approach to recommend that someone make a life decision such as taking a job, leaving a job, staying with or leaving someone, etc. If these decisions do not end up in the client’s favor, it could leave the counselor liable. Using assessments to find appropriate employment matches for your client is helpful, but the client has more pressing needs financially and has a more immediate employment need. Therefore, the correct answer is (A)",counseling skills and interventions
1547,"Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography","You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.",use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends,"Although pornography addiction is not a DSM-5-TR diagnosis, based on what you know about the client, which of the following is the most likely reason that he engages in frequent masturbation?",Loneliness,Self-esteem,Anxiety,Obsession/compulsion,"(A): Loneliness
(B): Self-esteem
(C): Anxiety
(D): Obsession/compulsion",Anxiety,C,"Masturbation can relieve this client’s aforementioned stress and tension, and therefore anxiety, through the release of hormones such as dopamine, endorphins, and others that improve mood and physical feelings. Those same “feel-good” hormones might also temporarily improve how the client feels about himself; however, self-esteem is not an issue that has been indicated at this time. Loneliness is not indicated in this client’s case either; however, an individual who feels alone might use pornography to feel a connection to other humans. The client’s behavior does seem to be compulsive, but it is not this client’s most likely reason for masturbation. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1548,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","You arrive at the client’s house for the session, and he decides to meet with you in the family office and brings some toys with him. He sits on the floor, and you decide to sit on the floor with him and engage in play to continue building rapport. While playing, you begin to ask the client about what frustrates him about his parents, and, through processing, you identify that he desires some independence. You meet with the parents after the session and encourage them to give him some choices throughout his day so that he can have a sense of control. You state that they can be choices that may not be consequential, such as the order of the bedtime routine, so that the routine still happens but he has some control over the order of the process","Based on the client’s developmental level, why is it important that his parents are engaged in his treatment?","The client does not want to participate in counseling, so his parents will be the ones participating in treatment.",The presenting problem is centered around the client’s difficulty with following directions from his parents and teachers.,"The client is not developmentally able to deal with strong emotions, so his parents will need to support him.",The client is not self-aware enough to know when he needs to cope with strong emotions.,"(A): The client does not want to participate in counseling, so his parents will be the ones participating in treatment.
(B): The presenting problem is centered around the client’s difficulty with following directions from his parents and teachers.
(C): The client is not developmentally able to deal with strong emotions, so his parents will need to support him.
(D): The client is not self-aware enough to know when he needs to cope with strong emotions.",The client is not self-aware enough to know when he needs to cope with strong emotions.,D,"Developmentally, the client does not have the self-awareness to know when he needs to cope with strong emotions and thoughts; therefore, it will be important for his parents to prompt him to cope when he is experiencing these triggers. The client is able to deal with strong emotions at this age, but he may not always know when he needs to, so his parents’ support will be very important. The presenting problem does involve a defiance in following directions from his parents, but this is not related to his developmental level. The client is currently resistant to therapy, but he has improved his engagement from the last session; therefore, it is possible that he will be able to fully participate at some point. Therefore, the correct answer is (A)",treatment planning
1549,"Name: Jeanne Clinical Issues: Fear and panic Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F41.9 Unspecified Anxiety Disorder Age: 35 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latin American Marital Status: Married Modality: Individual Therapy Location of Therapy : Community Center  ","The client appears tearful and overwhelmed. Her affect is mood congruent with her reported symptoms of panic, stress, and guilt. The client has a poor sense of control over her current mental state, leading to ideas and fears of not being able to cope with her current circumstances. She reports having panic attacks and expresses feeling overwhelmed by the demands of motherhood and home life. The client has difficulty concentrating on tasks, as well as changes in her eating habits, sleeping patterns, and overall mood, leading to worries about managing her responsibilities as a mother. She expresses an understanding of her situation and an awareness that her current mental state is not sustainable in the long-term. She has also expressed a desire to seek counseling as a first step towards managing her anxiety.","First session You are a therapist at a community center. The client is a married, 35-year-old mother of two young children. She is a stay-at-home mother, and the family is financially dependent on her husband's income. He works long hours and is very tired when he finally gets home, leaving most of the household tasks and childrearing to the client. She tells you, ""About eight months ago while driving my car, I began having hot flushes, sweating, and feeling like I was going to die. It has happened multiple times since then. What if my kids are with me, and it happens again while I'm driving? I can't stop thinking about it."" She states that her husband drove her to the session today because she has been afraid to drive since her first panic attack.    She describes another incident two weeks ago while getting her hair cut. She began feeling like she had a heart attack. She tells you, ""I sat straight up in the middle of having my hair shampooed and just ran out the door. The room felt so small all of the sudden and I couldn't stand it. It's so embarrassing. It doesn't make any sense."" As she wipes tears from her eyes, she shares, ""I'm becoming more and more afraid to leave my house by myself. I'm not even going to church anymore. The idea of being in a closed room full of people freaks me out. I'm terrified I'm going to have another 'attack.' I can't tell when another one will come on, and I don't even know how long it will last. Please, help me. I'm no good to anyone right now - not me, my kids, or my husband.""    She tells you that she had a ""bad experience"" with medications in the past and wants to try counseling before considering medications again. She expresses feeling afraid that she will never ""get better."" She also states she feels like a ""bad wife and mother"" because she cannot control her anxiety. You discuss the principles of panic-focused CBT and mindfulness-based stress reduction to effectively treat her.  Fourth session At the start of today's session, the client hands you a copy of a hospital discharge form. She went to the emergency room two days ago with severe dyspnea and fear of dying from a myocardial infarction. Upon arrival at the hospital, the client reported paresthesia, pounding heart, and chest pain. She appears ""frazzled"" and disheveled during today's session. She describes the circumstances leading up to her trip to the hospital. She reports that her husband has been emotionally distant and is becoming increasingly frustrated with her anxiety. Finally, he told her that ""this has been going on long enough"" and that she needed to ""get her act together."" After this conversation, the client experienced a panic attack and stated that she was ""terrified"" that she was dying. Her husband arranged for their neighbor to watch the kids and drive her to the hospital.    You tell the client that she must stop thinking she will die or progress in therapy will be unlikely. You reassure her that the physical sensations she feels during a panic attack are not life-threatening, even though they may feel that way. You discuss the importance of her bringing compassion and attention to her body rather than jumping into ""fight, flight, or freeze"" mode. The client appears anxious and has poor eye contact with an averted gaze. She is continuously wringing her hands together and bouncing her legs. She has trouble concentrating, as evidenced by her asking you to repeat questions. The client tearfully states, ""I'm ruining my family. What if I die? Who will take care of the kids?"" You provide empathy and walk her through a relaxation technique.  Ninth session You have seen the client weekly, and she is progressing. She arrives at today's session on time. She appears calm, alert and focused. She states that she has been actively journaling her thoughts and feelings. This has been helpful for her in identifying themes in her faulty cognitions. She tells you that she is surprised by how much she is learning about herself, including how much her past has influenced her current beliefs.    She showed some psychomotor agitation by pulling on the strings of her blouse. The client expressed that she and her husband have been trying to implement a date night which has helped their relationship and for him to better understand what Panic Disorder is. She said that having meaningful conversations with him and having his support in times of panic has helped reduce the attack's length. However, the client did express that she cannot shake the fear of dying and leaving her children. You discuss with her the potential triggers of these panic attacks and discuss ways to manage them.    As she leaves, you see that she has bruises on her arms as she is getting ready to leave and says she was ""roughhousing"" with her husband. You are unsure if she is telling the truth, making you wonder about everything she has been saying about her husband. You discuss with her the option of attending couples therapy to help them work through any issues they may face. She says she is open to it but worried about bringing up deeper issues surrounding their relationship. You reassure her that she and her husband will have a safe space to discuss any topics and remind her about the counseling.","The client has two young children, ages four and six, both of whom have been diagnosed with ADHD. She has been married for ten years. Her husband is 47, twelve years her senior. He works full-time, and she is a stay-at-home mom.    For the past year, the client has reported feeling overwhelmed with the demands of motherhood and home life. She feels that her husband does not understand her struggles, nor does he contribute enough to their household responsibilities. This lack of support from her husband has caused her to feel a deep sense of resentment. She is also concerned that her children are not receiving the support they need from their father, as his involvement in their lives appears to be minimal.    The client expresses frustration with her lack of motivation and has become increasingly more anxious and irritable over the past several months. She reports difficulty concentrating on tasks. She feels her stress levels are rising and she is having recurrent panic attacks. In addition, she has noticed changes in her eating habits, sleeping patterns, and overall mood. These changes have caused the client to worry about managing her responsibilities as a mother. The client has been a full-time stay-at-home mother since the birth of her older child. Before that, she was a salesperson and shift manager at a local women's clothing boutique for several years. Since becoming a stay-at-home mom, the client has felt increasingly isolated and disconnected from the outside world. She fears she has lost her ability to successfully manage conversations with strangers, her skills in sales and marketing have eroded, and she no longer feels as confident in herself. Previous Counseling: The client has been hospitalized as she feared she was having a heart attack which turned out to be a panic attack. According to he client, her husband (her designated emergency contact person) was responsible for creating the conditions that resulted in her being hospitalized. ","You have been using CBT as a theoretical model to work with the client's Panic Disorder, helping her learn to identify, challenge and modify her thoughts to reduce her anxiety associated with specific situations. Which of the following best typifies this approach?","""I would like you to read Panic Free: The 10-Day Program to End Panic, Anxiety, and Claustrophobia, by Joseph LeDoux. I have read it and have found it helpful. We can talk about it in session as you read the book. How do you feel about this idea?""","""What if you continue to have panic attacks for the rest of your life? Tell me what that looks like to you.""","""Let's practice some deep breathing. Take three deep breaths in through the nose and exhale through your mouth. Then we are going to breathe as normal. We are going to do this for about five minutes. Do you feel ready?""","You state: ""Good job. We're now in your car where you first had your panic attack.""

Client: ""I feel very uncomfortable. My hands won't stop shaking. I'm afraid it will happen again.""

You state: ""What is the worst thing that can happen?""

Client: ""I do not know; I might lose control of the car.""

You state: ""Let's step out of the car for a second. How do you feel now?""

Client: ""Still uncomfortable, but okay.""","(A): ""I would like you to read Panic Free: The 10-Day Program to End Panic, Anxiety, and Claustrophobia, by Joseph LeDoux. I have read it and have found it helpful. We can talk about it in session as you read the book. How do you feel about this idea?""
(B): ""What if you continue to have panic attacks for the rest of your life? Tell me what that looks like to you.""
(C): ""Let's practice some deep breathing. Take three deep breaths in through the nose and exhale through your mouth. Then we are going to breathe as normal. We are going to do this for about five minutes. Do you feel ready?""
(D): You state: ""Good job. We're now in your car where you first had your panic attack.""

Client: ""I feel very uncomfortable. My hands won't stop shaking. I'm afraid it will happen again.""

You state: ""What is the worst thing that can happen?""

Client: ""I do not know; I might lose control of the car.""

You state: ""Let's step out of the car for a second. How do you feel now?""

Client: ""Still uncomfortable, but okay.""","""What if you continue to have panic attacks for the rest of your life? Tell me what that looks like to you.""",B,"This is an example of the CBT technique of decatastrophizing. Decastastrophizing involves imagining the “worst-case scenario” and finding solutions to cope with it. It helps people to think more realistically, break problems down into manageable pieces and gain control over their thoughts. It involves challenging irrational beliefs, recognizing errors in thinking, and learning how to respond healthier to difficult situations. Therefore, the correct answer is (C)",counseling skills and interventions
1550,Initial Intake: Age: 40 Sex: Female Gender: Female Sexuality: Lesbian Ethnicity: African American Relationship Status: Partnered Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.","You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety.  She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.","Family History:
Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”",Which of the following should the counselor focus on during this session?,Exploring what the client dislikes most about her body,Exploring the client's success with work done in the last two sessions,Exploring what the client likes most about her body,Exploring the client's cognitive distortions about her body,"(A): Exploring what the client dislikes most about her body
(B): Exploring the client's success with work done in the last two sessions
(C): Exploring what the client likes most about her body
(D): Exploring the client's cognitive distortions about her body",Exploring the client's success with work done in the last two sessions,B,"The client has successfully addressed symptoms of depression and ineffective communication styles through counseling. Exploring these successes and how she accomplished them prepares her to continue making progress. Counseling is strengths-based, helping profession in which counselors assess and draw attention to the strengths that clients bring into counseling. This increases hope for change and encourages the client to see themselves as capable of making changes. Exploring the client's body satisfaction and dissatisfaction, will be helpful when beginning to target the client's cognitive distortions over the next several sessions. Beginning to explore cognitive distortions too early in therapy, before the client is ready, can rupture the therapeutic relationship and impact counseling attendance. Therefore, the correct answer is (B)",counseling skills and interventions
1551,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ",The client’s parents are paying for her college tuition. The client shares that she is worried that her parents will have access to her therapy records through the university as she is still a minor. What is the most appropriate way to respond to the client’s distress?,Review the exceptions and limits to confidentiality and indicate that her parents would not have access to her therapy records unless she chooses to release this information to them.,Reassure the client that she has a right to qualified confidentiality concerning the proceedings of her therapy sessions.,Acknowledge the client's feelings and help her explore why she is worried that her parents will have access to her therapy records.,"Review the exceptions and limits to confidentiality, informing her that because her parents are paying for her tuition, they can access her therapy records through the university.","(A): Review the exceptions and limits to confidentiality and indicate that her parents would not have access to her therapy records unless she chooses to release this information to them.
(B): Reassure the client that she has a right to qualified confidentiality concerning the proceedings of her therapy sessions.
(C): Acknowledge the client's feelings and help her explore why she is worried that her parents will have access to her therapy records.
(D): Review the exceptions and limits to confidentiality, informing her that because her parents are paying for her tuition, they can access her therapy records through the university.",Review the exceptions and limits to confidentiality and indicate that her parents would not have access to her therapy records unless she chooses to release this information to them.,A,"The Family Educational Rights and Privacy Act (FERPA) gives parents the right to access the educational records of a student under 18 years old. Once a student turns 18 OR ATTENDS a postsecondary institution, the rights under FERPA transfer to the student. A 17 year old enrolled in college is considered an adult student, and medical privacy rights apply. Parents would need consent from their daughter to access any therapy records. Therefore, the correct answer is (A)",professional practice and ethics
1552,"Name: Tabitha Clinical Issues: Family conflict and pregnancy Diagnostic Category: V-codes Provisional Diagnosis: Z71.9 Other Counseling or Consultation Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Latina Marital Status: Not Married Modality: Individual Therapy Location of Therapy : School  ","The client appears healthy but tired and distracted. She is dressed in loose-fitting clothing and sits with her hands between her knees. Eye contact is minimal. Speech volume is low. She is reluctant to talk at first and denies having a problem. Thought processes are logical, and her thoughts are appropriate to the discussion. The client's estimated level of intelligence is within average range. She appears to have difficulty maintaining concentration and occasionally asks you to repeat your questions. The client denies suicidal ideation but states that she has been considering abortion. She has not acted on anything but is feeling very overwhelmed and desperate.","First session You are a school counselor in an urban school setting. The client is a 16-year-old student who is reluctant to see you. The session begins with a discussion of the teacher's concerns and your role as a school therapist. After some gentle probing and reassurance, the client is able to open up more and discuss her difficult relationship with her father. She identifies feeling overwhelmed and frustrated by his expectations, which leads to frequent arguments between them. She appears tired and has trouble sleeping at home because her parents constantly argue. She suggests that her parents ""are the ones who need therapy, not me."" She briefly describes the arguments that she claims her parents get into regularly. ""They are always going at it, unless thay are at church. Then they act like everything is perfect.""    When you ask about her friends and activities, she tells you she is involved in her church youth group and has an on-again/off-again boyfriend. You ask the client, ""Can you tell me more about your relationship with your boyfriend? How long have you been together?"" She says that they have been seeing each other for about a year, and she thought he was 'the one', but they had a ""big fight"" last week and have not talked since. You ask what she means by 'the one'. She looks down at the floor and starts to bite her fingernails. You see a tear fall down her cheek. She says, ""I don't know what to do."" You continue the session by providing a safe space for her to express and explore her feelings about her relationship with her boyfriend. She takes a deep breath and tells you that there is something she has not told anyone and she is scared that if she says it out loud that ""it will make it too real."" You tell her to take her time and that you are here to listen without judgment. She tells you that she missed her last menstrual period, and several ""in-home"" tests confirm that she is pregnant. She has not told her boyfriend and is scared to tell her parents because she is afraid they will disown her, so she has decided to keep the pregnancy a secret.    While you are tempted to try to talk the client into telling her parents and boyfriend about her pregnancy, you recognize that it is important to respect her autonomy and allow her to make the best decision for herself. You provide her with accurate information about the options available to her and encourage her to explore the pros and cons of each option. You share that having a support system and someone to talk to during this time can be helpful. She nods her head and tells you that she knows that her parents will find out about the baby eventually, whether she tells them or not, but she is anxious about how they will react to the news. You listen and provide empathetic reflections to help her gain insight into her feelings. You then focus on helping the client develop effective coping strategies for managing her stress and anxiety about the situation. You let the client know that she can come back to see you at any time if she feels overwhelmed or needs additional support. The session concludes with an understanding of what to expect in future sessions, including exploring possible solutions for dealing with her parents and boyfriend, as well as developing healthy coping skills for managing her emotions.  Second session A fews day after the intake session with your client, she stopped by your office and asked if she could talk to you for a few minutes. She told you that since your last session, she decided that she wanted to tell her parents and asked if you could be there when she told them. You set up an appointment to meet with the family. This is your second session with the client and she appears very nervous. When she sits down in the chair in your office, she tells you that she changed her mind about telling her parents. She keeps repeating, ""I can't do this. You tell them."" Your office phone rings, and the secretary tells you the client's parents have arrived. The client immediately bursts into tears and begs you not to let them in. You calmly explain that you are here to provide a safe space for her and will support her. You walk her through a grounding exercise and encourage her to take slow, deep breaths. After a few minutes, she relaxes and indicates she is ready to talk to her parents.    You welcome the parents into your office and introduce yourself as a mental health professional who has been working their daughter. You explain that the client has something she would like to tell them and you will be here to help facilitate their conversation. Her father says, ""We know that something is going on."" He starts talking about his daughter's academic issues and recent argumentative behavior at home. The mother adds, ""We pray daily that she will grow out of this hormonal phase. We miss our innocent little girl."" You listen and reflect on the parents' feelings as they talk about their daughter. The client is quiet and looks down, not making eye contact with anyone. After a few moments, you gently encourage the client to share her thoughts and feelings. She tells you that she has something important to tell them but does not know where to start. You suggest that she take her time and start with whatever feels most comfortable for her.    The client takes a deep breath and slowly begins to tell her story. She tells them about her pregnancy and how scared and overwhelmed she has been. At that moment, everything changed. The client's parents are no longer focused on her academic or behavioral issues. Instead, they are now focused on their daughter and her pregnancy. They are full of questions and concerns for their daughter's well-being. The mother looks shocked, and the father demands to know who the boy is that ""did this to our daughter."" The initial conversation is difficult, but you provide support as the family talks through their feelings.  Fifth session You have been seeing the client weekly during her lunch break. After their initial shock, her parents have accepted the news and are now focused on helping their daughter. The client told you that they have been discussing the options available to them, such as adoption or parenting the baby. When you met with the client last week, she opened up about how she was feeling physically and emotionally. She told you that although her parents have been supportive, she was still feeling overwhelmed and uncertain about the future. She told her boyfriend about the baby, but he has been distant and unsupportive. Her parents met with the boyfriend's parents and tried to talk about options, but his parents said they did not want to be involved. They said they ""already had too many mouths to feed"" and could not help with the baby.    Today, the client and her mother come to see you for a scheduled appointment. The mother smiles as she pulls out a picture of the baby's sonogram to show you. She says, ""We met with our minister, and the three of us have been praying for guidance as we have been trying to cope with this situation."" They decided that the best option for their daughter and the unborn baby was to find a loving family who would be willing to adopt. The mother explains, ""We want our daughter to focus on her education and not worry about the responsibilities of raising a child right now. We are hoping that by finding a good home, we can provide this baby with a bright future."" As the mother talks, you notice that the client is more relaxed and looks alert and focused. You ask her about how she feels about the decision. She admits that although she still feels overwhelmed, she is also starting to feel more at peace with the idea of adoption. You nod your head in understanding and offer some words of support. Finally, the mother states, ""What we need at this point is for you to reschedule our daughter's classes so that she can continue with schoolwork virtually and also ensure that she gets the rest she needs during her pregnancy."" You assure them that you will work with the school administration to facilitate the client's needs. You end the session with a plan for the client's continued care. You will continue to meet with her as needed and provide additional support.","The client has an older brother who is in college. The client lives at home with her parents. They are members of a Christian church and are all actively involved in their church group, and the client has a good relationship with her pastor. The client has never felt close with her father and says he has always had ""high standards and expectations"" for everyone in their family. The client says her parents ""treat her like a child."" She has not told her parents about her 16-year-old boyfriend as she knows they will disapprove. For the last year, she has been asserting her independence from her parents, which has caused conflict, friction, and discord within the family. The teacher who referred the client to you mentioned that the client has seemed distracted and anxious lately. She has not been completing homework assignments and failed a test last week. The client acknowledges these concerns and tells you she struggles to keep her grades up and has difficulty adjusting to hybrid learning. ""One day, we're in school, and the next day we're virtual. It's just exhausting. I feel like giving up."" ","As a component of employment as a school therapist, and in an effort to help your client take note of her own growth, you regularly note the client's status in your notes, as well as apprising the client as part of your therapeutic process. How would you best evaluate this client's progress in therapy?",Review the treatment goals at the beginning of each session,Evaluate the client's relationship with her parents,Administer the Pregnancy Risk Assessment Monitoring System (PRAMS),Ask the client to journal as a method of self-monitoring.,"(A): Review the treatment goals at the beginning of each session
(B): Evaluate the client's relationship with her parents
(C): Administer the Pregnancy Risk Assessment Monitoring System (PRAMS)
(D): Ask the client to journal as a method of self-monitoring.",Review the treatment goals at the beginning of each session,A,"This would provide the best evaluation of the client's progress in therapy. Therefore, the correct answer is (A)",professional practice and ethics
1553,Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual,Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.,"Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.",,The counselor should respond to Darlene?,"""You know that it's not you, it's something going on with Destiny, right?""","""Just keep at it, she will eventually change her feelings.""","""This is difficult for everyone""","""It's okay to be frustrated, let's talk about how to get through this.""","(A): ""You know that it's not you, it's something going on with Destiny, right?""
(B): ""Just keep at it, she will eventually change her feelings.""
(C): ""This is difficult for everyone""
(D): ""It's okay to be frustrated, let's talk about how to get through this.""","""It's okay to be frustrated, let's talk about how to get through this.""",D,"This response validates Ms Maze's feelings but also gives her some hope and guidance. Choice a is dismissive of what Ms Maze is feeling and may make her feel guilty about her feelings. Choice b may be giving false hope and can also be seen as dismissive. Option d, although empathizes with Ms Maze, does not offer much more than a sympathetic response. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1554,Client s Age: Client 1: age 12 Client 2: age 14 Client 3: age 14 Client 4: age 16 Client 5: age 13 Client 6: age 16 Sex: Males Gender: Males Sexuality: Varying Ethnicity: Multiracial Relationship Status: Single Counseling Setting: Juvenile Justice Facility Type of Counseling: Group Counseling Presenting Problem: Involvement with the Justice System That Includes Various Mental Health Disorders and Crimes Diagnosis: Imprisonment (Z65.1),"Mental Status Exam: All of the clients appear to maintainappropriate hygiene, and they are all oriented to person, place, time, and situation. They are all somewhat reserved with regard to going into deeper topics, but theyparticipate f","You are a licensed counselor working in a juvenile justice facility for teenage males. The group comprises six males that are required to attend as part of their incarceration with the expectation that it will shorten their sentences. The purpose of the group is to work on emotional regulation and to work together to share common experiences and identify goals that can be helpful in preventing reincarceration. During the intake session, you explained the purpose of the group and started with an ice-breakeractivity. The clients participated in the ice-breaker activity that required you to redirect them back to the activity several times because they would joke and get off task. You attempt to go a little deeper by encouraging your clients to start talking about what happened to get them incarcerated, and they appear to be taking pride in the reasons they were in juvenile detention and making fun of those with lesser sentences. You redirect the clients to another topic.","You meet with the group for the sixth session, and they are focused and appear to be more respectful toward you because it appears that you can get their attention more easily to start the session. You separate the group into dyads at the start of the session and prompt the group members to talk about feelings related to the pros and cons of engaging in school. You overhear client 4 telling client 3 that it does not matter if client 3 does well in school because he is in juvenile detention for sexual assault and therefore he cannot redeem himself. You intervene and remind client 4 of the group rules about respecting others",Which of the following statements falls under a CBT approach to treatment?,"An activating event occurs, and irrational or rational beliefs respond that affect the consequences of the event.",Identify and use client motivation in order to improve negative behaviors.,"Behavior has a purpose, and what we do is intended to overcome a sense of inferiority.",The focus is on the client’s present life rather than on past experiences and also on understanding the context of a person’s present experience and taking ownership over it instead of placing blame.,"(A): An activating event occurs, and irrational or rational beliefs respond that affect the consequences of the event.
(B): Identify and use client motivation in order to improve negative behaviors.
(C): Behavior has a purpose, and what we do is intended to overcome a sense of inferiority.
(D): The focus is on the client’s present life rather than on past experiences and also on understanding the context of a person’s present experience and taking ownership over it instead of placing blame.","An activating event occurs, and irrational or rational beliefs respond that affect the consequences of the event.",A,"The concept that activating events lead to beliefs that affect consequences is in alignment with rational emotive behavior therapy, which is a subset of CBT. Motivational interviewing focuses on identifying client motivation and using that information to make changes regarding negative behaviors. The focus of overcoming a sense of inferiority is a focus of Adlerian therapy. Taking focus on the person’s present life instead of past experience and responsibility on present experience is a gestalt therapy perspective. Therefore, the correct answer is (A)",counseling skills and interventions
1555,"Name: Deb Clinical Issues: Worry and anxiety Diagnostic Category: Other Mental Disorders and Additional Codes Provisional Diagnosis: 300.9 Unspecified Mental Disorder Age: 40 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The general appearance is of a 40-year-old female of average height and obese weight. Her hygiene is within normal limits. The client seems a bit nervous when you begin your initial interview. She says, ""It's 'wine Wednesday' right? I wish I had a glass of wine right now to steady my nerves. A couple of glasses would really help right about now."" The client is alert and oriented x4, cooperating fully with the exam. Motor activity is within normal limits. Speech is within normal limits for rate, articulation, verbosity, and coherence. There are no signs of impairment in attention, concentration, or memory. There are some signs during the exam of deficits in impulse control.","First session You are a mental health therapist in a private practice setting. The client, a 40-year-old female, arrives for the intake and discloses concerns about her physical health. She has felt that the ""doctors are missing something"" for years. She ""feels sick all the time"" but cannot describe specific symptoms other than general fatigue. The client reports feeling incredibly frustrated by the ""lack of care"" she receives. She was provided with a referral to contact you and is asking for your help in determining what steps she should take to ensure her health and safety. You notice that the client is becoming tearful as she describes her situation.    You complete a biopsychosocial assessment and explore various aspects of the client's life and history, including her family dynamics, current living situation, lifestyle habits, and any stressors in her environment. The client indicates that she has a supportive family and has been open with them about her concerns regarding her health. She is also actively working to improve her diet and exercise, but has found this process to be challenging due to lack of motivation. Although she does not have any diagnosable mental illnesses, the client reports feeling anxious and overwhelmed lately, particularly when it comes to work. The client discloses feeling overwhelmed by her new role as charge nurse and is worried that she might not be able to manage all of her responsibilities effectively. She also expresses concern over how her weight may affect her ability to be successful in her career.","The client has a strong support network. She says that she is especially close with her mother, aunt, and two older sisters. The client goes on to explain that growing up she was close with her sisters, but because they were so far apart in age, they did not always get along. She remembers feeling like the black sheep amongst her older sisters since she was the youngest and had different interests from them. Her father was often away for work, which meant that her mother was the primary caretaker. Despite this, she speaks fondly of her parents and credits them for providing a stable home life.    She indicates that her father was recently admitted to a nursing home for dementia. The client reflects on how her father's illness has been hard to process. She remembers when he began to forget familiar places and people, as well as not being able to recognize himself in the mirror. His illness has been difficult for the family to accept, but they are working on a schedule to make sure that a family member sees him every day. The client has been working in the healthcare profession for over 15 years, and she currently works as a nurse at a local hospital. She discloses that she recently received a promotion to a ""charge nurse."" She has mixed feelings about the promotion. She states that she loves nursing, but sometimes worries about how she is perceived by her colleagues due to her weight. She fears being seen as lazy and unmotivated because of her appearance, which she believes is not in line with the expectations of a charge nurse. Overall, she experiences low self-esteem and difficulty feeling confident in her professional role due to her weight. She is also concerned that her co-workers may find out that she is seeing a therapist and will think less of her. Pre-existing Conditions: The client states that she is 75 pounds overweight according to her physician. She has been preoccupied with having an illness for several years and has seen multiple medical specialists. She is concerned that she has cancer or a heart condition ""because those issues run in my family."" There is no medical evidence to support any of her concerns, and during her last annual check-up, her primary care physician made a referral for her to see you. ",Which response from the client would indicate that you should further evaluate for a substance use disorder?,"The client states, ""I do like a glass of wine with my dinner. But I know my stepdad is a recovering alcoholic, so I only have water when I am having dinner with him and my mother.""","The client states, ""I have tried to stop drinking because I know how it makes me feel. I usually end up having more than I planned. Sometimes I drive home, even though I know I should have called an Uber.""","The client states, ""I like to drink wine to relax when I get home after work. I have a subscription to a wine club and I host parties a few times a month with friends.""","The client states, ""I only drink one or two drinks when I have dinner on Friday nights. I never drink at work. I called a cab one time when I was at a happy hour with friends to make sure I got home safe.""","(A): The client states, ""I do like a glass of wine with my dinner. But I know my stepdad is a recovering alcoholic, so I only have water when I am having dinner with him and my mother.""
(B): The client states, ""I have tried to stop drinking because I know how it makes me feel. I usually end up having more than I planned. Sometimes I drive home, even though I know I should have called an Uber.""
(C): The client states, ""I like to drink wine to relax when I get home after work. I have a subscription to a wine club and I host parties a few times a month with friends.""
(D): The client states, ""I only drink one or two drinks when I have dinner on Friday nights. I never drink at work. I called a cab one time when I was at a happy hour with friends to make sure I got home safe.""","The client states, ""I have tried to stop drinking because I know how it makes me feel. I usually end up having more than I planned. Sometimes I drive home, even though I know I should have called an Uber.""",B,"With this statement, your client has used more than she planned, appears to have tolerance to her normal amount of alcohol and risks driving home after use of alcohol. All three of these are considered to be impaired control of a substance which you may consider for a co-occurring diagnosis. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1556,"Name: Shelly Clinical Issues: Emotional dysregulation Diagnostic Category: Personality Disorders Provisional Diagnosis: F60.3 Borderline Personality Disorder Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Never married Modality: Individual Therapy Location of Therapy : Telehealth  ","The client's clothes are clean but her hair and make-up seem unkempt. She wears long sleeves but you notice some scarring on her left wrist when she steeples her hands together in front of her computer screen to answer a question. The client remains alert throughout the interview, though sometimes you have to repeat questions. She seems to be distracted by something off screen at times. She fidgets with a cigarette lighter. The client appears irritable and her affect is labile. The client is coherent. Her speech is unpressured though at times slightly slow. She is oriented to person and place but not time or situation. She is unsure of what day of the week it is and she does not seem to understand the significance of being court-ordered. Her thinking is mostly linear and goal-directed but at times tangential and unfocused. She displays persecutory thought content. Insight and judgment are poor.","First session You are a mental health therapist delivering telehealth therapeutic services. Your 41-year-old Black female client is sitting on her sofa with her arms crossed and an annoyed look on her face. When you first see the client, you are immediately attracted to her as she reminds you of your first wife. She has been mandated to therapy by the Court as part of the terms of her probation. She begins by telling you about her difficulties with her acting career. She recently auditioned for a new role but was turned down because the directors wanted to ""go in a different direction."" She also mentions relationship distress and tells you she has been dating a high-profile plastic surgeon on and off for two years. She tells you, ""We just had a big fight. He said I was 'too high maintenance' and he was tied of 'all my drama' and left. Can you believe it? I was obviously upset and stopped for a drink on the way home and met a very nice gentleman who bought me a few more drinks. But I don't know they think I have a drinking problem.""    As the intake progresses, it becomes evident that the client's frustration and agitation stem from a deep feeling of abandonment. She expresses her distress over feeling overlooked and not validated in her acting career. She reveals her struggle with the expectations placed upon her as a Black woman in the entertainment industry, believing that systemic biases may be limiting her opportunities. This realization amplifies her anger and resentment, fueling her resistance to therapy and perceiving it as a means of forced compliance rather than genuine support.    As you continue to gather information about her presenting problem, you notice that the client is becoming increasingly agitated. Her tone turns angry, and it becomes clear that she resents being in therapy, especially when she says you are ""no more than hired help."" You attempt to ease tensions and build rapport by sharing with her the names of two famous actors you have counseled. However, this does not change her demeanor or attitude toward you.    You detect a recurring theme of self-sabotage that manifests in the client's relationships. She complains about her relationships with the high-profile surgeon and other men. You note the client's lack of trust in men as well as casual female acquaintances who she sometimes sees as ""competition."" Her relationships appear strained due to her unresolved issues, leading to conflicts and feelings of worthlessness. As you continue your assessment, it becomes apparent that a complex interplay of societal pressures, past traumas, and a deep-seated fear of abandonment negatively impacts her self-perception. You also learn that she worries about her precarious financial situation, which adds to her insecurity and instability. The fear of being unable to meet her basic needs is an artifact of her unstable childhood.    You suggest that during the next session, you begin to explore what might be contributing to her current feelings and behaviors beyond just focusing on her career issues, mainly her emotional dysregulation and fears of being abandoned. She says, ""I'm an actress and have auditions. How long is this going to take?"" You reinforce that the client has been court-ordered to therapy and that therapy will continue for as long as it takes to address the mandated objectives in the court order. You schedule a follow-up appointment to meet with the client again next week.  Sixth session The telehealth session starts like any other; you log in and wait for the appointment to begin. However, after several minutes of waiting, you are concerned that something is wrong with the client. When she eventually logs on, she is 15 minutes late and crying uncontrollably. When prompted about what happened, the client begins pouring out her anguish over her boyfriend's recent departure from town on business. She explains how he will not be coming home this weekend like they had planned - leaving her feeling empty and alone. Then, with tears streaming down her cheeks, she says, ""I see no reason to go on if he will only cause me grief.""    At this point, you realize your client might be at risk of self-harm or worse. You spend the remainder of the session developing a safety plan together, which involves finding alternative ways to cope with loneliness and reaching out to friends and family members who can support the client during distress.    Despite your best efforts in the session to establish a safety plan, you perceive her adherence to it as shaky. Her body language and verbal feedback clearly show that she struggles to accept the idea of seeking help from her network of friends and family. She confesses feeling like a burden to others, reflecting a deep-seated inferiority complex that seems central to her emotional distress. This, coupled with her inability to visualize the situation from a holistic perspective, implies that she might be caught in the throes of an existential crisis, unable to see beyond the immediate emotional turmoil.    Tackling this crisis from an Adlerian lens, you gently challenge her self-defeating beliefs and attempt to imbue her with a sense of belonging and community. However, her tearful responses indicate a sense of discouragement and isolation, suggesting she perceives herself as alone in her struggle. It is apparent her social interest is significantly diminished. You note that this disconnection isolates her emotionally and poses a potential risk to her overall well-being.    Despite your attempts to reassure her, she repeatedly questions her self-worth and viability without her boyfriend, mirroring feelings of inferiority and an over-reliance on external validation. In the face of such severe emotional turmoil and potential risk, you recognize that her current mental state may require a more intensive approach beyond the scope of telehealth sessions. This solidifies your intent to seek a higher level of care and immediate intervention for her, emphasizing the severity of the situation and your dedication to safeguarding her well-being.    After the client leaves the session, you call her emergency contact and discuss your concerns. You tell the client you are considering referring her for further assessment by a psychiatrist or hospitalization to ensure her safety. You request the client's emergency contact person to call you if they see any indications that the client is decompensating.","The client shared significant details about her familial history, particularly on her father's side. She conveyed that her paternal relatives have contended with various mood disorders, although she could not provide specific diagnostic categories. As a result of her father's authoritarian parenting style of strict adherence to his rules and restrictions, she has rejected any limitations from any authority figures.    Notably, she also revealed several severe distressing incidents within her family, including suicide attempts, multiple instances of divorce, and hospital admissions. According to the client, these incidents often emerged due to relational difficulties, culminating in elevated levels of emotional distress.    Furthermore, the client reported a history of hospitalization, although her recollection of the admission circumstances was somewhat nebulous. She said that she was feeling ""distraught"" during that period. You determine that exploring this episode more thoroughly in future sessions when the client feels ready and comfortable could provide valuable insights into her emotional coping mechanisms and resilience.  The client was recently arrested for driving under the influence (DUI). This was not her first encounter with law enforcement regarding such a matter, as she has been charged with three DUIs over the past five years. However, this recent incident was markedly different and considerably more severe. She lost control of her vehicle and collided with a residential building, resulting in physical injury to a child. She underwent legal proceedings after her involvement in this accident and was found guilty. As part of her sentence, she was placed on probation under the court's oversight and mandated to attend therapy. The client disclosed that her consumption of alcohol is primarily social in nature. However, she also appears to use alcohol to self-medicate in times of emotional dysregulation. Despite these circumstances and her ongoing encounters with the law, she maintains the belief that her alcohol use does not pose a significant problem.",What Adlerian technique would best address the client's self-defeating beliefs and behaviors?,Reframing and Reorientation,Socratic Questioning,Lifestyle Assessment,Role Play,"(A): Reframing and Reorientation
(B): Socratic Questioning
(C): Lifestyle Assessment
(D): Role Play",Lifestyle Assessment,C,"This Adlerian therapy technique addresses self-defeating beliefs and behaviors by uncovering hidden goals and motivations that influence the individual's behaviors and experiences. It involves understanding the client's family constellation, early recollections, and dreams. Then, the therapist and client collaboratively evaluate these patterns to identify and change maladaptive lifestyle patterns. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1557,Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1),"Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors","You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.","The husband and wife come into the session and sit as far as they can from each other on the couch, and their individual body positions are oriented away from each other. You ask for any updates in the couple’s relationship, and the husband states that they have not been talking about the affair and continue to only communicate regarding the kids. You attempt to process with the couple what the affair means for their relationship and what events led up to the affair. During the session, the husband stops talking and looks away from his wife when she talks about how she became frustrated that her husband did not spend quality time with her prior to the affair. She thinks that this led to her seeking attention from a man outside of the couple’s relationship.  You want to explore the husband’s feelings regarding the affair using the downward/vertical arrow technique","You want to explore the husband’s feelings regarding the affair using the downward/vertical arrow technique. Which of the following questions demonstrates the use of this intervention in response to the statement “She cannot even remain faithful, so she clearly does not love me”?",“What would you need to see from your wife to be reassured that she loves you?”,"“If that is the case, what does it mean for your future in this marriage?”",“How does that feeling affect your current relationship with your wife?”,“How does this affect your hope for the marriage being successful?”,"(A): “What would you need to see from your wife to be reassured that she loves you?”
(B): “If that is the case, what does it mean for your future in this marriage?”
(C): “How does that feeling affect your current relationship with your wife?”
(D): “How does this affect your hope for the marriage being successful?”","“If that is the case, what does it mean for your future in this marriage?”",B,"The downward or vertical arrow technique is a CBT intervention that assists in identifying core beliefs regarding thoughts or a situation. The counselor accepts the premise of what the person says and asks a projective question such as what it means for the future of the marriage (if the wife does not love her husband) and then further questioning based on the husband’s response in order to narrow down what the husband’s core belief is. The other questions are all helpful to ask and to explore, but the downward/vertical arrow question technique can help identify what the husband’s deeper fear is regarding his wife’s infidelity. Therefore, the correct answer is (A)",counseling skills and interventions
1558,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.  Third session As the client enters your office, you notice she has been crying. She states that she does not want to be here and feels like she has ""no say"" in what happens to her. She says that she wants to start attending a virtual school, but her mother ""forced"" her back to a physical school. The client says, ""I can't stand it anymore. My mom yells at me every day about how I'm doing something wrong. Yesterday she blew up at me about leaving my shoes and backpack in the living room. It's my house, too. She's such a control freak."" You respond to her with empathy and understanding. You ask her to tell you more about how she has felt since the argument. She explains that in addition to feeling like she has no control over her life, she feels guilty and confused because she loves her mother but does not understand why she is so controlling and demanding. You let her know that it is natural to have complicated feelings in this situation and that you are here to help her work through them.    You create a plan with her, outlining different goals and activities she can do on her own or with the support of her mother. Through further exploration, you discover that she has an interest in drawing and is used to create characters for stories. She admits she feels calm when creating these drawings but that it does not take away from her depressive symptoms. You explain that having a creative outlet and developing it further can give her a healthy outlet for her emotions. The client appears to be receptive to this idea, expressing that she is willing to try it. She leaves your office feeling hopeful and slightly less overwhelmed. You make an appointment for the following week and suggest she come with a piece of art or design to share. She nods in agreement before leaving.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",What initial treatment goal would provide the client with the most relief from her depression?,Develop effective coping strategies to manage intense feelings stemming from her relationship with her mother.,Increase the client's self-esteem and confidence,Develop healthy social connections and support network,Find positive ways to deal with her substance use.,"(A): Develop effective coping strategies to manage intense feelings stemming from her relationship with her mother.
(B): Increase the client's self-esteem and confidence
(C): Develop healthy social connections and support network
(D): Find positive ways to deal with her substance use.",Develop effective coping strategies to manage intense feelings stemming from her relationship with her mother.,A,"In this situation, the client is expressing feelings of depression as well as a lack of control in her life. Her relationship with her mother seems to be the focus of her feelings of guilt, confusion, and depression. By developing an understanding of their dynamic, she will be better equipped to process her feelings and work towards gaining a sense of control. Therefore, the correct answer is (C)",treatment planning
1559, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,Autumn is likely to be successful in her goals because?,They are built on her strengths and interests,They are all long term,It was counselor initiated,She is diminishing her support system,"(A): They are built on her strengths and interests
(B): They are all long term
(C): It was counselor initiated
(D): She is diminishing her support system",They are built on her strengths and interests,A,"Goals are also more likely to be successful and worked on when they are built upon client's strengths and interests. Goals should be a mix of long term and short-term goals so progress can be seen, and goals are attainable. Clients are also more likely to be successful when they have a support system. Goals should be client driven- initiated by the client. Therefore, the correct answer is (A)",treatment planning
1560,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.","You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy.  During this session, client 1, who is a quieter member of the group, begins to cry and client 5 tries to rescue him by immediately providing comfort","During this session, client 1, who is a quieter member of the group, begins to cry and client 5 tries to rescue him by immediately providing comfort. Which of the following demonstrates the counselor’s most therapeutic rescuing response?",Support client 1 in engaging in coping skills to manage his strong emotions.,Encourage client 5 to allow client 1 to experience his pain.,Directly engage with client 1 using the skill of immediacy.,Allow client 5 to ease client 1’s pain because this builds group cohesion and helps client 1.,"(A): Support client 1 in engaging in coping skills to manage his strong emotions.
(B): Encourage client 5 to allow client 1 to experience his pain.
(C): Directly engage with client 1 using the skill of immediacy.
(D): Allow client 5 to ease client 1’s pain because this builds group cohesion and helps client 1.",Encourage client 5 to allow client 1 to experience his pain.,B,"When dealing with rescuing in the group setting, you want to encourage members to experience the emotion that they are feeling. It would be most helpful to encourage client 5 to allow client 1 to experience his pain because he has not been participating as openly in the group process, and this demonstrates a breakthrough. If client 1 had engaged more prior to display of emotions, it may be helpful to allow client 5 to ease his pain, but currently you want client 1 to experience his feelings. Engaging with immediacy and providing coping skills can be helpful, but in this case, prioritizing the client’s experience of his feelings is essential because he is just starting to participate meaningfully. Therefore, the correct answer is (B)",counseling skills and interventions
1561,"Name: Carter Clinical Issues: Developmental processes/tasks/issues Diagnostic Category: Neurodevelopmental Disorders Provisional Diagnosis: F90.0 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Presentation; F81.2 Specific Learning Disorder with Impairment in Mathematics Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ",The client is of average build. He is dressed in a neat and appropriate manner for school. He is reluctant to engage in the conversation but does not display any hostility or aggression. The client displays a flat affect with occasional brief moments of animation which appear to be fueled by fleeting interests. His mood appears to be somewhat dysphoric as he often responds with a shrug or a one-word answer. The client’s thought process is non-linear and circumstantial. He is able to answer questions in a straightforward manner once he understands the topic being discussed. The client’s speech is of normal rate and volume for his age but it does contain some articulation errors due to his speech disorder. His memory appears intact as he can recall details from previous conversations with ease.,"First session You are a mental health therapist in a public school. The client, an 11-year-old male, and his parents arrive at your office for the intake appointment per a referral from the committee on special education. The parents express concerns with their son's ongoing lack of concentration, being easily distracted, requiring multiple prompts and redirection throughout his day, and not following multi-step processes. The mother states that he tends to ""drift off and is fidgety."" He has trouble sitting still and cannot focus on anything for more than a few minutes. According to the parents, this behavior is present at both school and at home. As you progress with the intake session, you ask the parents to describe their current goals and any treatment barriers they have experienced up to this point. They state that they would like their son to be more focused throughout the day and be better able to follow instructions. They also mention that so far their efforts in trying to help him have been unsuccessful and he is still struggling.    After gathering more insight into the client's home life, school performance, and developmental history from the parents, you turn your attention to the client. He has been looking around the room and has not been actively engaged in the conversation. When asked directly about his feelings about school, he shrugs and says, ""It's okay."" You ask him if there is anything that makes it hard for him to stay focused in class, and after a few seconds of reflection he admits that it is sometimes difficult because ""there are too many things happening at the same time."" He states that he cannot keep up with all of the activity going on around him and it is distracting. You inquire further as to what else may be contributing to his difficulty maintaining attention in school and he admits that sometimes he gets frustrated when tasks are too challenging for him. While he is answering your questions, he is looking at the small tabletop clock sitting on the corner of your desk.    Once you feel that you have an accurate understanding of the current presenting issues, you discuss next steps with the parents. You discuss meeting with the client for individual weekly sessions to help him develop effective coping skills, build self-esteem, and manage emotions associated with frustration, failure, and low self-worth. You also suggest collateral sessions with the parents to check in with them about their son's progress and discuss strategies they can use at home to help him. They agree to this arrangement and ask if there are any tools or techniques they can try between now and the next time they meet with you. You suggest they start by creating a daily routine that will provide a sense of predictability and help to reduce chaos, and having a set time for homework, meals, and bedtime. You also mention that stimulant medication is often prescribed for children with ADHD, which can help to improve focus and concentration. Lastly, you let the parents know there is some evidence that certain foods can trigger or worsen ADHD symptoms, such as sugary, processed, or artificial foods.  Fourth session Last week you met with the client's parents to discuss behavioral parent management training, educating them on how this approach can be used to decrease disruptive behavior and encourage positive behaviors. You taught them how to identify and reinforce desired behaviors and asked them to start keeping a log to record the client's behaviors during the day, what actions they took in response to his behaviors, and how he responded. Additionally, you suggested introducing rewards for meeting goals and discussed the importance of consistency. They followed up with you prior to today's appointment, stating that they believe the parent management training has been beneficial so far, as they have seen a slight decrease in disruptive behaviors and an increase in compliance.    The client arrives for his fourth individual session with you. When you ask him how he has been feeling this week, he states that he does not want to go to math class because they ""move too fast,"" and he cannot keep up. The client says he does not feel it is fair that ""the teacher yells at me every day even when I'm trying my best."" He says, ""She's mean, and I won't go back to her class ever again!"" He is displaying signs of anger and frustration. His arms and legs are tense, he is tapping his feet, and his facial expression is scrunched up in a frown. His breathing is shallow and rapid. You attempt to calm him down by guiding him in a breathing exercise that you first introduced during a previous session that involves taking slow, deep breaths. You repeat this exercise a few times with the client until he is feeling calmer.    In order to further explore the client's feelings about math class, you ask that he draw a picture of the classroom and how it makes him feel. He draws an angry teacher standing in front of a chalkboard with a lot of numbers written on it in random order. The client says that this is how his math class feels to him: overwhelming and confusing. You explain to the client that you understand how overwhelmed and confused he feels, and that it can be really hard to focus on a task when it feels too hard. You also assess the client's perceptions of the teacher, noting his feelings of mistrust and apprehension. Additionally, you assess the client's ability to self-regulate in the classroom and his overall attitude towards class participation. You talk to him about some strategies to help him feel more comfortable in class, and you also reassure him that you are going to talk to his math teacher.  Ninth session The client, his parents, and the math teacher present to your office. The teacher reports that the client seems to be achieving academic success with the addition of having a separate location for tests and extra time to complete assignments. The parents state they see improvement at home after deciding to put him on Ritalin. They are smiling as they report that their son seems to have entered a ""new phase."" His progress is evident in his increased engagement in the classroom and his improved academic performance. He is able to follow instructions and complete assignments in a timely manner, and is better able to interact with his peers. His attitude towards class participation has improved and he is able to self-regulate his emotions better. He has also expressed an increased level of self-esteem and self-efficacy in math class. Overall, the client has demonstrated improved functioning in the academic arena and the addition of Ritalin has helped him to become more alert and focused. The client appears content and keeps asking if it is time to go back to class yet.    To further ensure successful progress and to provide additional support for the client, you suggest that the teacher and parents have consistent and frequent communication about the client’s academic progress. You recommend that the teacher provide regular feedback and encouragement to the client, and you suggest that the parents continue to provide a structured and supportive environment at home. Additionally, you discuss potential academic supports that the parents may consider to help the client maintain his academic progress. Finally, you suggest that the client continue to utilize his self-regulation strategies and other coping skills to manage any anxiety or other challenging emotions related to math class."," The client is currently a fifth grader participating in the general education curriculum. He has a disability classification with his school district as learning disabled. He receives consultant teacher services via classroom support aide for English Language Arts (ELA) and Math. In addition, he attends the resource room daily for added support. The client arrives to class prepared with necessary materials and homework assignments but requires prompts throughout his day to stay on track. He is conscientious about his grades and doing well academically but is easily distracted by environmental factors surrounding him. Three years ago, the client's triennial evaluation report indicated a classification of Speech Language Disorder. To date, staff suggests that the client's speech deficits manifesting as notably impaired speech do not seem to cause concern in social situations. Additional Characteristics: The client is a very pleasant, quiet, shy, reserved boy. He tends to lack confidence in his academic abilities, which seems to cause him stress. Small glimpses of the client's good sense of humor can often be seen in small group settings. ",What behavioral technique would be most appropriate to build confidence in math for the client?,Activity scheduling,Modeling,Utilizing the Premack Principle,Positive reinforcement,"(A): Activity scheduling
(B): Modeling
(C): Utilizing the Premack Principle
(D): Positive reinforcement",Positive reinforcement,D,"Positive reinforcement is a behavioral technique that rewards desired behaviors or outcomes, thus reinforcing the likelihood that the behavior will be repeated. This can be especially useful for building confidence in math for the client by providing him with positive feedback and recognition when he demonstrates success. Therefore, the correct answer is (B)",counseling skills and interventions
1562,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,A possible diagnosis based on the information provided in this case is?,Attention Deficit Hyperactivity Disorder,Persistent Depressive Disorder (Dysthymia),Intellectual Developmental Disorder,Adjustment disorder,"(A): Attention Deficit Hyperactivity Disorder
(B): Persistent Depressive Disorder (Dysthymia)
(C): Intellectual Developmental Disorder
(D): Adjustment disorder",Intellectual Developmental Disorder,C,"Nadia is displaying low cognitive functioning which may be an indication of intellectual developmental disorder. Attention deficit hyperactivity disorder is ruled out because Nadia is not showing symptoms with inattention or hyperactivity. There is not enough information for a diagnosis for Persistent Depressive Disorder (Dysthymia) in which one criterion is that the symptoms persist for at least two years or Adjustment Disorder, where the initial criteria is an emotional response to an identifiable stressor, within three months. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1563,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.","At the start of the session, the foster parents ask the client if she would mind meeting alone with you; she agrees and asks to have access to the toy bin in your office. You and the client begin to play together, and you ask her if she talked to her birth parents. The client says “yeah, Mommy talked about coming home in a few years.” You ask how she feels about living with her mother again, and she says she does not want to be with her because her mother does not want to be with her. You try to process this with the client, and she says that she likes her house and her school and does not want to leave. You meet with the foster parents and the client at the end of the session, and they report that spending quality time with the client on a daily basis has been helpful in improving their relationship. They state that they think they had been too afraid to overwhelm her and that at times they were trying to give her space, but they realize that the intentional time together has been helpful. You empathize with the foster parents and encourage them to continue to spend quality family time with her.  This is the first session in which the client expresses any significant thoughts or feelings",This is the first session in which the client expresses any significant thoughts or feelings. Which of the following demonstrates a clinically appropriate response to the client’s expression of feelings regarding the statement “no one wants me” that keeps in mind the client’s need for comfort in sessions?,Cognitive reframing.,Continue playing and do not provide a response to her expression of emotions.,Empathy.,Use downward arrow questioning to find a deeper feeling behind this statement.,"(A): Cognitive reframing.
(B): Continue playing and do not provide a response to her expression of emotions.
(C): Empathy.
(D): Use downward arrow questioning to find a deeper feeling behind this statement.",Empathy.,C,"Empathy would support the client in feeling heard and would assist you in connecting emotionally with the client’s situation. Cognitive reframing may be developmentally difficult for the client and also might feel like you are pushing the client to move past her comfort level. It would not be helpful to continue playing and to refrain from acknowledging what the client said. Acknowledging the client’s expression of emotions would reinforce her with expressing herself and would demonstrate care toward the client. The downward arrow technique would likely seem aggressive to the client, and she might refrain from further engagement in this session. Therefore, the correct answer is (A)",counseling skills and interventions
1564,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",What short-term goal might be most appropriate to address the couple's most immediate concerns?,Determine interpersonal dynamics of the family,Work on future goal setting with the couple,Focus on the origin of Ruth's and her husband's discord,Explore Ruth's childhood to determine if she has any unresolved childhood trauma,"(A): Determine interpersonal dynamics of the family
(B): Work on future goal setting with the couple
(C): Focus on the origin of Ruth's and her husband's discord
(D): Explore Ruth's childhood to determine if she has any unresolved childhood trauma",Focus on the origin of Ruth's and her husband's discord,C,"The children appear to be the principal cause of the problems between the client and her husband. Focus on this issue would be a high-priority goal to establish. Therefore, the correct answer is (B)",counseling skills and interventions
1565, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual,"The client appears older than his stated age, with weight appropriate for height. He demonstrates positive signs of self-care in his hygiene and dress. He appears to be open and cooperative, with some hesitancy noted in his speech pattern, due to age or possible alcohol use. The client endorsed several positive responses to alcohol dependence but states he has not used alcohol prior to this session. He states he does not take any medication. He identifies his mood as ambivalent and his affect is congruent with little lability. His responses to questions demonstrate appropriate insight, judgement, memory, concentration, and orientation. He does state that he has never considered harming himself, but acknowledges passive ideas such as, “what’s the point,” he would be “better off dead,” or he should “drink a lot of wine and go to sleep.” He acknowledges these as previously unrecognized suicidal ideations and states he does not have a wish or plan to follow through or harm himself.","You are a counselor in a private practice setting.  Your client is a 68-year old male who presents with difficulties stemming from his role as a caregiver to his wife of 26 years and who now has Parkinson’s disease and requires his full attention. He tells you that he has been providing care for the past 40 years, first for his parents and now for his wife.  The client endorses feelings of sadness, anger, guilt, irritability, and being overwhelmed. He states that he has difficulty concentrating, anxious, losing things, and having unwanted thoughts like that he might be better off dead. He tells you also that he has difficulty sleeping and can’t enjoy any hobbies or social activities because of caring for his spouse. The client states that he distracted himself from his negative feelings last year by preparing for the move to their new home and then getting settled in. The client and his wife moved into an assisted living facility, but live in independent housing. The client endorsed a history of alcohol use that includes drinking more than he intends, feeling the need to cut down, being preoccupied with drinking, and using alcohol to relieve emotional pain. He states he drinks one to two bottles of wine daily and has done so for the past 6 years. He acknowledges that he has not admitted the extent of his alcohol use to others and works diligently to hide it. He reports he is unwilling to attend AA or other alcohol support groups, but “lurks” on an online support group for alcoholics. The client tells you that he attended counseling twice: 15 years ago, related to depression about his wife’s diagnosis and 10 years ago related to depression and anxiety related to caregiving. On both occasions, he was prescribed antidepressants but said he refused to fill the prescriptions because he doesn’t like to take medicine.","Family History:
The client describes his family history as containing a significant number of family members who use alcohol in great quantities and multiple, maternal, close relatives diagnosed with schizophrenia. Client states that two of his aunts have male children with schizophrenia and that one of these aunts has been diagnosed with Bipolar I disorder. The client’s father was diagnosed with Parkinson’s disease and was in an assisted living facility prior to his death while the client’s mother remained in their family home. The client was the main caregiver for both of his parents until their deaths. The client reports two siblings, one with an alcohol and drug use history who is a paraplegic following a motorcycle accident and one who identifies as “gay” with a history of alcohol dependence and hospitalizations for “nerves.”","Using the information provided, which of the following would be most effective for drawing attention to the client's ineffective use of alcohol for coping?",Reflect back to the client how he felt while not drinking and how he feels now while drinking,Remind the client that alcohol is a depressant and he has been prescribed antidepressants,Review the negative impacts of alcohol on the brain and neurotransmitters,Ask the client whether the half bottle of wine is helpful for him since it is a reduction in use,"(A): Reflect back to the client how he felt while not drinking and how he feels now while drinking
(B): Remind the client that alcohol is a depressant and he has been prescribed antidepressants
(C): Review the negative impacts of alcohol on the brain and neurotransmitters
(D): Ask the client whether the half bottle of wine is helpful for him since it is a reduction in use",Reflect back to the client how he felt while not drinking and how he feels now while drinking,A,"Reflecting back to when he felt a greater sense of personal control over himself, was able to employ techniques like thought-stopping, and was more clear and less angry during the time he did not drink and comparing that with his current reduced use of alcohol and its effects (flattened affect, negative thoughts about the future) will be most effective in helping the resistant client acknowledge the differences when he uses alcohol for coping. Reminding him that alcohol is a depressant and he has been prescribed antidepressants may make him defensive as he views alcohol use as a normal coping method and the prescription as medication, which, he has stated, he doesn't like. Asking the client about the efficacy of his reduced intake does not draw attention to the negative effects of his alcohol use as a coping strategy since he is demonstrating a depressed mood and negative thoughts. Reviewing the physiological effects of alcohol may not be viewed as personally relevant to the client. Therefore, the correct answer is (D)",counseling skills and interventions
1566,"Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)","Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af","You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.","You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing",Which of the following is a helpful goal following this session to support the client in writing and playing the guitar more often?,Recommend that the client choose two nights this week to play guitar for at least 30 minutes.,Refocus the goals back to management of ADHD because this is why the client came to counseling.,Identify goals that are easily achievable within the week.,Identify goals that are slightly difficult in order to push the client.,"(A): Recommend that the client choose two nights this week to play guitar for at least 30 minutes.
(B): Refocus the goals back to management of ADHD because this is why the client came to counseling.
(C): Identify goals that are easily achievable within the week.
(D): Identify goals that are slightly difficult in order to push the client.",Identify goals that are easily achievable within the week.,C,"To build momentum with new goals, it can be helpful to identify goals that are easily achievable to increase the client’s confidence in goal attainment. Considering that playing guitar and writing are new goals, you would not focus on identifying slightly more difficult goals because these are new skills and rigor should start lower and slowly build. Recommending a specific interval of attempts toward the goal does not consider what the client thinks is achievable and likely would not build confidence and momentum toward a goal. Although the client came to counseling for ADHD, his symptoms of concern are likely linked to his desire to play guitar more and to start writing again. For this reason, refocusing back more explicitly and specifically on his initial ADHD difficulties at work would not be appropriate. Therefore, the correct answer is (A)",treatment planning
1567,Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3),"Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua","You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.",rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives,"All of the following are important factors when considering the setting of this counseling session, EXCEPT:",Ensuring that the building’s janitorial staff knows not to interrupt sessions when the door to your personal office is closed,Minimizing outside distractions such as telephones,providing different seating options within the office and allowing the client(s) to choose their own seat,Sitting directly in front of the clients,"(A): Ensuring that the building’s janitorial staff knows not to interrupt sessions when the door to your personal office is closed
(B): Minimizing outside distractions such as telephones
(C): providing different seating options within the office and allowing the client(s) to choose their own seat
(D): Sitting directly in front of the clients",Sitting directly in front of the clients,D,"Because this is a group therapy session, it will not be possible to sit directly in front of each client, although that is usually a helpful way of making clients feel comfortable. You must ensure that everyone who could potentially enter your office, from clients to support staff, knows that if your door is closed, they should not enter. Allowing clients to choose the location of their seat and the type of seat provides them with a sense of comfort and control during the counseling session, while you as the counselor can still maintain some control by selecting the types of seating arrangements available. You should also make the effort to minimize distractions in the counseling setting by controlling interruptions by phones (requesting that all cell phones be placed on silent mode and considering removing or silencing any office telephones). Therefore, the correct answer is (B)",counseling skills and interventions
1568,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.","Using a solution-focused approach, what would you say to foster a sense of hopefulness and empower the client?","""What has been helpful for you in the past when facing a difficult situation?""","""Even though your current situation may feel overwhelming, I believe in you and your strength to cope with all of the challenges that come your way.""","""On a scale from zero to ten, with zero being no hope and ten being complete confidence in your ability to overcome this challenge, how confident do you feel?""","""It sounds like this has been an incredibly difficult time for you, and it's understandable why you feel so overwhelmed and frustrated.""","(A): ""What has been helpful for you in the past when facing a difficult situation?""
(B): ""Even though your current situation may feel overwhelming, I believe in you and your strength to cope with all of the challenges that come your way.""
(C): ""On a scale from zero to ten, with zero being no hope and ten being complete confidence in your ability to overcome this challenge, how confident do you feel?""
(D): ""It sounds like this has been an incredibly difficult time for you, and it's understandable why you feel so overwhelmed and frustrated.""","""What has been helpful for you in the past when facing a difficult situation?""",A,"Coping questions like this can encourage the client to reflect on their own strengths, skills and resources. By focusing on what has been helpful in the past, it can help foster a sense of hopefulness and empower the client to take ownership over their lives and regain a sense of control. Therefore, the correct answer is (A)",counseling skills and interventions
1569, Initial Intake: Age: 65 Gender: Male Sexual Orientation: Heterosexual Race/Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Inpatient detox facility Type of Counseling: Individual,"William presents as irritable and quite anxious with congruent strained affect. William is casually dressed and with good hygiene. William’s rate and tone of speech are normal with motor movements appearing tense and agitated as evidenced by shifting of position and frequent crossing of arms. William avoids eye contact the entire visit. William denies any depression however his chart indicates that he reported having a history of depression with suicidal thoughts. He says, “Only God can judge me, and I know where I’m goin’ so I don’t have any worries about whether I go now or later.” You then notice in his intake he identified as Christian with active faith-based beliefs. He repeats several times that he plans to leave as soon as he meets with the doctor later today and receives “medical clearance” saying “I can’t stay the whole three weeks it’s just not possible, not going to happen.”","Diagnosis: Alcohol dependence (F10.20), Major depressive disorder, single episode, unspecified (F32.9)
 

You are a mental health counseling intern providing brief crisis intervention and counseling support for patients admitted to a substance use rehabilitation facility at the detox-level of care. Your clinical director schedules William to meet with you on his first Monday morning after being admitted the Friday night before for alcohol dependency. William tells you he had a “medical issue” last week that “freaked his wife out” and she said she would “kick him out of the house” if he did not come to your program. He notes that he has been drinking their entire marriage and does not understand why it is suddenly such an issue for her, but that he would have “nowhere to go” otherwise so he conceded to coming in. You learn from the overnight staff nurse that William had several bouts of delirium and vomiting with tremors over the weekend, and one instance of a seizure which required emergency interventions to have him stabilized. You ask what “medical issue” he was referring to and she tells you that his chart indicates he had a heart attack. William interjects, saying “She thought I had a stroke, but it wasn’t that big a deal I just had some bad indigestion.” He is now on a benzodiazepine regimen to help regulate his symptoms and stabilize his mood throughout his detox process until he can report a reduction in anxiety and be seen by the weekday psychiatrist.","Work History:
William has worked has a construction company manager for almost 30 years until just before reaching retirement he was let go due to COVID-related company downsizing. He attempted to file a legal case against his company for wrongful actions that would in William’s words “rob him of his hard-earned retirement” however they cited his daily alcohol use on the job as an additional reason he was fired. He was informed due to his longevity with the company that they would offer him a generous severance package and not pursue administrative actions against him for breaking company policies. He adds that he was not planning on stopping working when retiring from his company, saying “I’m too young to just stop. I was going to start my own business.” He also retorts that no one calls him William but his wife and insists that you call him “Bob.”",Which of the following should you administer in an intervention for helping Bob realize his severity of use?,"Caring confrontation reviewing his wife's complaints, medical condition, and work status",It is not necessary at this time for Bob to reflect on the severity of his use,Severity of Alcohol Dependence Questionnaire (SADQ-C),The Alcohol Use Disorders Identification Test (AUDIT),"(A): Caring confrontation reviewing his wife's complaints, medical condition, and work status
(B): It is not necessary at this time for Bob to reflect on the severity of his use
(C): Severity of Alcohol Dependence Questionnaire (SADQ-C)
(D): The Alcohol Use Disorders Identification Test (AUDIT)",Severity of Alcohol Dependence Questionnaire (SADQ-C),C,"It is quite necessary in a detox facility for counseling to support a client's recognition of the severity of their use but doing so in a confrontational manner is not necessarily the most effective way to gain a client's agreement on the subject and especially not when the age, experience and presentation of the person is resistant to the rehabilitation process. The AUDIT is a 10-item screening tool created by the World Health Organization to assess for alcoholism. It is both clinician-administered and has a self-report component. The results of this test can support your client in developing insight into their alcohol consumption and compare it to what is considered disordered behavior. Bob has already admitted to drinking his entire life and is aware of his reason for admission into rehabilitation, however, presents as in denial over the severity of his use. The SADQ-C is specifically tailored to measure the severity of dependence once alcohol dependence has already been identified. This tool is the best intervention of the given choices because it will help Bob see his condition for himself based on his own answers. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1570,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","The client no-showed for her last session without calling to cancel. She arrives today, appearing disheveled and irritable. The client states that she has not been sleeping well. She explains that she was talking to someone on an online dating site and had planned a face-to-face meeting this past weekend. She says she waited at the bar for more than an hour and finally realized that her date had stood her up. She explained that she was in so much shame after the incident that she engaged in self-harm. The client reveals superficial razor cuts on her thigh and upper arm. She says she feels like she is a failure and undeserving of love",How might a gestalt therapist respond to the client’s resistance to change?,Engage the client in forceful disputing.,Roll with the client’s resistance.,Analyze the client’s life scripts.,Identify the client’s boundary disturbances.,"(A): Engage the client in forceful disputing.
(B): Roll with the client’s resistance.
(C): Analyze the client’s life scripts.
(D): Identify the client’s boundary disturbances.",Identify the client’s boundary disturbances.,D,"Gestalt therapists would identify the client’s boundary disturbances as a way of responding to the client’s resistance to change. Gestalt therapists use the term boundary disturbance to describe various forms of resistance. Boundary disturbances include projection, introjection, retroflection, confluence, and deflection. Gestalt therapists embrace the idea that individuals are the sum total of their mind, body, and soul. Integration of all components is the overall goal of gestalt therapy. Forceful disputing is a rational emotive behavior therapy (REBT) technique. Transactional analysis analyzes a client’s life scripts, which are unconscious justifications for erroneous beliefs originating in childhood. Roll with resistance or rolling with resistance is used in motivational interviewing as a nonconfrontational means to help the client, rather than the counselor, argue for change. Therefore, the correct answer is (A)",counseling skills and interventions
1571, Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual,"Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.
","Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.",,The first thing to assess for at this point is?,Any medical conditions,Mental status exam,Family history of mental illness,Any recent substances used,"(A): Any medical conditions
(B): Mental status exam
(C): Family history of mental illness
(D): Any recent substances used",Any medical conditions,A,"Due to the physical symptoms of fever and rapid heartbeat, it is important to stabilize her health and look at any medical conditions Sandy may have. Other items to assess for after the initial assessment are: any recent substances used as they can trigger symptoms that Sandy is displaying; family history of mental illness can give information on possible genetic loading of psychiatric disorders. Finally, a mental status exam can help to assess current mental capacity after the initial assessment. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1572,Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23),"Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa","You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.","   tion. Family History: The client has been married for 25 years. He has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together.  The client states, “I’m unemployable because I’m old and have nothing to offer. They were right to let me go and not move me to another plant","The client states, “I’m unemployable because I’m old and have nothing to offer. They were right to let me go and not move me to another plant.” What kind of cognitive distortion does this represent?",Mental filtering,Catastrophizing,Fortune-telling,Labeling,"(A): Mental filtering
(B): Catastrophizing
(C): Fortune-telling
(D): Labeling",Labeling,D,"This is an example of labeling because the client is making a generalized judgment about himself based on one event. The client is taking one bad experience and labeling himself as unemployable, which may not be an accurate assessment. The client is not catastrophizing because he is not exaggerating the impacts of the situation; rather, he is making a judgment about himself based on the situation. The client is not fortune-telling, and although identifying himself as unemployable may be a projective statement, it falls more under labeling because he is identifying himself based on one experience. Mental filtering occurs when an individual filters out the good and only focuses on the bad, and although this may also be happening, the statement does not present explicitly as mental filtering. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1573,"Name: Jill Clinical Issues: Depression and recent death of a close friend Diagnostic Category: Depressive Disorders;Substance Use Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder, with Anxious Distress, and F10.99 Unspecified Alcohol-Related Disorder Age: 26 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Eastern European Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 26-year-old female who appears slightly disheveled and unkempt with bags under her eyes, suggesting recent lack of sleep. Her affect is flat and her behavior is withdrawn. She speaks in a quiet monotone and is tearful at times. Her speech is coherent, though her thoughts are sometimes diffuse. She exhibits difficulty in focusing on topics and has some difficulty in supplying relevant details. The client reports that she has difficulty concentrating and recalling information, as well as making decisions. No perceptual distortions are reported. The client has limited insight into the cause of her distress, but appears to understand that her drinking is a problem. Her judgment appears impaired due to her drinking, as evidenced by her blackout episodes. The client expresses feeling overwhelmed and states that if counseling does not help, she is not sure she wants to go on living. She has also had thoughts of death and dying.","First session You practice as a mental health therapist at an agency. A 26-year-old female presents for therapy following a recent incident involving the death of her close friend. The client elaborates on her friend's death by saying, ""He was beaten to death because he was transgender."" The attack occurred a week ago, but the client states she has felt depressed for as long as she can remember. She says, ""He was the only person who could actually put up with me. Now that he's gone, I feel like I have no one."" She tells you that during the past few years, she has been drinking as a way to cope with her feelings. She states that she is usually able to control her drinking, but admits that lately it has ""gotten out of hand."" After her friend was killed, she went to a party and blacked out after drinking. She states that she cannot seem to find joy in anything and cannot stop thinking about her friend. You continue your assessment by exploring the client's history and current symptoms. After gathering more information, you determine that the client is experiencing a major depressive episode which has been compounded by her friend's death.    When asked what she is hoping to gain from therapy, she responds, ""I just want to stop feeling so awful all the time."" You validate her feelings and applaud her willingness to seek help. You share information about the counseling process and treatment options, including potential risks and benefits. You tell her that it is important to be open and honest during therapy and that she may need to talk about some difficult topics to make progress. After explaining the importance of developing a trusting relationship, you encourage her to ask questions and ask if she has any concerns. She asks if she can contact you outside of your counseling sessions. You review your agency's policies with her, including information about therapist availability.","The client grew up in a very chaotic household with five siblings. The client is a first-generation Eastern European whose family immigrated to the United States before her birth. Her parents never adapted to the culture. Her father committed suicide when she was in high school. She says, ""It was like my dad leaving us just made everything worse."" The client says she has no patience with her siblings when they call and has little desire to keep in touch with them. After completing her associate's degree, the client immediately started her job as a paralegal. She is a paralegal at a law firm where she has worked for two years. She describes her work as ""okay, but not something I'm passionate about."" She says that she has been feeling increasingly overwhelmed and stressed out. At work, she becomes easily annoyed, has trouble concentrating, and feels tense. She has difficulty getting along with her colleagues and tries to avoid them when she can. ",Which of the following best reflects the diagnostic criteria for the client's diagnosis?,"Sleep disturbance, loss of interest, guilt","Depressed mood for most of the day, more days than not",Severe recurrent temper outbursts,Obsessions and compulsions,"(A): Sleep disturbance, loss of interest, guilt
(B): Depressed mood for most of the day, more days than not
(C): Severe recurrent temper outbursts
(D): Obsessions and compulsions","Depressed mood for most of the day, more days than not",B,"Depressed mood for most of the day, more days than not, is a symptom. Persistent Depressive Disorder lasts greater than two years and can present with poor appetite or overeating and insomnia or hypersomnia. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1574,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",How would you first intervene with this client?,Perform suicide assessment,Refer the client for medication,Administer the CAT (Children's Apperception Test),Arrange for in-patient treatment for depression,"(A): Perform suicide assessment
(B): Refer the client for medication
(C): Administer the CAT (Children's Apperception Test)
(D): Arrange for in-patient treatment for depression",Perform suicide assessment,A,"Having just come from the hospital but showing few signs of progress, the client could be at continued risk of harm. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1575,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Which part of the treatment planning process should you collaborate with Shawn as opposed to completing on your own?,"Every goal, objective and intervention should be screened and approved by Shawn",Only the long-term goals; it is your job to decide all the objectives and interventions,Creation of behavioral goals and discussion of action steps,"It's great to involve Shawn if he wants, but it's not necessary for you to include him at all","(A): Every goal, objective and intervention should be screened and approved by Shawn
(B): Only the long-term goals; it is your job to decide all the objectives and interventions
(C): Creation of behavioral goals and discussion of action steps
(D): It's great to involve Shawn if he wants, but it's not necessary for you to include him at all",Creation of behavioral goals and discussion of action steps,C,"This is the best practice answer because Shawn will be most likely to be motivated to attain goals if he is involved in developing them, and more likely to follow through with your plans if he knows what will be expected of his actions. It is not necessary for Shawn to review every detail of interventions for the treatment plan to be effective, unless he wants to be informed; however, if you create all the objectives and interventions without him, he may not feel as involved in the process and could default to feeling like he is being told what to do as his parents have done. It is necessary to include your clients in some portion of your treatment planning process, even if their choices result in you informally reviewing some goals and action steps and obtaining his agreement to follow them. Therefore, the correct answer is (B)",treatment planning
1576, Initial Intake: Age: 8  Gender: Male  Sexual Orientation: N/A Ethnicity: Caucasian  Relationship Status: N/A  Counseling Setting: Through agency inside school and via telehealth  Type of Counseling: Individual,"Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home.","Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2)
 

Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors.","Family History:
Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school.",Which instrument is the most appropriate for further screening Avery's diagnosed symptoms?,Conners Parent and Teacher Rating Scale (CPTRS),Vineland Adaptive Behavior Scales (VABS),Screen for Childhood Anxiety Related Emotional Disorders (SCARED),Child Behavior Assessment Instrument (CBAI),"(A): Conners Parent and Teacher Rating Scale (CPTRS)
(B): Vineland Adaptive Behavior Scales (VABS)
(C): Screen for Childhood Anxiety Related Emotional Disorders (SCARED)
(D): Child Behavior Assessment Instrument (CBAI)",Conners Parent and Teacher Rating Scale (CPTRS),A,"The CPTRS measures the presence and severity of behaviors related to ADHD exploring inattention, hyperactivity, learning problems and social skills, filled out by parents and teachers. It also helps point out where further testing may be needed or monitor how well medication is working for children already diagnosed with ADHD, as is the case with Avery. The VABS measures how a child's daily living skills compare to those of other kids his age, helpful for screening diagnoses of autism spectrum disorder, Asperger's syndrome, and developmental delays. This instrument would be more helpful for use with Avery's brother in this case, but no evidence suggests Avery is having developmental issues. The SCARED is a child and parent self-report instrument used to screen childhood anxiety disorders ages 8-18 years old and could be used to identify anxiety issues, however the question asks about Avery's already diagnosed conditions. The CBAI helps identify young children at risk of behavioral problems in community settings, which is not the most appropriate choice for this case study. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1577,"Name: Robin Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.20 Alcohol Use Disorder, Moderate Age: 28 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Not Married Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is well-groomed. She reports her mood as depressed due to her relationship breakup and feeling that she is unable to talk to family members about her life. Her affect is characterized by anxiousness and difficulties in answering questions. Her overall speech is slow and soft, with little eye contact as she speaks. The client's insight is fair. She recognizes that alcohol has been a major factor in her life, and she is aware of the negative effects it has had on her relationships and work performance. She states that she is at a point where she feels like she needs help to make changes in her life. Though she presents as sober at the time of the interview, her judgment appears impaired due to her continued heavy drinking despite the negative consequences.","First session You are a clinical mental health counselor at a community mental health center. You see many clients who struggle with substance use issues. A 28-year-old female presents for outpatient services today. She is an attorney who works long hours, specializing in family law. She and her boyfriend of ten years recently ended their relationship due to the client's excessive drinking. She says, ""I can't live with the pain of our separation much longer, and I don't know how to cope with it."" She tells you she is devastated and does not know what to do next. The breakup has triggered her to drink even more lately, and she is currently facing a DUI charge. Her attorney recommended that she seek an assessment for substance use disorder treatment in an effort to avoid a criminal conviction.    You administer an assessment to determine the severity of the client's alcohol use and further evaluate her statement about being unable to live with the pain of her breakup. She reports an urge to drink daily, and acknowledges she has lost control of her drinking on many occasions. She also states that she has increased her alcohol intake because ""it helps numb the pain and I can forget about everything for a little while."" The client discusses her father's death when she was 17 and how this affected her life. She states that his death hit her hard, and only made matters worse because of her family's lack of emotional support in the wake of his passing. Even though she was still in High School, she began drinking heavily to cope with the grief, a pattern which has been present ever since. She drinks alone, typically at home or in bars after work. When asked about the effects of alcohol on other areas of her life like her finances, she says, ""One of the perks of my job is that I get paid pretty well, so at least I'm not in debt like my brother."" She pauses for a moment, then says, ""Well, not yet anyway. I've got some court costs coming up.""    You explain to the client that substance use disorder is treatable and that it is important to take an honest look at her relationship with alcohol, in order to make positive changes to her lifestyle. You discuss the effects of excessive drinking on physical health, mental health, and personal relationships. You review the various options for treatment available and encourage her to be proactive in seeking help. The client acknowledges your advice but expresses hesitancy about beginning treatment due to fear of the stigma associated with addiction. You empathize with her feelings while emphasizing the importance of taking action now rather than waiting until her issues become worse. You present evidence-based treatment modalities that have been shown effective in managing substance use disorders. You let the client know you are here for her to help develop healthy coping skills, explore the underlying causes of her drinking, and create a plan to avoid future drinking and driving offenses. Then, you both discuss a treatment plan with the goal of helping the client resolve her current crisis and developing a strategy to maintain sobriety and avoid future legal issues. She provides you with releases to speak with her mother and her attorney. You set up a follow-up appointment one week from now.  Second session The client had an appointment to meet with you two weeks ago, but she called to reschedule twice, citing a busy work schedule. The client shows up 10 minutes late for her second counseling session today, looking slightly disheveled. She starts off by telling you that ""this morning has been a mess."" She overslept and missed two appointments with clients. She contacted her secretary to reschedule the appointments, but she is still feeling stressed and overwhelmed. She tells you she was up late last night talking to her ex-boyfriend. You ask what motivated her to talk with her ex-boyfriend and she tells you, ""It felt like the only way I could make sense of what had happened between us."" She is not forthcoming with any additional details about their conversation. You then ask if anything else has been on her mind lately. She reports that her mother told her that she should be focusing more on finding someone new to date instead of worrying about getting back together with her ex.    The client becomes distant and quiet during the session. She makes minimal eye contact and her responses are brief, often giving a one-word response to your questions. You can tell that something has shifted in her since last week's session as she presented to the intake as more talkative and open. You decide to address her change in behavior directly, saying ""I notice that you seem more closed off today compared to the last session we had. Is there something specific that is causing you to feel this way?"" The client responds, ""I don't know, I'm just so tired of it all."" When you ask her to elaborate, she closes her eyes and takes a deep breath before responding. She says that she feels emotionally drained. She is overwhelmed with the weight of all that has been happening and feels like she is a ""total failure"" for allowing things with her ex-boyfriend to come this far. She describes feelings of guilt for ""treating him like dirt"" the entire time they were together and sad that ""I messed things up so badly."" She also shares that she is feeling ashamed about being charged with a DUI. She says, ""I'm an attorney, not a criminal. People like me don't get DUIs, yet here I am. What's wrong with me?"" The client expresses both a desire and a fear of change. She often talks about wanting to make changes in her life, but is also uncertain about how to go about it, feeling overwhelmed by the idea of taking action. Her tone reveals a sense of hopelessness as she talks about where her life is headed. You empathize with her, acknowledging the difficulty of changing deeply-rooted patterns. You provide her with psychoeducation about the nature of addictions and the biological and environmental factors that can contribute to substance abuse.","The client has a younger brother. Her father died when she was 17, and her mother never remarried. The client's family has a history of problematic alcohol use, with family members utilizing alcohol to mask underlying emotions and distress. This pattern can be seen in her mother and brother, as well as extended family. Her mother is particularly reliant on alcohol and uses it as a way to cope with negative feelings. This has been an ongoing issue for many years. The client was raised in an environment where emotions were not discussed openly. The client expresses she learned early that it was best not to bring attention to any discomfort or upset she may have felt because it would only be met with more criticism and judgments. She states, ""My mother and brother 'don't believe in depression.' When I told my mom that my boyfriend broke up with me and I was feeling depressed, she told me to that I needed to 'get over it and move on.' It's like I'm talking to a wall when I try to tell her anything about how I'm feeling."" Although the client does not feel that her family understands her problems, she does communicate with her mother weekly.  The client has been using alcohol as a way to cope with stress for many years. She expresses she has ""been through a lot"" in her life and that going to bars after work is an escape. Alcohol has maintained a significant presence during various phases of her life.","Using a Motivational Interviewing approach, you have determined that the client would be best served by helping her to become aware of ways to help herself through homework. of the following, which would be most appropriate for this client to assign as homework?",Keep a daily journal recording thoughts and feelings that precipitate drinking,Make a list of ways that alcohol has negatively affected her life and ways that sobriety might positively affect her life,Make a list of positive affirmations to use as alternatives to negative self-talk,Use a list of cognitive errors and make note of which ones the client uses most frequently,"(A): Keep a daily journal recording thoughts and feelings that precipitate drinking
(B): Make a list of ways that alcohol has negatively affected her life and ways that sobriety might positively affect her life
(C): Make a list of positive affirmations to use as alternatives to negative self-talk
(D): Use a list of cognitive errors and make note of which ones the client uses most frequently",Make a list of ways that alcohol has negatively affected her life and ways that sobriety might positively affect her life,B,"This homework assignment encourages the client to reflect on the consequences of her drinking, while also envisioning the potential benefits of sobriety. By considering both outcomes, she will be better equipped to make an informed decision regarding her relationship with alcohol. Furthermore, this type of reflection is consistent with motivational interviewing principles which focus on helping clients explore their ambivalence regarding change. By engaging in this type of reflection, the client can develop a more informed understanding of her own motivations for change. This will help her gain clarity about what steps to take next and build motivation for making changes in her life. Therefore, the correct answer is (A)",treatment planning
1578,Initial Intake: Age: 53 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Agency Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.  He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.","You are a counselor in a community agency setting.  Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.","Family History:
The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.","Based on the information provided, which of the following is most appropriate to discuss with the client during this session?",The client's rights and responsibilities during counseling,The importance of maintaining documentation for the client's care,The requirement for release of information to third party providers,The limits of confidentiality related to subpoenas by the court,"(A): The client's rights and responsibilities during counseling
(B): The importance of maintaining documentation for the client's care
(C): The requirement for release of information to third party providers
(D): The limits of confidentiality related to subpoenas by the court",The client's rights and responsibilities during counseling,A,"Discussing the client's rights and responsibilities will be most important during this first session. The client has experienced relationships where he makes obligations and does not keep them, tunes out those whom he may feel conflict with, and avoids self-reflection of emotions and behaviors. Discussing the need for regularly attending counseling sessions and engagement in those sessions will best help the client receive the most from his work in counseling. Explaining the limits of confidentiality are always included in counseling, but specific emphasis in discussion of the limits related to subpoenas is not most important as the client demonstrates no evidence of legal issues at home or work. There are no requirements for releases of information from other providers, though these can be helpful should the client wish to give these permissions. Since there is no requirement, it is not an area that is most important to cover through discussion with this client. Maintenance of documentation during counseling is often covered in intake documents such as Informed Consent and is not most important to cover through discussion. Therefore, the correct answer is (C)",professional practice and ethics
1579,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","When working with Rick, which circumstance would necessitate that you break confidentiality?",If he discloses rage concerning his mother and sister.,If he tells you that his ex-girlfriend is pregnant,If you see scars and cuts up and down the client's arms,Your discovery that his mother flicks his forehead when he does something she disapproves of,"(A): If he discloses rage concerning his mother and sister.
(B): If he tells you that his ex-girlfriend is pregnant
(C): If you see scars and cuts up and down the client's arms
(D): Your discovery that his mother flicks his forehead when he does something she disapproves of",If you see scars and cuts up and down the client's arms,C,"If the client poses a safety threat to himself or others, confidentiality must be broken. The exceptions to confidentiality are: when the client is a threat to self and others, abuse or neglect of a child, abuse or neglect of the elderly, abuse or neglect of a person with a disability, if mandated by the courts, or if you need to discuss the situation with a supervisor or clinical team. Therefore, the correct answer is (A)",professional practice and ethics
1580,"Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate",Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam,"You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.","   ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation",Which screening instrument would you choose to determine the severity of the client’s depression?,Achenbach System of Empirically Based Assessment (ASEBA),Patient Health Questionnaire (PHQ-9),Bender-Gestalt Test,Brief Psychiatric Rating Scale (BPRS),"(A): Achenbach System of Empirically Based Assessment (ASEBA)
(B): Patient Health Questionnaire (PHQ-9)
(C): Bender-Gestalt Test
(D): Brief Psychiatric Rating Scale (BPRS)",Patient Health Questionnaire (PHQ-9),B,"The PHQ-9 is a 9-item self-report screening instrument used to assess the severity of depression. The test takes approximately 5 minutes to administer. It is one method used to help practitioners appropriately match interventions for the following levels of depression: none/minimum, mild, moderate, moderately severe, and severe. The Bender-Gestalt is used to help determine an individual’s level of neuropsychological impairment. The Brief Psychiatric Rating Scale (BPRS) consists of 24 items used to assess symptoms of psychosis in those with psychotic disorders, including schizophrenia. The Achenbach System of Empirically Based Assessment (ASEBA) assesses adaptive functioning, as well as behavioral, emotional, and social competencies. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1581,"Name: Jackson Clinical Issues: Behavioral problems Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.8 Disruptive Mood Dysregulation Disorder Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ",Appearance: The client is dressed in clothes associated with anime. He is well groomed and appears to be a few years younger than his chronological age. Orientation: The client is oriented X3. Mood: The client's mood is dysphoric. Affect: The client's affect is restricted. Speech: The client's speech is soft and hesitant. Thought Process: The client's thought process is slow and labored. Thought Content: The client's thought content is pessimistic and focused on negative themes. Perception: The client's perception is intact. Insight: The client's insight is poor.,"First session You are a therapist in private practice specializing in working with children. The client is an 11-year-old male. His mother brought him to therapy because of the ""latest incident at school,"" wherein he had an angry outburst and threatened to come to school with a gun and shoot everyone, including himself. The mother states that the police were notified, and the client was suspended from school for a week. The client was unwilling to discuss his emotions or the incident at school. He became agitated and defensive whenever the topic was brought up and now will not talk to you. He seemed to be in a state of denial, minimizing the impact of the incident at school. You observe a bald spot on the top of the client's head, indicating that the client has been pulling his hair out. The client was evasive when asked about the bald spot on his head and became increasingly anxious. He could not articulate why he was pulling his hair out and seemed embarrassed, avoiding the topic. He has difficulty identifying and expressing emotions outside of anger. His mother reports that he lashes out at home with family and classmates at school, aggressively arguing and making threats. He had difficulty engaging in self-reflection and could not make meaningful connections between his behavior and the consequences that may follow.  His mother is extremely frustrated and worried that this school will also expel him. She is upset with the lack of progress his previous therapist made with her son and is now considering residential treatment options. The mother has been receiving conflicting diagnoses from previous therapists and is seeking a definitive diagnosis from you. Halfway through the session, you ask to speak with the client by himself for a few minutes. The mother exits the room, leaving you alone with the client. You take notice of his anime shirt and ask him more about anime. He quickly starts talking and making eye contact.  Second session After your initial session with the client, the school performed a risk assessment and concluded that the client could return to school. You have requested to meet with the client and his mother every week. Today is your second session, during which time you spend the first thirty minutes talking with the mother and the second half talking with the client. During your conversation with his mother, she shared that she believes her son might have Autism. She says she has been debating whether to tell you this because she is ""concerned about the stigma associated with Autism"" and the possibility of her son being treated differently. She has been anxious about her son's issues and wants to have him tested to get him the ""right help.""  Jackson's mother appeared very anxious during the session. She shared concerns that he may have Autism but has hesitated to disclose this for fear of stigma. She has been struggling with getting him properly assessed and finding adequate support. Her anxiety around Jackson's issues was evident in her tense body language and rapid speech. She is worried about her son's well-being and future. However, the stigma she associates with an Autism diagnosis seems to be preventing her from getting Jackson the help he likely needs.  You recognize that Jackson's mother feels overwhelmed and alone trying to understand her son's difficulties. Her eagerness to have him tested indicates she believes an Autism diagnosis would provide answers and open up access to services. Yet she is torn about the potential labeling and discrimination Jackson could face. Her desire to protect her son's privacy competes with her need to get him help. This is causing Jackson's mother significant inner turmoil. She presented today as a caring parent under great strain.  In the second part of the session with the client, you find him disinterested and bored until you start talking about gaming. Then, he appears to perk up and becomes talkative. When you ask why he thinks he is here, he tells you about an incident at school. A student in another room texted his entire class, saying he was ""short."" This angered him, and he left the classroom and started a fistfight with that student, resulting in disciplinary action.  Jackson told this story with clenched fists, still visibly upset. He explained that the school was unfair and justified his violent reaction by stating he has Autism. This suggests Jackson feels his neurodiversity excuses poor behavior. Rather than take responsibility, he blamed external factors for the altercation. Jackson's body language and tone indicated he remained defensive and saw himself as the wronged party.  Jackson believed his Autism diagnosis makes aggression an inevitable response in certain situations. By citing Autism as the cause of his actions, he abdicated any sense of personal responsibility. Without intervention, he may continue acting out when provoked and making excuses based on his diagnosis. There is a risk that Jackson will not develop appropriate coping skills or learn to navigate his interpersonal conflicts. He appears fixed in the view that others are at fault, while his neurodiversity pardons any misdeeds.  Fifth session As today's session starts, the client's mother says she is at her ""wit's end"" because her son is getting worse. As a result, the school may not let the client come back next year. In addition, there has been a major incident at home. The mother, stepfather, and younger sister went for a drive without the client. When they returned, the client was upset and claimed that no one in the family loved him; he wanted to live with his grandmother. The mother responded that his behavior was unacceptable and that he would not live with his grandmother.  Jackson went into his bedroom and began throwing objects around the room in anger after his family left without him. He broke a lamp and overturned his dresser. Jackson's destructive outburst caused damage to his possessions and his room. After his mother told Jackson a second time that he could not live with his grandmother, he started shouting insults at her and his stepfather. Jackson then told them they were not fit parents and only cared about themselves.  In response, his mother told him he was not getting his laptop back until his behavior improved. The client grabbed a dish, threw it against the wall, and threatened to break more items in the home. He said he would continue his destructive behavior until his family realized how much they hurt him on a daily basis and then ran out the door. The stepfather found him wandering the neighborhood and drove him home. Jackson told his stepfather he wished he was dead and not part of their family. You note that the client is pulling his hair as he tells you this. You also notice that he is decompensating. You spend the remainder of the session practicing self-calming skills with him.","The client's biological father was diagnosed with Bipolar I Disorder. The biological father is unaware of the client's existence although the client knows that his step-father is not his biological father. The client has transitioned from school to school. Each time his behavioral problems have escalated. This is his third school. The client's issues have become so severe that his parents have been called to the school multiple times. They have been unable to get him to listen to them or follow directions. His outbursts are becoming more frequent and aggressive, and his refusal to do work or cooperate has become a problem for his teachers.  The school has tried various approaches to try and help the client, but he has been resistant to them. He has been put on a behavior plan but has not followed through. The administration has also tried talking to him on multiple occasions to try and get him to open up, but he has been unresponsive.  The administration has now exhausted all of its options and is at a loss as to what to do. They are willing to give him one more chance, but they will be forced to find another solution if he does not improve. Previous Counseling: The client has been seeing a pediatric psychiatric nurse twice a month for two years for his frequent temper outbursts at home and school. His irritable and angry mood is a daily occurrence, with verbal rages and physical aggression occurring three or more times a week. He is currently taking Respidol for emotional regulation. The medication affects his appetite and energy level. ",Which of the following theoretical models would be most appropriate to address the client's feelings of being unloved?,Behavioral therapy,Person-centered therapy,Cognitive-behavioral therapy,Play therapy,"(A): Behavioral therapy
(B): Person-centered therapy
(C): Cognitive-behavioral therapy
(D): Play therapy",Play therapy,D,"Play therapy incorporates an array of play and creative arts techniques to alleviate chronic, mild, and moderate emotional and psychological issues of children that are leading to behavioral problems or that are preventing children from embracing their potential. Therefore, the correct answer is (C)",counseling skills and interventions
1582,Initial Intake:  Age: 23 Gender: Male     Sexual Orientation: Heterosexual Ethnicity: Indian American Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual,"Shawn is slightly unkempt, completes ADLs and has good hygiene. His motor movements are fidgety and tense, and he consistently averts eye contact and darts his eyes around the room and towards the door every time he hears a noise. He appears to be sensitive to the lighting in the office as evidenced by fluttering his eyes when he looks up and commenting about its brightness. Shawn speaks within normal rate and tone, however low volume and often mutters under his breath. He denies any past suicidal or homicidal ideation and denies hallucinations or delusions. Shawn also denies history of trauma.","Diagnosis: Social Phobia, unspecified (F40.10) provisional; Alcohol Use Disorder, moderate, in early remission (F10.10)
 

Rishaan is a 23-year-old heterosexual male of Indian origin and is being referred to you by his parents for counseling in your private practice who are telling you Rishaan is at risk for going back to his drinking because he “never does anything constructive.” Further complaints by Rishaan’s parents include that “all he does is play video games and watch TV,” that he “never has money to pay for anything himself” and is constantly asking them for money. His parents offer to self-pay for Rishaan’s sessions. You welcome Rishaan to your office for an initial assessment. He respectfully requests that you refer to him as “Shawn,” which he explains is his preferred American name, and remarks that his parents really want him to talk to you. Shawn has agreed to counseling because he shares with you that he “has stuff to talk about anyway” and does not think he can go to his parents.","Substance Use History:
Shawn entered treatment and rehabilitation five months ago after his ex-girlfriend’s family had an intervention with him about his abusive drinking and he has now been through all phases of treatment for Alcohol use disorder. Shawn tells you he is ashamed that his parents found out about his problem through his ex-girlfriend’s parents, because he had been lying to his own parents about his well-being for several years since he left home for college at 18 years old. Shawn is currently five months sober but is not engaged in any post-treatment recovery program nor has he continued counseling.
 
Family History:
Shawn has two older siblings, both of whom he shares are “successful and have families.” Shawn says, “my parents always want me to be like them and are constantly comparing me to them, it’s so annoying.” Shawn’s father is a dermatologist, and his mother is his father’s secretary in their medical practice. Both parents observe traditional Indian cultural practices in their social lives and with respect to Hinduism.
 
Work History:
Shawn has attempted part-time work following his graduation from his alcohol rehabilitation treatment program but was unable to make his shifts on time and was let go from his job. He tried another job selling products by cold calls but could not keep up with the volume required to make a viable salary. When asked what Shawn would like to do for a living, he says “I’d like to be a gaming coder or tester, something like that.”",Which of the following long term goals is the most reasonable?,Get involved in organized hobbies and obtain employment in three months,Develop a recovery support system of five friends and a girlfriend within six months,Participate in at least three social performance requirements without undue fear or anxiety,Complete psychological tests designed to assess the severity of his social anxiety,"(A): Get involved in organized hobbies and obtain employment in three months
(B): Develop a recovery support system of five friends and a girlfriend within six months
(C): Participate in at least three social performance requirements without undue fear or anxiety
(D): Complete psychological tests designed to assess the severity of his social anxiety",Participate in at least three social performance requirements without undue fear or anxiety,C,"Answer a will encompass a wide range of objectives that will need to be addressed for this goal to be accomplished, which sets your treatment planning on a clear path. Expecting a specific number of friends, relationships or even a time frame within which to gain employment are all factors that are partially outside of Shawn's control and can therefore be too demanding or unreasonable. They do not provide Shawn enough time to accomplish his goals within his own timeline of capability, and further are not effective demonstrations of cured social phobias as Shawn has been able to obtain employment before, he was just unable to maintain it. Conducting a screening test would be considered a short-term objective. Therefore, the correct answer is (A)",treatment planning
1583,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","Client Age/Gender: Sexuality: Both Heterosexual Ethnicity: Both Caucasian Relationship Status: Married Counseling Setting: Outpatient Behavioral Health Type of Counseling: Couples Counseling  Marital Discord Diagnoses:  You are a certified counselor providing couples therapy in an outpatient behavioral health setting. The wife serves as the primary client due to the complexity of her clinical and diagnostic presentation. She is a 34-year-old female seeking marital counseling with her 44-year-old husband of 18 months. The client explains that shortly after returning from the couple’s honeymoon, she began having chronic, debilitating migraines causing her to remain bedridden, sometimes for days on end. She reports that she no longer engages in activities that she once enjoyed and feels chronically tired and depressed. Despite being treated by several neurologists, her chronic migraines persist, and she is now on long-term leave from her job. The client’s husband is a chief financial officer for a large hospital system and works long hours. The couple has joint custody of the husband’s 12-year-old son from a previous marriage. The client thinks that there is an unfair amount of burden placed on her to parent her stepchild, which has caused conflict among the client, her husband, and the husband’s ex-wife. The husband admits to growing impatient with the chronic nature of his wife’s illness and says she is not the same person that she was when they met nearly 3 years ago.  The client and the husband are both well dressed. The client is wearing sunglasses and explains that her migraines cause her to be light sensitive. It is the middle of the husband’s workday, and he is dressed in a suit and tie. The client reports daytime sleepiness, which she attributes to her migraine medication. Her appetite is fair. She denies current suicidal or homicidal ideations. However, the client does report that she has previously had thoughts of not wanting to live. Her mood is depressed, and her affect is congruent with her mood. The client is tearful when discussing how her illness has affected the marriage and states that she receives little support from her husband. When the client begins to cry, the husband responds by sitting silently, crossing his arms, shaking his head, and looking around the room. The client states, “See! This is what I’m talking about! Whenever I need his support, he checks out.” Family History and History of  The client’s parents were never married. The client was placed in foster care at age 3 due to parental neglect. She remained in foster care until age 6, when the courts granted her paternal grandmother full custody. The client’s husband has two younger brothers and was raised by his biological mother and father. He describes his father as “hardworking” and his mother as a stay-at-home mom. Approximately 5 years ago, the husband was treated for alcohol use disorder. He states that he stopped drinking independently and “didn’t have to rely on a 12-step program to get sober.” The couple met when the husband was married, which contributed to a drawn-out and acrimonious divorce.  Research indicates that depression and migraine headaches may be reduced by engaging in an activity involving tensing and releasing muscle groups",Research indicates that depression and migraine headaches may be reduced by engaging in an activity involving tensing and releasing muscle groups. This is an example of which one of the following?,Progressive relaxation,Biofeedback training,Rhythmic breathing,Autogenic training,"(A): Progressive relaxation
(B): Biofeedback training
(C): Rhythmic breathing
(D): Autogenic training",Progressive relaxation,A,"Research indicates that depression and migraine headaches may be reduced by engaging in progressive relaxation. Progressive relaxation involves tensing and releasing muscle groups one by one. Biofeedback training is a similar exercise in that muscle relaxation is involved; however, biofeedback uses an external monitoring device to measure physiological responses. Instruments provide information or feedback on specific measures under the participant’s control (eg, heart rate, body temperature, muscle tension). Autogenic training is used to promote relaxation by “telling” one’s body to relax using verbal prompts (eg, “your arms are becoming heavy”). Rhythmic breathing provides relaxation by inhaling and exhaling slowly (eg, “count to five as you inhale and as you exhale”). Therefore, the correct answer is (B)",professional practice and ethics
1584,Initial Intake: Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.","You are a counselor in a private practice setting.  Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.  Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”","Family History:
The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.","Based on the information, what will be the most difficult barrier during treatment for this client?",Lack of support,Lack of finances to pay for treatment,Lack of interventions that treat OCPD,Lack of insight,"(A): Lack of support
(B): Lack of finances to pay for treatment
(C): Lack of interventions that treat OCPD
(D): Lack of insight",Lack of insight,D,"The greatest barrier for the client and for most people with OCPD is a lack of insight about their thoughts and behaviors. They frequently do not see these as issues and instead believe others are lazy, ungrateful, unmotivated, or incapable of following logical rules and schedules. The client demonstrates a lack of insight in both the intake and next session as to why his thoughts and behaviors are upsetting others. The client appears to have appropriate support, particularly in his family as he and his wife were engaged in reading about the issues and his wife reported on some behaviors that are troublesome at home. Interventions are widely researched in treating OCPD and have shown that OCPD is moderated with consistent and long-term therapy. There is no indication in the case study that the client lacks finances to pay for treatment. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1585,"Name: Alberto Clinical Issues: Sexual functioning concerns Diagnostic Category: Sexual Dysfunctions Provisional Diagnosis: F51.22 Erectile Disorder, Situational Age: 43 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Married Modality: Individual Therapy Location of Therapy : Agency  ","The client is dressed in casual clothing and appears to be clean and well-groomed. He is of average height and build, with short black hair. He is noticeably tense and avoids eye contact when describing his symptoms. His speech is audible and clear. He is able to express himself clearly and articulately. The client reports feeling frustrated, embarrassed, and confused concerning issues with his wife. He denies any suicidal or homicidal ideation. His mood is anxious and affect is flat. He is able to recall pertinent events and information. He has no difficulty understanding the session process or comprehending instructions. He appears to be alert and oriented to person, place, and time. The client displays average insight into his current situation and expresses willingness to explore relevant issues in more depth with the therapist. He displays average judgment when answering questions.","First session The client, a 43-year-old male, presents for his first Telehealth session through the agency where you are an intern, finishing your final hours for licensure under clinical supervision. You begin the session by striving to create a safe, comfortable, and non-judgmental environment. You provide the client with an introduction to yourself, your qualifications, and your approach to therapy. You also explain how Telehealth works and provide the client with an opportunity to ask questions about the process. Next, you review his informed consent and other paperwork that was filled out prior to the session. You explain the policies and procedures for confidentiality within your agency. He nods his head and verbally acknowledges understanding.    You then begin to explore the client's presenting issues and goals for therapy. You ask what prompted him to schedule an appointment for counseling, and he responds saying, ""I don't know what is wrong with me, but lately, I've been having trouble with my wife....on an intimate level. It's been very frustrating and embarrassing, and it's causing a lot of tension between us. My wife is getting frustrated and accusing me of cheating on her. We have two children. I never thought this would happen to me."" The client has seen a urologist and has no sign of prostate cancer but is in poor health. The client appears anxious when describing his symptoms. He is fidgeting and has trouble maintaining eye contact as you explore the issue more deeply.    This is your first client who presents with this particular issue, and you are not entirely sure of how to proceed. You take a few moments to pause and reflect on what he has said while also noting his body language. As you consider the best way forward, you remember the importance of validation in establishing rapport. You nod your head and say, ""I can see how this has been difficult for you and your wife. It's understandable why it might be causing tension between the two of you.""  Fourth session It has been a month since you began therapy with the client. You have been meeting with him weekly. Today, the client states he and his wife attempted to have sex last week, and he could not maintain an erection. He says she called him ""a lousy cheat with a beer belly who can't satisfy her."" He lets you know that this remark triggers him as it reminds him of his relationship with his mother. He reports that sex feels like a ""chore,"" and it is not fun anymore. ""Sometimes, I fantasize about being with an ex-girlfriend of mine just to get an erection."" The client seems sad and looks down at his feet.    You and the client discuss his wife's comments, and he expresses feeling overwhelmed and helpless. You ask him to reflect on how he feels about his wife's reaction, and he reports feeling ""hurt and rejected."" You then discuss the possibility of exploring underlying issues that may be impacting his ability to find pleasure in sex. You then ask if he is able to recall any past experiences or traumas contributing to his difficulty with erectile dysfunction. He has never felt anxious about past experiences with erectile dysfunction, but now he sees to be struggling with feelings of guilt and shame. You then discuss strategies for improving communication with his wife and ways to build trust within their relationship. You encourage the client to explore his feelings and identify potential triggers impacting his ability to enjoy sex. Lastly, you role-play a scenario in which the client communicates his feelings to his wife in a non-confrontational manner. At the end of the session, he tells you that he is beginning to understand how he can relate better to his wife. He states, ""I guess it's important to tell each other what we need and want.""  Eighth session The client has been coming to therapy consistently for seven weeks. During today's session, he states that he has been able to have sex once to full term and has been practicing his relaxation skills before initiating sexual activity with his wife. The client tells you, ""My wife just doesn't do it for me anymore. With the other two women I am currently seeing, I can go two, even three times. I don't feel guilty, and it feels great to feel like a man now."" This is the first time your client has admitted his infidelity to you.    The client expresses feelings of relief to speak honestly about his infidelities and the dual benefit of ""feeling like a man again"" and being able to perform sexually. He reports that he feels more confident and his anxiety levels have decreased since engaging in extra sexual activity with the other two women and his wife.","The client is an only child. As he grew up, he reports that his father was often vocal about his dissatisfaction with his sex life. The client also reports that his mother often expressed resentment toward him from the day he was born. This has left him with a deep-seated dislike of his mother, as well as resentment of women in general. Currently, his parents are facing health issues, with his father drinking heavily and his mother having lung cancer. The client feels overwhelmed and stressed due to his job and family responsibilities. He is worried about his parents' health and is not happy about the potential of having to take care of his mother if his father passes away. After a decade of working as an illustrator designing greeting cards, the client has recently been promoted to creative director of his department. Because of his introverted nature, he is now feeling overwhelmed with the new responsibilities and having to communicate with other departments within the company. The client drinks weekly and occasionally smokes marijuana. The client drinks at least one beer every other night after work with dinner. He will finish two six-packs on some weekends if they have company over to watch football. He says he rarely drinks hard liquor. The client has reported that his alcohol use or smoking marijuana is not causing any impairments in his ability to carry out his daily responsibilities, but he is overweight because of his inactivity and indicates he would like to return to his normal weight. He also says that he has never experienced any adverse physical or psychological effects due to his substance use.","Your father cheated on your mother, and now you know the client is cheating on his wife. You are aware your body language has changed, but you try your best to focus on the client. What may be happening?",Release of repressed memory after confronting your own past,"Countertransference, from reliving your own personal memories","Failure, at having missed the client's infidelity to his wife","Transference, as a result of confronting a painful episode","(A): Release of repressed memory after confronting your own past
(B): Countertransference, from reliving your own personal memories
(C): Failure, at having missed the client's infidelity to his wife
(D): Transference, as a result of confronting a painful episode","Countertransference, from reliving your own personal memories",B,"The client has awakened your own personal issues about your family life by his actions and story. It is important to be aware of these things and discuss your own feelings with a supervisor. Therefore, the correct answer is (A)",professional practice and ethics
1586,Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1),"Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par","You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.",ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report,Which one of the following is a differential diagnosis for reactive attachment disorder?,Oppositional defiant disorder,Parent-child relational problems,Conduct disorder,Autism spectrum disorders,"(A): Oppositional defiant disorder
(B): Parent-child relational problems
(C): Conduct disorder
(D): Autism spectrum disorders",Autism spectrum disorders,D,"Many features of reactive attachment disorder are also common in autism spectrum disorders; therefore, it is important to differentiate between the two diagnoses for the client. Oppositional defiant disorder and conduct disorder are not differential diagnoses for reactive attachment disorder because they are not based on the child’s attachment to their caregivers; rather, they are based on behavioral problems. The existence of parent–child relational problems might be an appropriate description for this case, but it is not a formal diagnosis, and is rather a Z-code. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1587,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.  Third session In accordance with Ruth's decision at the last session, she ceased communication with her ex-husband. After affirming this, she turns to her husband and says, ""He called twice last week, but I didn't answer. At least someone wants to talk with me!"" Dale gives her an exasperated look, folds his arms over his chest, and shakes his head in disgust, at which Ruth says, ""See? That's all I ever get! Nothing!"" and begins to cry. Dale seems angry but remains quiet.    Dale sighs and rubs his temples. ""This is why I don't talk about it,"" he says. ""You always make it about you. Do you think I don't want to talk to you? Do you think I don't care?"" Ruth sniffs and wipes her eyes. ""Of course not, but it feels like you don't want to talk to me. Like you don't care. You never talk to me, and then you get quiet when I try to talk to you.""    Dale rolls his eyes. ""That's because you don't listen when I try to talk to you. You just jump to your own conclusions and then get mad at me when I don't do what you think I should do. I'm tired of it. I'm tired of trying to talk to you, but you never listen."" Ruth bristles, tears streaming down her face. ""Well, what am I supposed to do? You never tell me what you want me to do, so how am I supposed to know?"" Dale throws his hands and walks away in frustration. ""I don't know, Ruth. I really don't know.""  Tenth session The couple enters in better spirits than previously. They have been speaking with each other in the lobby while waiting. They enter laughing. Ruth reports that the communication techniques you shared seem to have helped. She no longer feels the need to leave her husband. They report that the 16-year-old daughter arrived home from her time at the crisis center somewhat subdued by the experience, although still showing challenging behaviors. They also say that the five-year-old still exhibits defiant behaviors at home and school.    The couple had worked hard to repair their communication and marriage, which is paying off. The husband and wife have found a new understanding and mutual respect. They have developed newfound patience and empathy for one another, helping to create a more harmonious environment at home. The couple had also applied the communication techniques they had learned to their interactions with their children. As a result, Ruth and her husband are now workings together to find a way to better understand and respond to their children's needs. They have set up a school conference to determine how to handle their children's behavior.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ","During the termination phase, what recommendations might you make for this couple?",Refer the couple to a divorce lawyer,Refer the couple for substance abuse evaluation,Refer the couple to a parenting class,Refer the couple to a sex therapist,"(A): Refer the couple to a divorce lawyer
(B): Refer the couple for substance abuse evaluation
(C): Refer the couple to a parenting class
(D): Refer the couple to a sex therapist",Refer the couple to a parenting class,C,"This activity would assist the couple to align their parenting approaches. Therefore, the correct answer is (B)",treatment planning
1588,"Name: Gordon Clinical Issues: Mood instability and substance use leading to occupational impairment Diagnostic Category: Bipolar and Related Disorders;Substance Use Disorders Provisional Diagnosis: F31.0 Bipolar I Disorder with Rapid Cycling; F10.20 Alcohol Use Disorder, Severe Age: 33 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : Agency  ","The client appears to the intake session disheveled and displaying a strong presence of body odor. He is inconsistently cooperative within the session. His mood and affect are anxious and labile. His attention and concentration are impaired, and he is easily distracted in the session. He admits to his recent suicidal ideations and hospitalization but minimizes the impact stating, ""Everyone overreacts these days."" He mentions that when he was in his 20s, he was prescribed Lithium. He denies any homicidal ideations and displays no acts of delusion or hallucination. The client's ability to abstract and generalize is slightly lower than average. The client grapples with his impulse control regarding alcohol. He has insight into the level of the illness with which he is struggling but lacks judgment when making healthy choices.","First session You are a mental health therapist in an agency. The client, a 33-year-old former cab driver, comes to see you per his hospitalization discharge. The client's speech is characterized by an increased rate of speech, tangentially, and circumstantiality. He reports feeling overwhelmed and out of control, often losing his temper and having difficulty regulating his emotions. He reports a history of alcohol abuse, as well as self-medicating to cope with his emotional distress. He states that he has lost his job due to his difficulty controlling his emotions, and he is hopeful that therapy can help him regain his job. He also reports a history of legal trouble and has been incarcerated multiple times in the past. His legal record shows a history of violent offenses and domestic abuse.    After the initial interview, you review the paperwork from the client. You recognize his last name and realize he is a distant cousin by marriage, although this is your first time meeting him. You consider the ethical implications of continuing to see him for therapy along with the possibility of transferring him to one of your colleagues."," The client had a history of alcohol abuse and had been warned multiple times by his employer to stop drinking while on the job. The client's boss tried to counsel him, but he refused to accept help or advice. Instead, he continued driving while under the influence, and his reckless behavior eventually led to an accident. As a result, the client was dismissed from his job and has struggled ever since.    The client has been unsuccessful in finding other employment due to his record of drinking on the job. He has been trying to seek help with his drinking but without any success. He believes that therapy may be his last hope for getting his job back, and he is desperate to change his life. The client tells you, ""I started drinking years ago. I've tried to quit, but I can't do it."" He further states, ""It used to be a couple of beers, but that doesn't do it for me anymore. So now, I drink almost half a bottle of whiskey a day. I usually start in the morning because if I don't, I feel terrible; my hands shake, I feel clammy, and I get an upset stomach. For years, I used just to let the mood pass, but in the last year or so, the alcohol has helped.""",What assessment would you perform to determine if the client is competent to provide informed consent?,"Informal questions and observation, to keep the client centered and calm.",Mental Status Examination,The Bipolar Spectrum Diagnostic Scale (BSDS),Michigan Alcohol Screening Test (MAST),"(A): Informal questions and observation, to keep the client centered and calm.
(B): Mental Status Examination
(C): The Bipolar Spectrum Diagnostic Scale (BSDS)
(D): Michigan Alcohol Screening Test (MAST)",Mental Status Examination,B,"In order to assess if the client is competent to provide informed consent, you will need to perform a mental status examination. This assessment is used to determine cognitive functioning, intellectual level, and emotional state. You will also evaluate his information processing skills, ability to understand the rights and responsibilities of being a client in therapy, and any potential conflicts of interest. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1589,Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual,"Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.
","Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.",,"If the counselor accepts Nadia for who she is, even though he or she may not agree with Nadia's values, this is called?",empathy,nonjudgement,unconditional positive regard,apathy,"(A): empathy
(B): nonjudgement
(C): unconditional positive regard
(D): apathy",unconditional positive regard,C,"Unconditional positive regard is warmth and acceptance towards the client regardless of what the client says or does. Being nonjudgmental means avoiding moral judgements. Empathy is the ability for the counselor to put themselves in the shoes of the client to understand their perspective. Apathy is a lack of interest or concern. Therefore, the correct answer is (B)",counseling skills and interventions
1590,"Name: Logan Clinical Issues: Bullying Diagnostic Category: V-codes Provisional Diagnosis: Z60.4 Social Exclusion or Rejection Age: 11 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Asian American Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : School  ","The client is wearing clean clothes appropriate to his age. Initially hesitant and withdrawn, he becomes more relaxed and responsive as the interview progresses. He is soft-spoken but articulates clearly. Mood is depressed, anxious, and irritable. Affect is euthymic with occasional sadness. Thought process is logical, goal-directed, and organized. No evidence of any cognitive deficits. Good insight into the impact the bullying has on his emotional well-being and his ability to make appropriate decisions is intact. No suicidal ideation was reported.","First session You are a school counselor seeing an 11-year-old male named Logan. He presents to your office with his mother. His mother reports that her son has been struggling in school and has been the target of bullying. She tells you that he recently started at a new school after their neighborhood was re-zoned. The bullying started a few weeks ago when he was sitting alone in class during lunch. A group of boys, whom Logan had never seen before, sat beside him and began teasing him about his clothes, shoes, and hair. When Logan tried to ignore them, they started calling him names. He went home that day feeling embarrassed and alone. Since then, the boys have devised new ways to make fun of Logan. They sneak behind him in the hallways, push him around when the teacher is not looking, and push him into the bathroom.    Logan has been refusing to go to school, saying he has stomach aches. His mother says, ""He used to love school. He even loved doing his homework. How many parents are lucky enough to have a child who likes doing homework?"" When questioned, Logan says that he now hates school and wants to be home-schooled. He says he is being bullied throughout the day, and it does not stop until he leaves the bus. Logan's mother has been worried about him and wants to know how to stop the bullying. At first, she thought it was just ""kids being kids"" when they tease each other, but she is now concerned that it has gone too far. She also asks if you can help him to make friends in his new school.    During today's session, you notice that Logan appears anxious and withdrawn. As you gently probe further, Logan shares that he feels overwhelmed by the constant bullying, which has begun to affect his self-esteem. You observe that he appears hesitant to discuss the specifics of his experiences, suggesting that he may fear rejection by you or be embarrassed by what was done to him. This indicates that the situation has caused significant distress and has started to erode his resilience.    As you explore Logan's support network, he hesitantly reveals that he has been unable to make new friends since starting at the new school. The fear of being targeted by bullies has made it challenging for him to approach other students or engage in extracurricular activities. Consequently, Logan feels increasingly isolated and struggles to see a way out of his current situation. This lack of social connection exacerbates his feelings of loneliness and despair. As part of his treatment plan, you include developing and maintaining positive relationships with peers to work on his tendency to isolate himself.    Toward the end of the session, Logan's mother inquires about possible strategies to address the bullying. You acknowledge her concerns and emphasize the importance of a collaborative approach involving the school, family, and community. You suggest initiating communication with Logan's teachers and school administrators to create a safe and supportive environment for him. Additionally, you recommend Logan's mother encourage her son's interests and hobbies outside of school to help him build self-esteem and form new friendships. Meanwhile, you will continue to work with Logan on developing coping strategies and strengthening his emotional resilience in future sessions.  Third session As the session progresses with Logan, you notice that he seems more withdrawn and less willing to participate in your planned activities. You ask him how he has been feeling since your last session and if he has progressed in handling the bullying situation at school. Logan hesitates to answer your questions, looking down and avoiding eye contact. He eventually shares that the bullying has intensified and he feels overwhelmed and helpless. He tells you about the boys in his gym class calling him names and making fun of him. He says they continue to bully him, says he ""won't ever go to school again,"" and ""hopes those boys die.""    As an REBT practitioner, you emphasize the importance of determining some of his core issues contributing to his distress. You ask him to share some of the thoughts he has had about the bullying and the boys in his gym class. Logan admits that he believes he is ""worthless"" and ""deserves the bullying"" because he is not ""cool"" enough. You help him recognize that his self-worth is not dependent on the opinions of his bullies and that he does not deserve to be mistreated.    You also address Logan's intense emotions and help him understand the relationship between his thoughts, feelings, and actions. You encourage Logan to reflect on the possible consequences of wishing harm upon his bullies and discuss alternative, healthier ways of coping with his feelings. You introduce Logan to relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, which he can use to manage his emotional distress.    In this session, you also explore Logan's social support network to identify potential allies to help him deal with the bullying. You ask him about friends, family members, or other school staff who he trusts and feels comfortable talking to about his experiences. Logan mentions a few friends who he thinks might be willing to help. You discuss ways he can approach these individuals and ask for their support, emphasizing the importance of open communication and honesty.    When he gets ready to leave, you notice a cigarette fall out of his backpack. You ask him about the cigarette, and he admits that one of the boys in his gym class gave it to him. He says the boy said if Logan smoked it, he would be ""cool"" and finally accepted by them. You explain to Logan that smoking is not an excellent way to fit in and can harm his health. Instead, you encourage him to find other ways to express himself, such as participating in activities he enjoys or joining clubs at school.    Following today's session, you check in with Logan's mother. You also advise her on how she can support her son by having conversations with him about the importance of making good choices and helping him find healthy ways to cope with his feelings.","The client has a large supportive family. The extended family often gathers together for Sunday dinners. The client says that he has fun playing games with his cousins. The client's mother states that their family is very close, and she and her husband make a concerted effort to prioritize shared time with the extended family.  ",What should you do about Logan's disclosure to you regarding not attending school?,Consider having the client attend an online school for some time.,Consider if modifying your treatment plan may be warranted to better help the client with his reactive responses.,"Inform the authorities, as is required for a mandated reporter.",Discuss what he is feeling and what he means in expressing his statement.,"(A): Consider having the client attend an online school for some time.
(B): Consider if modifying your treatment plan may be warranted to better help the client with his reactive responses.
(C): Inform the authorities, as is required for a mandated reporter.
(D): Discuss what he is feeling and what he means in expressing his statement.",Discuss what he is feeling and what he means in expressing his statement.,D,"Assist the client with managing his anger, resentments, fears, and unresolved grief responses. His not wanting to go to school is a result of bullying. It is important to reduce the emotional impact of bullying and teach the skills to respond to the perpetrator. Therefore, the correct answer is (D)",counseling skills and interventions
1591,Initial Intake: Age: 43 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client presents appropriately dressed in a long-sleeved t-shirt and jeans and is well-groomed. Her weight appears appropriate to height and frame. Her movements and speech demonstrate no retardation and she is cooperative and engaged. The client reports her mood as anxious, however you note her to be relaxed in speech and appearance. She reports no recent suicidal ideations and demonstrates no evidence of hallucinations or delusions. The client reports that she is in good health and takes no medication except birth control.  She reports she has difficulty falling asleep at night because she worries whether her husband finds her attractive. She states she also frequently worries about the children or situations that have happened during the day, but is often able to dismiss these after a few minutes.","You are a counselor in a private practice setting.  During the intake session, you learn that your client has been married for 15 years and has four children and is currently struggling with her marital relationship. She states her husband does not want to attend counseling with her. Your client complains of occasional feelings of unhappiness, irritation, difficulty sleeping, as well as worrying. These have been present for the past 8 to 10 months, with the worry being almost daily. She states she feels alone in the marriage because her husband is an introvert and is often too tired after work to engage emotionally with her. She views the marriage as “good” and they engage in sex at least 5 times per week, where she is often the initiator. She reports that she repeatedly asks her husband and best friend to reassure her that she is still attractive. She tells you that her best friend is encouraging, but her husband tells her he is tired of her constant, daily questioning and says she must be in a midlife crisis. She confides that her husband frequently looks at pornography and sometimes they watch pornographic movies together prior to sex.","Family History:
Approximately 6 years ago, the client’s family doctor prescribed a short course of Valium, while she and her husband were building their house. She also was diagnosed with postpartum depression after her first child was born. She reports she did not seek counseling at the time but her obstetrician prescribed antidepressants, which she took for 10 months with good results. Her doctor then prescribed the same antidepressants for 12 months as a preventative against postpartum depression prior to each of her subsequent births.",Which of the following interventions should be implemented during this session?,Complete a family genogram with information on substance use,Ask client why she did not endorse any substance use on the intake form,Administer the Michigan Alcoholism Screening Test (MAST),Administer the Hamilton Anxiety Rating Scale (HAM-A),"(A): Complete a family genogram with information on substance use
(B): Ask client why she did not endorse any substance use on the intake form
(C): Administer the Michigan Alcoholism Screening Test (MAST)
(D): Administer the Hamilton Anxiety Rating Scale (HAM-A)",Administer the Michigan Alcoholism Screening Test (MAST),C,"Substance-related disorders commonly occur with body dysmorphic disorder. The client mentioned alcohol so the MAST is the most important intervention at this time. Completing a family genogram related to substance use and completing the HAM-A would provide good information about substance use and anxiety in general but would not target the client's current substance-related behaviors. Asking why she did not endorse these would likely make the client feel defensive and threatens the therapeutic relationship. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1592,"Name: Bianca Clinical Issues: Difficulty adjusting to life changes Diagnostic Category: V-codes Provisional Diagnosis: Z60.0 Phase of Life Problem Age: 62 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Black Marital Status: Separated Modality: Individual Therapy Location of Therapy : Agency  ","The client is a 62-year-old female, wearing work attire. She appears to be in good hygiene and her dress is neat and appropriate for the situation. Her facial expression is sad and she has tear tracks on her cheeks. Her mood is noticeably depressed, anxious, and tearful. Her affect is constricted. She has coherent thought processes with appropriate content. She expresses feelings of sadness over her failed marriage and overwhelm about being alone. The client has intact memory and concentration. She has fair insight into her current situation and is able to verbalize her feelings in a coherent manner.","First session The client comes to the agency practice where you currently work as a licensed mental health therapist. She is a 62-year-old female who recently retired from an accounting firm employment. She is seeking treatment after her marriage recently failed. A few months ago, he husband filed for a legal separation and is currently romantically involved with another woman. The client looks at you tearfully and says, ""I can't believe this is happening at my age. I am all alone. What am I going to do?"" She continues to cry uncontrollably. You focus on providing a safe and secure environment. You assure her that she will not be judged or criticized in any way, and all of the conversations during the session will remain confidential. You gently let her know that it is okay to cry, and you are there to listen without judgement. You also tell the client that it is natural to feel lost and alone after a separation, especially since she and her husband have been together for such a long time. She says, ""I just feel like such a fool. He cheated on me once before - that I know of - and now he's done it again. I stayed with him for over 30 years, and now I have nothing."" She describes having mixed feelings of anger, sadness, fear, and confusion. She states, ""There are moments where I'm so mad at him for leaving. Mad enough that I could break something! Our marriage wasn't perfect, but I thought he was committed to me. Well, obviously he wasn't. Then I start to question what's wrong with me that made him leave. And then I think about the future and how I'm going to live by myself. It's all so overwhelming."" She further discloses that she is worried about having panic attacks again because ""that's what happened the last time something of this magnitude happened to me.""    You reinforce the idea that it is important to focus on the fact that she is not alone and many people in similar situations feel overwhelmed and uncertain about their future. You let her know she is in a safe space to explore her feelings, work through her loss, and develop a plan for moving forward. You encourage her to reach out for support during this challenging time rather than isolate herself as she goes through this difficult change.",,The client presents with multiple issues. Which data best supports her diagnosis?,The client is having difficulty adjusting to major life events,The client has a history of anxiety and has experienced panic attacks,The client is 62 years old and is struggling to find meaning in her life,The client has reached the stage of Generativity vs. Despair,"(A): The client is having difficulty adjusting to major life events
(B): The client has a history of anxiety and has experienced panic attacks
(C): The client is 62 years old and is struggling to find meaning in her life
(D): The client has reached the stage of Generativity vs. Despair",The client is having difficulty adjusting to major life events,A,"The client's recent retirement from an accounting firm employment, and the fact that her husband has recently filed for a legal separation and is romantically involved with another woman all point to the likelihood that this could be a phase of life problem. The client's emotionality in expressing her feelings of isolation and uncertainty also suggest she is struggling with major life transitions. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1593,Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3),"Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam","You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”","You and the client develop a clear and explicit treatment contract to provide a foundation for informed consent. Through this collaborative process, you establish an agreement outlining treatment roles, responsibilities, and expectations for you and the client. The client agrees with your suggested goals but does not want to include safety issues as part of her treatment plan. You provide psychoeducation on BPD, and she relates to experiences of abandonment. She would like to learn how to navigate romantic relationships and requests interventions targeting this area.  To address the client’s desire for successful intimate relationships, you select an approach that uses a process known as “limited reparenting” as a means for helping the client form more secure attachments","To address the client’s desire for successful intimate relationships, you select an approach that uses a process known as “limited reparenting” as a means for helping the client form more secure attachments. Which of the following interventions makes use of limited reparenting?",Dialectical behavioral therapy,Mentalization-based treatment,Transference-focused psychotherapy,Schema-focused therapy,"(A): Dialectical behavioral therapy
(B): Mentalization-based treatment
(C): Transference-focused psychotherapy
(D): Schema-focused therapy",Schema-focused therapy,D,"Schema-focused therapy is an EBP for BPD. It uses a process known as limited reparenting to help clients establish a secure attachment with counselors within the confines of their professional relationship. The goal of schema-focused therapy is to help the client replace maladaptive schemas or negative patterns of behaving, thinking, and feeling with healthier experiences and interactions. Transference-focused psychotherapy is also an EBP for BPD. Transference-focused psychotherapy is a psychoanalytic therapy based, in part, on the assumption that primary defense mechanisms (eg, “splitting” and “all-or-nothing” thinking) stem from identity defusion that fuels intense emotional states, transference, and strained interpersonal relationships. Dialectical behavior therapy, another EBP for BPD, is a combination of cognitive therapy, behavioral shaping, and mindfulness practices to overcome erratic patterns of emotions and behaviors. Lastly, mentalization-based treatment is an EBP that uses a psychodynamic approach to examine one’s capacity to understand oneself in relation to others. The counselor identifies and addresses certain mental states that contribute to impulsivity and unstable interpersonal relationships. Therefore, the correct answer is (B)",treatment planning
1594,"Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)","Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through","You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.","The client comes to the session, sits down, and is quiet. The parents report that prior to the session he was playing an online game and became so upset that he threw his video game console. The parents express frustration that they do not know what to do when this happens. You provide psychoeducation to the client regarding coping skills to manage frustration. You find out that the parents respond by removing access to video games, and this usually results in yelling back and forth with the parents and the client. The parents do typically encourage the client to listen to music because this appears to be very effective in calming him down. The client expresses frustration with the people that he was playing with by saying that they “cheated and are lying about it.” You support the client with cognitive reframing",Which of the following populations often responds best to eye contact being maintained most of the time?,Caucasian,Native American,Asian,African American,"(A): Caucasian
(B): Native American
(C): Asian
(D): African American",Caucasian,A,"When conducting clinical interviews, it’s important for the counselor to practice cultural sensitivity. While blanket generalizations cannot be presumed across ethnicities, there are general cultural norms that have been studied, which can be grouped as high-context and low-context cultures. While no cultural demographic can be considered exclusively high or low, there are tendencies that have been identified. Low-context cultures, which generally include Caucasian Americans, utilize communication that is characterized as being blunt and direct and are more comfortable with direct eye contact when communicating. Words are the primary source of meaning in this form of communication. Conversely, high-context cultures, which generally include Asian Americans, Native Americans, and African Americans, consider words as only part of the message and rely heavily on nonverbal messaging and context. High-context cultures tend to prefer less eye contact. In the more general counseling experience, most clients prefer more eye contact when the counselor is speaking, and less when they are speaking (Sommers-Flanagan & Sommers-Flanagan, 2015). Therefore, the correct answer is (A)",counseling skills and interventions
1595,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client’s son accompanies her to her appointment today. Since the initial intake, COVID-19 has become a global pandemic and has greatly impacted the client’s anxiety and fear. The client was visibly trembling when she spoke and requested that her son remain nearby. She explained that complying with the statewide mask mandate has been difficult, stating, “Wearing this mask makes me feel like I can’t breathe. It’s the same feeling I get when I’m walking up stairs or taking the elevator.” The client’s internist prescribes alprazolam (Xanax), which she has been taking for years. However, she thinks that it is no longer effective and asks if you can help her discontinue the medication. Given the COVID-19 outbreak, you discuss providing distance counseling to the client",How should you respond to the client’s request to help her discontinue her alprazolam?,Encourage gradual tapering and monitor any side effects.,Obtain a signed release for you to speak with her prescribing doctor.,Encourage her to follow up with the prescribing doctor.,Obtain a signed release to speak to your agency’s psychiatrist.,"(A): Encourage gradual tapering and monitor any side effects.
(B): Obtain a signed release for you to speak with her prescribing doctor.
(C): Encourage her to follow up with the prescribing doctor.
(D): Obtain a signed release to speak to your agency’s psychiatrist.",Encourage her to follow up with the prescribing doctor.,C,"You should encourage her to follow up with the prescribing doctor. According to the ACA Code of Ethics, “Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” Counselors do not have the competence required to help clients discontinue medication. Medical supervision may be required for clients taking benzodiazepines, particularly those taking higher doses for more extended periods. Obtaining a signed release to speak with her doctor is appropriate; however, requesting a tapering schedule to present to the client is not. The agency’s psychiatrist is not the prescribing doctor, making answer B incorrect. Offering advice on how the client can gradually taper off the medication places the client at increased risk. Therefore, the correct answer is (D)",treatment planning
1596,"Client Age: 19 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Suicidality related to body image Diagnosis: Body Dysmorphic Disorder 300.7 (F45.22), with absent insight/delusional beliefs","Mental Status Exam: The client’s mood is sad and irritable. His speech is pressured when discussing his appearance but is otherwise normal. He is appropriately groomed and wears a beanie covering his ears. He admits to repetitively dissecting his face in the mirror several hours a day. The client offers that he cannot hide his ears with his hair because “it is too thin.” He denies audio/visual hallucinations. The client’s thought content is organized and coherent, but he shows poor insight and delusional thinking about how he and others regard his appearance. The client avoids social settings and reports that sometimes, an entire week goes by where he doesn’t leave the house. He denies suicidality and currently does not have a plan or intent to harm himself or others. Appetite and sleep are fair. The client denies drug use and states he consumes alcohol occasionally. You provide an in-depth suicide assessment, and you and the client work together to create a suicide safety","You are working in private practice and conducting an initial intake session with a 19-year-old male who presents today with his mother. The client was recently admitted to a psychiatric hospital for suicidality and was discharged four days ago. His mother reports that the client tried to commit suicide by overdosing. The client reports feeling increasingly hopeless following a “failed” cosmetic surgery procedure. He explains that he had an otoplasty performed to change the proportion and position of his ears. He states he has always hated his ears and is convinced people are staring and laughing at his “deformity.” His mother reports that she reluctantly consented to the surgery a year and a half ago, despite believing it was unnecessary. The client does not leave the house without wearing a beanie or hoodie. He has completed high school with no interest in attending college. He is unemployed due to shame and embarrassment over his “defective” appearance. Two weeks ago, the hospital psychiatrist changed his medication and placed him on a selective serotonin reuptake inhibitor (SSRI).","    plan. Family History: The client’s parents are divorced and he lives with his mother and two younger siblings. There is a history of child protective services (CPS) involvement due to reports of domestic violence between his parents. The client witnessed these incidents between that ages of 10 and 12. His parents subsequently divorced and the client has had minimal contact with this father since. The client’s maternal aunt is diagnosed with obsessive-compulsive disorder. His mother previously attended therapy for anxiety and other trauma-related symptoms. The client began experiencing symptoms of body dysmorphic disorder at age 13, with symptoms worsening after starting high school.  With the overall goal of creating anxiety habituation, you instruct the client to gradually face feared social situations without performing ritualized tasks (e\. g., mirror-checking)","With the overall goal of creating anxiety habituation, you instruct the client to gradually face feared social situations without performing ritualized tasks (e.g., mirror-checking). This is an example of which of the following?",Behavior activation,Distress tolerance,Exposure and response prevention,Cognitive diffusion,"(A): Behavior activation
(B): Distress tolerance
(C): Exposure and response prevention
(D): Cognitive diffusion",Exposure and response prevention,C,"Instructing the client to gradually face feared social situations without performing ritualized tasks (eg, mirror-checking) is known as exposure and response prevention (ERP). Exposure and response prevention, also known as ritual prevention, is an evidence-based practice for BDD treatment. ERP involves suggesting that the client remain in social situations until the urge to ask for reassurance or engage in mirror-checking decreases noticeably. Anxiety habituation occurs when the desire for the client to engage in mirror-checking discontinues indefinitely. Cognitive defusion, also called deliteralization, is used in acceptance and commitment therapy (ACT). The goal of cognitive defusion is to recognize and detach from thoughts that contribute to increased anxiety. Behavioral activation is a treatment for depression that involves identifying and initiating values-based activities to help lift depression rather than waiting for depression to lift before participating in values-based activities. Distress tolerance is a dialectical behavior therapy (DBT) technique that teaches radical acceptance of the present situation by using coping skills such as self-soothing and distraction. Therefore, the correct answer is (D)",counseling skills and interventions
1597,"Name: Denise Clinical Issues: Hopelessness/depression Diagnostic Category: Bipolar and Related Disorders Provisional Diagnosis: F34.0 Cyclothymic Disorder Age: 38 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Divorced Modality: Individual Therapy Location of Therapy : Private Practice  ","The client is appropriately dressed. She is overweight and appears edgy and irritable. Her attention wanders during the intake. She is articulate and able to communicate her thoughts logically. The client focuses on the negative aspects of life and appears to have a strong external locus of control. Insight is low, and judgment is strong.","First session You are a mental health counselor in a community agency. The client is a 38-year-old White female teacher referred to you by her principal. The client is experiencing difficulty with her school colleagues. She wants to keep her job and is motivated to improve her social skills. Since she was a young adult, she has had tumultuous relationships with co-workers, friends, and family. She tells you she has periods of highs and lows. During the high periods, she is overly talkative, impulsive, and insensitive to others. However, during the low periods, she withdraws from social contact, feels hopeless and helpless, and has trouble concentrating. She expresses a desire to be liked, but people see her as an ""emotional roller coaster"" and avoid her. She is very talkative throughout the session and changes the topic frequently. You raise your hand periodically to summarize what she is telling you.    Early on during the session, the client says, ""Please help me. I know something is wrong, but I don't know what to do. Can you fix me?"" You discuss the scope of your practice and explore options for treatment with her. You explain that one of your responsibilities as a therapist is to provide a safe space where she can express her thoughts and feelings without fear of judgement or criticism. You explain that through understanding and integrating different aspects of herself, she has the potential to develop healthier relationships both in and outside of work. You emphasize the importance of building self-awareness and developing effective coping skills as part of her journey towards healing. Ultimately, you focus on empowering the client by providing support, guidance, and skills that will enable her to make positive changes in herself so she can function more effectively in life moving forward.    You discuss the importance of the client taking an active role in her treatment process and explore methods she can use to become more mindful of her thoughts, feelings, and behavior. You suggest that this will help her gain better insight into the sources of her distress, which will enable her to take more control over how she copes with difficult situations in the future. The client appears relieved that there is something constructive she can do. You end the session by scheduling another appointment for next week and encourage the client to focus on self-care in between sessions. You also reassure her that you will be there as a supportive resource throughout the therapeutic journey ahead. The client leaves feeling empowered and energized to take the first steps towards change.  Fourth session During the previous two sessions, you spent the majority of the time listening to the client describing her conflicted relationships. You asked her to start keeping a mood diary, and while you review it together today, you notice that entries involving her father always precipitate a depressive mood. While you try to bring her attention to this trigger, she says, ""I bet my dad enjoys watching this from the grave,"" and laughs. She tells you that she never felt like her father really loved her, and she believes that he blamed her for her mother's death. You demonstrate empathy and unconditional positive regard in response to her feelings. You begin to explore the client's thoughts about her father's suicide. Her demeanor changes, and she begins to talk about finding his body and the pain he must have gone through. She has ""an epiphany"" as she describes how she feels and realizes that he must have suffered a lot.    Following the client's disclosure, you take the time to normalize her feelings and process her experience. You acknowledge the immense amount of pain and suffering she has endured, both from her father's death, as well as his emotionally distant behavior during life. Through your therapeutic dialogue, you emphasize that it is natural for a person to feel overwhelmed and disconnected in such circumstances, and that these feelings are not a source of shame or weakness. You prompt her to think of new ways in which she can build healthier relationships with others, including developing more meaningful connections through open and honest communication. Finally, you ask her to brainstorm different activities and interests that she finds joy in doing so she can incorporate them into daily life as a way for her to find balance amidst the chaos.    At the end of the session, the client mentions that she is going to be visiting a friend who lives on the other side of the country. They are planning to explore one of the national parks for a few days and spend the remainder of the time ""just chilling"" at her friend's house. She tells you that she is looking forward to spending some time in nature. The client does not want to miss her weekly appointment with you and asks if you can meet with her for a virtual session next week instead of your usual in-person counseling session.  Sixth session The client has not been following through with her mood journal. She says that she ""got bored and didn't feel like writing in it anymore."" During this session, a month and a half into therapy, she relays an incident that happened with the friend she went to visit out-of-state. They argued due to political differences and are currently not talking to each other. The client now considers her friend ""a drunk who doesn't know what she's talking about."" You suggest that the client's anger and judgment may be a defense that she uses to avoid feeling rejected as she did with her father. You state, ""It seems that in an attempt to avoid feeling hurt and rejected, you use anger and alcohol to push people away."" The client responds with reflective silence and begins to tear up.    You guide the client to examine her defensive behavior and understand why she relies on it when faced with difficult emotions. You emphasize that her feelings of hurt, rejection, and anger are valid, however, they can be managed in healthier ways. You suggest that part of processing these feelings is to recognize them and make attempts at reconnecting with her friend. Additionally, you recommend cultivating self-care practices. The client acknowledges the importance of looking after herself during this difficult time, understanding that if she is able to take care of herself first she will be in a better position to address her relationships.    You remind the client that it is important to take steps to move forward, even if those steps are small. You highlight her willingness to talk through her emotions and gain insight into her reactions as an opportunity to grow in self-awareness. You explain that having knowledge of one’s own feelings helps them to make better decisions and boundaries, which can lead to healthier relationships with others and ultimately, more peace within oneself. With this understanding, you create a plan of action together for how she will move forward between now and your next session. You close the session by telling the client that she has made progress today by having gained insight into her feelings, and that will lead to exploration of how to respond to them more productively. You conclude by encouraging her to keep exploring new methods of self-care and to bring up any additional topics she wants to discuss in the next session.","The client's mother was diagnosed with Bipolar I Disorder. The client's mother passed away ten years ago in a car accident. The client reported constant criticism from her father when she was growing up. When the client's mother was not depressed, she acted as a buffer between the client and her father. The client reports getting married immediately after graduating high school to an abusive man who was similar to her father in many ways. The couple divorced two years ago after the client wound up in the emergency room after reporting that she ""slipped on the last step of the staircase and fell into a door jam."" She got full custody of their son and went to live with her father until he passed away a year ago from suicide. He was chronically ill with cancer. The client is currently a science teacher. For the past three years, every school she has worked at has declined to renew her contract. The client's father left his house and all of his financial assets to her, so she does not have to make a mortgage payment. She has savings, but she is burning through it quickly. Previous Counseling: The client sought grief counseling at the time of her mother's death. She felt the therapist was ""not spiritual enough"" to deal with the client's beliefs. The client knew she needed help, and her pastor recommended a group. She attended four group sessions before leaving the group due to interpersonal conflicts with some of the group members. She tells you that she is not interested in participating in any group therapy. ",Which defense mechanism is the client demonstrating in her interaction with her friend?,Sublimation,Reaction formation,Intellectualization,Projection,"(A): Sublimation
(B): Reaction formation
(C): Intellectualization
(D): Projection",Projection,D,"Projection is an unconscious defense mechanism stemming from the ego. An individual takes an unacceptable part of him or herself, such as feelings, thoughts, tendencies, or fears, and then disowns it by placing it on someone else. That is what is being demonstrated in the client's interaction with her friend. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1598,"Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)","Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th","You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.","   e  The client’s mother and father are both realtors. The mother states that she used to see a therapist for anxiety, which she now manages with medication. The father works long hours, and the mother returns home early to attend to the client’s needs. The mother states that she realized that the client wished to be another gender when they were younger, but she believed it was just a phase. She explains that the father is not supportive and refuses to discuss the issue. The mother is concerned about the client’s truancy and desires to be supportive but has mixed feelings about it. She says that she is fearful every day and believes that if she accepts the client’s truth, it will set the child up for “a lifetime of prejudice and discrimination",Preventing the client from using a gender-neutral restroom or a restroom that corresponds to their gender identity violates which one of the following?,The First Amendment of the United States Constitution,Title II of the Americans with Disabilities Act (ADA),The Family Educational Rights and Privacy Act of 1974 (FERPA),Title IX of the Education Amendments of 1972,"(A): The First Amendment of the United States Constitution
(B): Title II of the Americans with Disabilities Act (ADA)
(C): The Family Educational Rights and Privacy Act of 1974 (FERPA)
(D): Title IX of the Education Amendments of 1972",Title IX of the Education Amendments of 1972,D,"Title IX of the Education Amendments of 1972 prohibits discrimination based on sex in any federally funded educational program (ie, public schools or state universities). Title IX further defines “sex” to include sexual orientation and gender identity. In 2021, the US Department of Education Office for Civil Rights issued a Title IX Notice of Interpretation, stating that the Department of Education “will enforce Title IX’s prohibition on discrimination based on sex to include: (1) discrimination based on sexual orientation and (2) discrimination based on gender identity” Title IX helps ensure that all students experience equity in education. This protection includes allowing students to use gender-neutral restrooms or a restroom that corresponds to their gender identity. FERPA, also known as the Buckley Amendment, protects the privacy of educational records by giving parents the right to access and, if necessary, amend their child’s academic records. This same right is given to students 18 and older or students of any age entering postsecondary institutions. Students who wish to change their educational records to reflect their gender identity or name change may be entitled to FERPA protections. Counselors must stay up to date on legislation affecting transgender rights and protections because the scope of these protections varies according to state and federal laws. The First Amendment of the United States Constitution protects freedom of speech. Title II of the ADA protects students with disabilities from discrimination or exclusion from events, services, and programs. Students experiencing gender dysphoria may be protected under ADA or Section 504 if they have a qualifying disability; gender dysphoria itself is not a qualifying disability. Therefore, the correct answer is (B)",professional practice and ethics
1599,"Name: Gregory Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 14 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: Black Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears obese and his clothing is unkempt. His behavior is uncooperative. He finds people ""annoying"" and can at times be vindictive toward people he finds ""annoying."" His mood is angry and affect is irritable. His flow of thought is coherent and goal-directed. His overall responses at times show themes of low self-esteem. He denies any current thoughts of suicide or homicide. He does not display any signs of hallucinations or delusions. His vocabulary is age-appropriate, but his speech is at times sarcastic. He answers questions coherently. Thought process is linear and coherent. He is oriented X3. Memory is intact for recent, remote, and immediate. Insight and judgement are poor.","First session You are a mental health counselor working in private practice. Gregory, a 14-year-old male, presents to the initial session with his mother. She reports that her son has been skipping school, hanging out with a negative peer group, and his grades are starting to slip. He refuses to listen to his mother, saying she is ""strict and unfair."" Gregory, who up to this point has been sitting quietly with his arms crossed, rolls his eyes and says, ""She should be in therapy, not me.""    Gregory's mother continues on to express concern over his decline in school performance, noting that ""he is having problems with some teachers and staff."" Last week, he got up in the middle of class and when told to sit down, he said, ""I have to go to the bathroom."" He walked out and slammed the door behind him. He was sent to the principal's office as a consequence. He has also become vindictive toward certain classmates. When asked why, he states, ""because they think they're better than me.""    His mother reports that at home, Gregory has become increasingly isolated, spending most of his free time alone in his room or out with a group of teenagers she does not recognize. He has has become increasingly hostile and verbally abusive toward his mother and brothers, resulting in frequent arguments. He routinely ignores his curfew and refuses to participate in family activities.    You thank the mother for sharing her concerns and ask to speak with Gregory alone to give him a chance to express himself freely. You want to obtain his assent to join in therapy and understand what is causing him to act out.  Third session Today is your third session with Gregory and you are meeting him on a weekly basis. Last week, you met with him alone and explored his feelings about his family and triggers for his anger and irritability. He reiterated that his mother and brothers were the problem, not him. You recommended meeting with Gregory and his mother for today's session to develop a treatment plan to address Gregory's issues. As you prepare for his appointment, you hear yelling in the waiting room and find Gregory screaming at his mother. She is sitting in the chair, shaking her head. You call them both into your office. His mother yells, ""I've had enough of you today! This time, I'm going to talk!"" Gregory rolls his eyes and mocks her. According to his mother, Gregory was ""caught by the school resource officer today with a vape on him."" She chokes back tears, saying, ""I don't know who my son is anymore."" Gregory responds, ""You're overreacting. That's all you do. Big deal. It's just a vape. Get over it."" His mother looks at you and says, ""He's not getting better even with therapy. He won't listen to anyone, and dealing with him is a constant pain. He's spiteful and working against me. How do I get my son back?""    Gregory has been exhibiting increasingly concerning behaviors since he began using a vape. He has become easily frustrated, struggles to regulate his emotions, and often resorts to aggressive outbursts. He continues to be defiant and uncooperative, straining his relationship with his mother. Despite her best efforts, Gregory remains uninterested in following your guidance, further complicating his mother's efforts to help him.","The client resides with his mother and three older brothers. He describes his brothers and mother as ""annoying"" and tells you that none of them listens to him. 18 months ago, his father passed away after a long illness. The client says that his dad was the only family member who understood him.    The client feels he has no one to talk to and does not get along with his family members. He reports difficulty trusting others and is guarded in his relationships. He has become more irritable and vindictive since his father's death.  The client denies drug or alcohol use and responds to your question, saying, ""What? Are you an idiot? Do I look like someone that would be stupid enough to do drugs?"" The client scoffed and continued, ""Why would I waste my time and energy risking my future for something so pointless."" He then crossed his arms and stared defiantly, clearly not interested in discussing the matter further.",Which would you prioritize as part of the treatment planning process?,Medication,Functional family therapy,Parental skills training,Problem-solving skills training,"(A): Medication
(B): Functional family therapy
(C): Parental skills training
(D): Problem-solving skills training",Parental skills training,C,"Parental training helps improve parent-child interactions. Some of the skills taught include how to maintain appropriate discipline, track the child's behavior, and use of positive reinforcement. Therefore, the correct answer is (A)",treatment planning
1600, Initial Intake: Age: 45 Sex: Female Gender:  Female Sexuality:  Heterosexual Ethnicity: Asian   Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual,"During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past.
 ","Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety.
 
History:
Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work.",,Li is concerned about her ability to pay. Which of the following is NOT true in regard to counselor code of ethics?,"If a counselor's usual fees create undue hardship for the client, the counselor may adjust fees or make an appropriate referral.","In establishing fees for professional counseling services, counselors consider the financial status of clients and locality.",Counselors make a reasonable effort to provide services to the public for which there is little or no financial return.,Counselors do not have to discuss payment during informed consent since it may change during treatment.,"(A): If a counselor's usual fees create undue hardship for the client, the counselor may adjust fees or make an appropriate referral.
(B): In establishing fees for professional counseling services, counselors consider the financial status of clients and locality.
(C): Counselors make a reasonable effort to provide services to the public for which there is little or no financial return.
(D): Counselors do not have to discuss payment during informed consent since it may change during treatment.",Counselors do not have to discuss payment during informed consent since it may change during treatment.,D,"Counselors must discuss payment during the informed consent process, as well as payment modalities and inform clients that they may change at any time, if applicable. When establishing fees, there are many things for the counselor to consider such as location and financial status of clients. If the counselor realizes that payment is causing a hardship, appropriate steps must be taken such as referring out or lowering fees. Counselors also ensure that they give back in providing services pro bono to the community, trainings for future counselors, or reducing fees. Therefore, the correct answer is (B)",treatment planning
1601,"Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)","Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner","You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.","   vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week",Which of the following would be considered a differential diagnosis for adjustment disorder?,Disinhibited social engagement disorder,Normal stress response,Bereavement,Generalized anxiety disorder,"(A): Disinhibited social engagement disorder
(B): Normal stress response
(C): Bereavement
(D): Generalized anxiety disorder",Normal stress response,B,"When bad things happen, it is normal that it affects the individual. A normal stress response is expected for situations that are difficult, but what distinguishes it as an adjustment disorder is when the stress affects functioning. Generalized anxiety disorder would involve anxiety surrounding general situations that affect functioning, but this would not be appropriate because the anxiety is surrounding his relationship with his wife and children. Although the client is experiencing the loss of a relationship, bereavement is not a consideration because the client is experiencing anxiety and depression surrounding the adjustment to a different way of life as opposed to just about the loss of a relationship. Disinhibited social engagement disorder is when children approach and engage with individuals with whom they are not familiar, but this does not define this individual’s situation. Therefore, the correct answer is (A)","intake, assessment, and diagnosis"
1602,Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0),"Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th","You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.","The client has attended and actively participated in all group therapy sessions. You are preparing the group for termination and discussing a “graduation” ceremony. The client has taken on a leadership role in the group, and you have asked him if he would be your “assistant” for the next group of neurodiverse men. The client approaches you, shakes your hand, and uses eye contact as he politely thanks you for the offer. You state you are pleased he has accepted. He then says, in a matter-of-fact tone, “Absolutely, I see that you really need help with offering better refreshments and teaching certain skills.”  In part, attitudes stemming from ableism prevent many young adults with ASD from receiving adequate education on intimacy and sexuality","In part, attitudes stemming from ableism prevent many young adults with ASD from receiving adequate education on intimacy and sexuality. Which statement best describes ableism?",Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from an unwillingness to acknowledge and address deficits among individuals suffering with ASD.,Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.,Ableism is he intentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.,Ableism is the intentional discrimination and marginalization of individuals with ASD supported by prejudicial actions that they are less capable and worthy.,"(A): Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from an unwillingness to acknowledge and address deficits among individuals suffering with ASD.
(B): Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.
(C): Ableism is he intentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.
(D): Ableism is the intentional discrimination and marginalization of individuals with ASD supported by prejudicial actions that they are less capable and worthy.",Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy.,B,"Ableism is the intentional and unintentional discrimination and marginalization of individuals with ASD resulting from prejudicial beliefs that they are less capable or worthy. Ableism is rooted in biases that can be either explicit (ie, conscious or intentional) or implicit (ie, unintentional or unconscious). Ableism grants privilege and favor to individuals who are healthy or non-disabled. Answers A and B refer solely to intentional discrimination, making those options incorrect. Answer D includes intentional and unintentional discrimination but is incorrect because it refers to an unwillingness to acknowledge and address deficits among individuals suffering from ASD. The medical model perpetuates stereotypes and biases by referring to individuals with ASD (and other disabilities) as having deficits (akin to being sick) that need an intervention to be cured from the suffering. Neurodiverse advocates maintain that barriers hinder those with ASD from reaching their full potential, and promote an integrative approach by valuing impairment as an integral part of diversity. In terms of sex education and ASD, ableism can lead to perceptions of individuals with ASD as asexual and childlike, leading to the overprotection of individuals expressing normal drives and interests. As a result, sexually active young adults with ASD encounter victimization, unwanted pregnancies, and sexually transmitted infections at higher rates than neurotypical individuals. Further, the ACA Code of Ethics (2014) calls for the promotion of social justice defined as, “treating individuals equitably and fostering fairness and equality”. Therefore, the correct answer is (C)","intake, assessment, and diagnosis"
1603, Initial Intake: Age: 15 Gender: Female Sexual Orientation: Unknown Ethnicity: Hispanic Relationship Status: Unknown Counseling Setting: School-based through a counseling agency Type of Counseling: Individual,"Maria is slightly unkempt with a flat expression and normal rate and tone of voice. Maria is highly tense, hypervigilant, and anxious, flinching in response to loud noises and intermittently darting eye contact. She appears to “veer off” mentally while you are speaking with her, then realizes she is doing so and returns her attention to you by nodding her head and reconnecting with her gaze. She denies history of trauma, prior to this event, has no prior experience in counseling, and denies SI/HI. Maria maintains the position that she does not need counseling for herself but is willing to talk to someone about how she can better help her siblings.","Diagnosis: Acute Stress Reaction (F43.0), Provisional
 

You are a mental health counseling intern providing sessions for students inside of a high school. Maria enters the conference room that you use to meet with students and sits down to tell you that she needs help for her siblings. You have no referral for Maria and were not scheduled to meet with anyone during this hour of the day. Maria shares that two days ago, her and her two younger elementary school siblings witnessed their father take a gun to their mother, shoot and kill her, and then use the gun on himself. She tells you she is fine and does not need counseling, but she wants her brother, age 7, and sister, age 4, to receive counseling because it was likely “very traumatic for them.” Identifying that Maria is clearly in shock, you offer your sincere condolences, followed by recommending Maria have counseling as well. She declines at first, insisting she is doing okay and has nothing to talk about. After inviting the school counselor and assistant principal to the discussion, with Maria’s permission, they help convince her that it would be healthy for her and her siblings if she was also being seen by a counselor. The principal adds that some of the school staff, including herself, responded to the incident the following day by going to the neighbor’s house to assess for the children’s safety and let them know they had permission to take a leave of absence from school. Maria insisted on coming to school the next day, saying she was “fine” and “needed the distraction.” Maria consents to meeting with you, but only because she believes it will help her family stick together. Due to the nature of the trauma and obvious client need, you receive permission from your supervisor to provide services pro bono until insurance or payment can be established.","Family History:
Maria is the oldest child of three children, and to her knowledge her siblings were born of the same two parents as herself; but she was unable to confirm this with absolute certainty during the initial assessment. She has difficulty providing historical information on her parents but can tell you in her own words she knows her dad was “sick” with “mental problems” and that her parents fought often. She tells you after the incident occurred her neighbors rushed to their aid and were able to take them in until they can establish a more permanent living situation with their grandmother, who lives across town and is preparing to have them move in soon. You ask if she can have her grandmother sign your company’s consent paperwork, but she replies that she has no transportation and does not speak English. She adds that her mother always told her she would want her to “go to her grandmother” if something ever happened to her and her father.",Maria is anxiously shaking her leg. Why should you point out this observation to her?,To increase her self-awareness and hope she shares her feelings.,Anxious behaviors further increase anxiety.,To demonstrate her need for counseling.,It is distracting you from things she is saying.,"(A): To increase her self-awareness and hope she shares her feelings.
(B): Anxious behaviors further increase anxiety.
(C): To demonstrate her need for counseling.
(D): It is distracting you from things she is saying.",To increase her self-awareness and hope she shares her feelings.,A,"Making observations of physical behaviors in session can either help a client share more because they feel seen and validated or cause a client to become more self-conscious and withdraw. It is an empathic technique, much like the active listening skill of reflection, only because it is non-verbal it draws a different reaction. Telling Maria, ""I noticed as you discuss your brother's fears, your leg begins to shake,"" is an open invitation for Maria to share if or why she thinks they are connected phenomena. This can lead to a CBT discussion about how thoughts and feelings affect our behaviors. Anxious behaviors, such as leg shaking, do tend to increase anxiety; however, your goal is not to get her to stop shaking. She may need this subconscious, compulsory action to release tension as she speaks. Regarding answers b) and d), you would not use these observations to prove the point that Maria needs counseling, or to make your counseling experience less distracting. Therefore, the correct answer is (C)",counseling skills and interventions
1604,"Name: Ruth and Dale Clinical Issues: Parenting/co-parenting conflicts Diagnostic Category: V-codes Provisional Diagnosis: Z63.0 Relationship Distress with Spouse or Intimate Partner Age: 41 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Married Modality: Couples Therapy Location of Therapy : Agency  ","Appearance: The client is casually dressed and adequately groomed. She appears healthy, and her age is consistent with her stated age.  Behavior: The client's behavior is tense and purposeful. She is cooperative with adequate rapport.  Speech: Speech volume is normal, and speech flow is normal and spontaneous.  Mood: The client's mood is dysphoric and anxious.  Thought Process: Thought process is logical. Thoughts are negative.  Affect: The client's affect is broad and appropriate to the discussion.  Cognition: The estimated level of intelligence is within average range with abstract thinking. Concentration is intact. The client shows no problems with memory impairment.  Insight and Judgment: Insight is fair. Impulse control and judgment appear to be below average.","First session You are a therapist working at a marriage counseling agency. Ruth is a 41-year-old female who comes to your office with her husband. The couple has been married for seven years and have two children, ages five and one. The husband also has a 16-year-old daughter from a previous marriage who lives in the home. The client is a stay-at-home mom, and her husband works at a correctional institution. Their five-year-old has been removed from three separate daycare facilities because of her defiant behavior. In addition, the 16-year-old was recently arrested for shoplifting.    At the end of the session, the client turns to her husband and says, ""I'm the one who has to stay home with the kids all day. You just don't get it. You don't know what it's like having no time for yourself and no quiet place to relax. You think all this stuff with the kids is a normal phase and everyone will grow out of it. Well, I don't think it's normal, and I'm tired of it! I've been talking to my ex-husband lately because he listens to me, and I feel better after I talk to him.""    Ruth demonstrates elevated stress and anxiety levels, as evidenced by her verbalization of feeling overwhelmed by the demands of caring for their children and lack of personal time. She also expresses feelings of frustration with her husband, who she perceives as not understanding her struggles. Her husband's absence during the day and the children's challenging behaviors have likely contributed to the client's feelings of isolation and burnout. Ruth's decision to reach out to her ex-husband for emotional support may indicate that she is not receiving adequate support from her current partner.","Ruth's parents died in a boating accident while she was in college. She has two brothers and one sister, but they are not close, partially due to the strain of losing their parents. Her husband's first wife left him soon after their daughter was born. She does not discuss her place in the family's dysfunction but talks about other family members who need help. Ruth has been unable to heal her relationship with her sister and feels guilty about it. She also expresses concern for her husband's well-being after his first wife's divorce, which she was partly responsible for. Additionally, Ruth struggles with depression and anxiety due to trauma related to the death of her parents. Personal/Social Relationships: Ruth feels that her husband minimizes their children's problems and is to blame for their lack of improvement. Ruth feels her marriage is ""on the rocks.'"" Her husband knows his wife is unhappy but does not know what to do. Finally, you learn that Ruth recently reconnected with her ex-husband and is seriously considering having an affair. Previous Counseling: The client has been working on her low self-esteem through therapy but says she is not getting any better. Her husband says, ""I know Ruth is unhappy. That much is obvious. She's stressed out all the time, and she's stopped talking to me. She gets in the car, is gone for hours, and isn't home when I arrive after work. I'm worried I will lose her, but I don't know what to do.""  ",Which of the following behaviors best describes the communication style displayed by the couple in the above session?,"Defensive communication style, as described by Gottman's four horsemen theory.",Stonewalling communication style,Contemptuous communication style,Repair communication style,"(A): Defensive communication style, as described by Gottman's four horsemen theory.
(B): Stonewalling communication style
(C): Contemptuous communication style
(D): Repair communication style",Contemptuous communication style,C,"Contemptuous communication as described by Gottman's four horsemen theory is characterized by sarcasm, eye-rolling, name-calling, and hostile humor. The wife's statement that she has been talking to her ex-partner because he listens to her and makes her feel better can be seen as an expression of contempt towards her current partner. This style of communication is highly correlated with relationship dissatisfaction and breakdown. Therefore, the correct answer is (A)",counseling skills and interventions
1605,"Name: Gary Clinical Issues: Behavioral problems Diagnostic Category: Disruptive/Impulse-Control/Conduct Disorders Provisional Diagnosis: F91.3 Oppositional Defiant Disorder Age: 10 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Not Assessed Ethnicity: White Marital Status: Not Assessed Modality: Individual Therapy Location of Therapy : Agency  ","The client reluctantly enters the session accompanied by his mother. He is slightly overweight for his age and is wearing clothes that appear too small for his physique. He is sitting in the chair with his arms crossed, refusing to make eye contact with you. His mood is angry, and his affect is irritable. His attitude during the initial part of the examination is defiant. Speech characterized by short responses and refusal to engage in conversation. Client refuses to discuss feelings or issues. He appears to have difficulty focusing. He lacks insight into his behavior and impact on others. Judgment and impulse control are poor. He denies suicidal or homicidal ideation.","First session You are a mental health therapist in an agency, and a 10-year-old male is referred to you due to behavioral issues. The client and his mother arrive at your office, and you note that he has an irritable look on his face. The two are arguing with each other. His mother threatens him with punishment if he does not cooperate with you and says that this is his ""last chance"". He glares at her and then stares at the floor. You introduce yourself and explain what you do as a therapist. The client barely says a word and keeps his head down with his arms crossed over his chest. You ask the mother to describe the issues that prompted her to seek help and she begins to tell you the story.    She explains that her son has difficulty listening to adults and gets into verbal altercations with his peers. She informs you that he got suspended again from school because he lost his temper in the cafeteria when the student in front of him in the lunch line ""wasn't moving fast enough"". When you ask about how often his temper outbursts occur, the mother pauses for a moment to think and says, ""It seems like he's always losing it, but I guess maybe a few times a month? The rest of the time, he's just angry, mostly at me and other adults. No matter what I do, he seems like he hates me."" As she tells you this, you notice that the client is not paying attention and continues to look down at the floor, appearing disinterested in the conversation. His mother goes on to say that the school is threatening expulsion if her son's behavior does not improve.    After thanking the mother for sharing this information with you, you look toward the client who has been sitting quietly the entire time. You explain that you understand it must be hard for him to be here and that you are not here to judge or criticize him. He looks up at you with a surprised expression on his face. He slowly nods and mumbles something under his breath. You let him know that you want to help him find ways to better manage his emotions so he can get along better with the people in his life. He looks away again, but this time there is a hint of curiosity in his eyes. You sit in silence for a moment. The client finally looks up at you and says, ""It's just...everyone's always telling me what to do and they never listen to me. They think they know everything, but they don't. I can't help it if I get angry, but then everyone looks at me like I'm a monster. It's not fair."" His mother looks away, tears in her eyes. You thank the client for expressing his feelings and explain that it is normal to feel upset when things are unfair. You further emphasize that you are here to help him find positive ways to handle his anger and other emotions. You then address the mother, ""Parenting can be challenging, especially when it feels like your child is angry or upset with you. I'd like to work with both of you to improve your communication and relationship. It might be helpful to schedule separate sessions for you and your son, as well as joint sessions, so we can address individual concerns and work on improving your relationship together."" The mother agrees, and you proceed to discuss a plan of action, including setting up regular weekly therapy appointments and providing resources to help support the family.  Fifth session It has been over one month since you first began working with the client. You've been meeting with him for individual therapy and have implemented parent training with his mother. During previous counseling sessions, you focused on building rapport with the client and talked about different triggers for his outbursts. He said that he often gets angry when people do not listen to him or when they try to tell him what to do. You also discussed strategies for managing these triggers and the importance of communicating his needs in a respectful way. Last week, as part of your parent management training approach, you assigned the mother homework to read from a parent training handbook.    When the client arrives for today's session, he is clearly upset, saying that he does not want to be here. His facial expression is one of anger and frustration. His mother is exasperated and apologetic. You calmly remind her that it is all right, that this is a normal part of the process. You ask if she would like to accompany them into your office, but she declines, saying that she needs some time to herself and she would like to wait in the waiting room for the first half of her son's session. Once inside your office, you start by asking the client why he does not want to be here. He says that he is tired of talking about his problems and he does not think it will make any difference. When you ask him to tell you more, he glares at you and says, ""Why do you care? You're only asking because you want to get paid."" You acknowledge how difficult it can be to keep coming back, but emphasize that whatever feelings he is having in this moment are valid and important. The client then looks away and sighs. He slowly says, ""I don't know why I have to keep coming here...it feels like no matter what I do, nothing changes. I still get mad, my mom and teachers still get mad at me, and the school still threatens to kick me out.""    After a few moments of silence, you ask the client if he remembers what goals were set for the session today. He looks away and mumbles something under his breath. You gently remind him that you want to help him learn how to manage his emotions in a healthier way so he can get along better with the people in his life. He gradually relaxes and you ask him what strategies he has been using in the past week to work toward this goal. He thinks for a few moments before recounting an incident at school where instead of getting angry, he took a deep breath and walked away from the situation. You use behavioral modification techniques to encourage this positive behavior. You then move into today's activity, which is a role-play exercise. Once you have completed your planned tasks with the client, you invite his mother in to your office to provide her with feedback on her son's progress and discuss next steps with parent training.  Eighth session The client and his mother arrive for today's session. You begin by meeting with the client alone and plan to speak with his mother afterwards. You ask the client how he has been doing since last week. He is quiet and shrugs his shoulders. You take a moment to notice his non-verbal cues and then gently ask him, ""It looks like something is on your mind. Do you want to tell me about it?"" He hesitates for a moment and then says, ""I don't know. My mom told me that I have to stop playing video games so much. She said it's getting in the way of my homework. But I don't have any friends and video games are the only thing that makes me feel better. It's not fair. My mom gets to do whatever she wants."" You listen attentively and validate his feelings. You explain to him that it is important to have a balance between recreational activities and taking care of responsibilities, like doing your homework. You say, ""Your mom has a job, right? Sometimes she has to take care of things like going to work or paying bills, and it's the same when we have responsibilities at school. It takes time and effort, but if we do it, then it can free up some time for fun activities like playing video games."" He shrugs and says, ""Yeah, I guess.""    You continue the session by discussing his behavior in school and ask him if he can think of any positive experiences he has had since the last session. He thinks for a moment, then starts to shout excitedly, ""Yes! There was something!"" You intervene by giving him a choice of writing down his feelings or starting over with a quieter tone. He stops, takes two breaths, then proceeds to tell you about his experience in the school playground, where he managed to stay calm when he was provoked by a classmate. He said that his teacher was watching and praised him for staying calm. She gave him a sticker and told him that he could choose the game they would play at recess. You congratulate him on his success and praise him for his efforts.    After you conclude the session with him, you invite his mother to your office and direct the client to wait in your waiting room. You talk to his mother to determine how her home parent training is going and review the client's treatment plan with her. His mother states that when she tried to set boundaries on gaming time, he had a ""melt down"". You suggest that she could consider increasing the amount of time he can play his video games in increments if he meets certain goals, such as completing all of his homework or cleaning up his room. She agrees to try this during the upcoming week. She also mentions that her son continues to struggle socially. When she told him that he could invite a friend over for pizza, he said, ""What friend? Making friends is dumb. Who needs them anyway?""    Following the session, you receive a phone call from the client's father who states that he has recently reconnected with his family. He says, ""My wife told me that you've been working with my son. I know he's got some issues. I'm trying to get back in his life and make things right. What should I do?""","The client's father left the family two years ago. The mother, still married to him, retains sole legal custody of the client. Since his father left, the client will not help out around the house, seems angry, and sometimes loses his temper when he does not get his way. The client receives frequent but inconsistent corporal punishment from his mother. His mother made the appointment with you but did not tell him where they were going. The relationship between the client and his mother has been strained as the mother does not know how to handle the abandonment of the father. The client is in fifth grade and has been skipping school for the last six months and refuses to do any homework. His school records were released to you and show A's and B's through third grade, but C's and D's during the past two years. His decline in grades coincides with his truancy. He is also known as a ""bully"" at school and has been suspended and given detention a few times due to his behavior. He has a history of walking out of classrooms, running down the hallways, refusing to sit in his chair, and running away from the school counselor or anyone in an authoritative position. Personal/Social Relationships: The client does not have friends his age in the neighborhood, and parents do not want their children playing with him because they believe he is a ""troublemaker"". In addition, children in school avoid him because they are afraid of upsetting him. He does not seem interested in making friends and does not care to engage in any play time with the neighborhood children. Instead, he spends most of his time alone playing video games. ",What defense mechanism is the client exhibiting when he talks to his mother about making friends?,Reaction formation,Denial,Rationalization,Projection,"(A): Reaction formation
(B): Denial
(C): Rationalization
(D): Projection",Denial,B,"By denying his feelings about how it makes him feel, he acts as if he does not care. Clients who engage in denial believe that expressing genuine emotion would make them vulnerable, so they mask their true feelings with an ""I don’t care"" façade. Therefore, the correct answer is (B)","intake, assessment, and diagnosis"
1606,"Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)","Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses","You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.","You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated","If you suspect that the client may be intoxicated, all of the following are important considerations, EXCEPT:",Processing the client’s intoxication,Transportation home,Termination with the client,Continuing or ending the session,"(A): Processing the client’s intoxication
(B): Transportation home
(C): Termination with the client
(D): Continuing or ending the session",Termination with the client,C,"Termination would not be your primary concern when suspecting that this client is intoxicated. Although you may want to consider ending the current session, a discussion about termination would not be very helpful in the client’s current state and it does not support his needs at the moment. It is important to consider whether continuing the session is going to cause more harm, be helpful, or do nothing for the client. You do not know what the client is like when he uses inhalants; therefore, this could be a dangerous or harmful circumstance. You do need to consider how the client will get home if he is planning on driving and is unable to drive. It is important to know state laws because you may be liable if someone gets hurt when the client is driving home. It may be appropriate to try and process what led the client to use when he left the office because you might gain further insight into his condition. Therefore, the correct answer is (D)",professional practice and ethics
1607,Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0),"Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng","You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.","You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services.  The client asks you if she could return to work with you after the termination session if panic symptoms were to worsen or return",The client asks you if she could return to work with you after the termination session if panic symptoms were to worsen or return. Which one of the following is the most ethical response?,There is nothing ethically wrong with working with this client again,"Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy",The client should find a new therapist because you would be affected by bias if you reestablished the counseling relationship. But you can counsel her until she begins meeting with her new therapist.,You would not be able to provide counseling services without bias and should refer the client to another therapist if she needed to reinitiate counseling,"(A): There is nothing ethically wrong with working with this client again
(B): Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy
(C): The client should find a new therapist because you would be affected by bias if you reestablished the counseling relationship. But you can counsel her until she begins meeting with her new therapist.
(D): You would not be able to provide counseling services without bias and should refer the client to another therapist if she needed to reinitiate counseling","Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy",B,"There is nothing ethically wrong with working with a past client again, unless you think their current needs are outside of your scope of practice. Should symptoms worsen, your counseling would likely be very helpful for the client due to your already established rapport and familiarity with her issues. That said, it is important to encourage a client upon termination to recall the skills that were learned during your sessions as a means of preparing her for functioning and dealing with her symptoms independently. For that reason, the most appropriate response would be to first encourage her to use the learned coping skills should symptoms return, but to also reassure her that she will have access to you should those skills be insufficient. Bias is not a concern when a former client returns to counseling; rather, it would be an issue to consider should that former client request your counsel in the context of a family or a relationship, in which case you would have bias toward her over the rest of the group members. Therefore, the correct answer is (A)",professional practice and ethics
1608,"Name: Dawn Clinical Issues: Maladaptive eating behaviors Diagnostic Category: Feeding and Eating Disorders Provisional Diagnosis: F50.01 Anorexia Nervosa, Restricting type Age: 17 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Single Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client presents as a female in her late teens who appears malnourished and underweight, dressed in loose, concealing clothing. She exhibits poor eye contact and a guarded, closed-off posture with arms protectively crossed. Her affect is tense and anxious. Speech is logical and goal-directed, with no evidence of hallucinations or delusions. She denies any suicidal or homicidal ideation. Cognition is grossly intact for person, place, and time. Her insight and judgment appear limited, as evidenced by unresolved conflict with her parents and changing college majors without considering long-term career goals. She reports a strained relationship with authoritarian parents who were often physically and emotionally absent, leaving her feelings of neglect. She exhibits low self-confidence and an inability to trust her thoughts and desires. She continues to seek parental approval but feels unable to assert her needs. Her mood is anxious and frustrated due to perceived external control and lack of autonomy.","First session You are a mental health counselor in a university counseling center. Dawn, a 17-year-old college student, is referred to you by her physician. The client's parents recently visited during their parents' weekend at the university campus and were very concerned when they saw their daughter, who appeared severely underweight. They had not seen her for several months and immediately contacted the family physician for guidance. After performing a complete physical exam, the physician could not determine any medical causes for the client's low weight. The physician noted, however, that the client expressed that she did not understand her parents' concern about her weight. During the physician's examination interview, she reported feeling intense anxiety about gaining weight and implied that she was unhappy with her appearance.  Dawn reported feeling stressed and anxious about her schoolwork, friendships, and body image concerns. She explained that she often skips meals or severely restricts her food intake in an effort to maintain control. Dawn acknowledged that her eating habits have become more disordered over time and expressed openness to learning new coping strategies.  While Dawn initially resisted her parents' efforts to intervene, their concern made an impression. She agreed to continue counseling to address the underlying issues driving her unhealthy behaviors. Dawn wants to improve her well-being despite lingering uncertainties.  In today's initial counseling session, you focus on establishing trust and providing the client with a safe space to share her feelings without fear of judgment or reprisal. You begin by asking the client how she feels today and if there are any particular topics she would like to discuss. You also explore her feelings about her parents and brother and ask targeted questions to better understand the family dynamics and how they have impacted her self-esteem. You provide the client with psychoeducation regarding healthy eating habits, body image, and the consequences of not caring for oneself. Lastly, you discuss possible resources and referrals that may be helpful for the client during this time.  Dawn seemed receptive to discussing her feelings and experiences in a judgment-free environment. She sometimes became emotional when describing her struggles but appeared relieved to openly share things she had kept private. Dawn stated the counseling session felt like a positive first step.  After reviewing healthy coping tools and strategies, Dawn agreed to keep a daily food and feelings journal. She also committed to reaching out for support if feeling triggered or unable to care for herself. Dawn left the session with referrals for a nutritionist and an eating disorder support group.  Fourth session You and the client have met twice weekly for therapy sessions on Monday and Thursday afternoons. This is your fourth session, and you begin to explore the client’s support network. She reports having a difficult time making friends at college and says that she feels very lonely. She shares a dorm room with two other female students who have been best friends since elementary school. The client says she feels like an “outsider” and struggles to share a living space with these two roommates.  Dawn shared that she often spends time alone in her dorm room on weekends while her roommates go out together. She said this makes her feel even more isolated. Dawn explained that she has tried reaching out to her roommates to get to know them better, but they seem uninterested in including her in their plans.  Dawn mentioned that her older brother is the only person she feels close with right now. However, since he lives so far away, they rarely see each other in person. Dawn said she misses having her brother around to talk to and confide in.  One of her classmates invited her to have lunch on campus, but she was so anxious about eating in public that she declined the offer. Although she would like to have friends, she is worried that, eventually, she will end up in a social situation involving food; this idea creates intense anxiety for her. She believes that it is easier to avoid social situations altogether. The client begins to cry and says she often thinks about moving back home but does not feel like she belongs there anymore, especially since her parents repurposed her old bedroom. She continues crying and says, “I don’t have any friends at school, and I don’t even have a room at home. I feel like I don’t belong anywhere. I really miss my brother.”  Dawn tearfully explained that she feels caught between missing her previous life and feeling unable to adjust to her new environment at college. She is longing for connection but finds it challenging to put herself out there socially.  Crying, Dawn shared that she feels like she has no place where she truly belongs right now. She misses the security and familiarity of high school and being with her brother but also recognizes that things have changed there as well. Overall, Dawn conveyed profound feelings of loneliness and isolation.","The client has a 25-year-old brother who is a Navy Seal. The client's parents have government jobs and frequently travel to foreign countries for work. When the client moved away to live on campus, her parents immediately turned her old bedroom into a home gym, which the client found unsettling. The client says that while she knows her parents love her, they have never been very affectionate or spent much time with her. When she was younger, the client traveled with her family for a few weeks during the summer but was often left alone during their trips. She describes her relationship with her parents as ""strained"" but states that she does have a positive relationship with her brother. She plans to see him when he is on leave from the Navy. The client is a freshman at the university and has already changed her major from pre-med to music history. She is anxious about telling her parents that she switched majors and is worried they will be disappointed. She reports that she has always felt a lot of pressure from her parents to excel in school as her brother did. Since she was a child, her parents have expressed their desire to see her become a physician. Her parents have always set high expectations for her academic performance. Their authoritarian parenting style has left her doubting her confidence in her own capabilities. She is frustrated by this dynamic because she does not feel like she can think for herself or pursue her own goals without outside approval. ","Given the client’s tearfulness as she describes her feeling of not belonging anywhere, how do you proceed?",Encourage her to make an appointment with a psychiatrist,Gently help her to analyze her cognitive distortions.,Create a list of situations in which she has felt a sense of belonging in the past,Normalize her emotive response,"(A): Encourage her to make an appointment with a psychiatrist
(B): Gently help her to analyze her cognitive distortions.
(C): Create a list of situations in which she has felt a sense of belonging in the past
(D): Normalize her emotive response",Normalize her emotive response,D,"The client has verbalized that she is lonely and has expressed feelings that she does not belong anywhere. Sharing these thoughts in session has evoked an intense emotional reaction, and the therapist should normalize and validate the client’s response. Rather than discounting the client’s experience, you let the client know she has been understood by providing an empathic response. Therefore, the correct answer is (C)",counseling skills and interventions
1609, Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual,"Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.","History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.",,Autumn meets the criteria for?,Bulimia,Social anxiety,Avoidant/Restrictive Food Intake Disorder,Anorexia Nervosa,"(A): Bulimia
(B): Social anxiety
(C): Avoidant/Restrictive Food Intake Disorder
(D): Anorexia Nervosa",Anorexia Nervosa,D,"Autumn restricts her eating, has intense fear of gaining weight and purges by laxatives or over exercise, all symptoms of anorexia nervosa. Bulimia is ruled out due to lack of binge eating behaviors. Social anxiety is also ruled out as her social fears are limited to eating behaviors. Avoidant/restrictive intake disorder is ruled out because of Autumn's fear of gaining weight or becoming fat which is not a symptom in avoidant/restrictive intake disorder. Therefore, the correct answer is (B)",counseling skills and interventions
1610,"Name: Camron Clinical Issues: Worry and anxiety Diagnostic Category: Anxiety Disorders Provisional Diagnosis: F40.10 Social Anxiety Disorder Age: 20 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: White Marital Status: Never married Modality: Individual Therapy Location of Therapy : University Counseling Center  ","The client looks anxious and uneasy, presenting with a ""nervous"" laugh. He twirls his thumbs and shakes his legs while seated. Mood is anxious and frustrated. He feels isolated and misunderstood by his family and peers. Speech is soft and hesitant. Eye contact is sporadic. Thought process is concrete and linear. He has some difficulty with abstract concepts. Thought content reveals fear of social interactions, feeling judged by others, and feeling inadequate. He seems to recognize the negative consequences associated with his anxiety and behavior, but he has limited insight with regard to recognizing the source of his anxiety. He reports difficulty recalling past experiences or conversations due to anxiety levels. No suicidal or homicidal ideation noted.","First session Your client is a 20-year-old male who has been seeing your colleague at the university counseling center where you both work as mental health therapists. The client requested to be transferred to another therapist because his former therapist reminded him too much of his father and therapeutic progress could not be made. The client's former therapist contacted you as a referral, and you agreed to transfer the client to your caseload. When you meet with the client today, he seems very anxious and laughs nervously. You can see he is shaking his legs as he sits, twirling his thumbs, and making little eye contact with you. You explain the therapy process and that you need to go over some intake questions. You ask him who his ICE (in case of emergency) contact is, and he says it is his roommate. You continue with your assessment, gathering information about his presenting problem and what he would like to accomplish in counseling.    He continues by telling you, ""I thought that going to college would alleviate my social anxiety, but I'm not doing well here. I want to be social, but I can't."" The client feels frustrated and overwhelmed by his fears of interacting with others. He tells you that when he is feeling anxious, he punches bathroom mirrors to try to distract himself from the anxiety. He notes that the anxiety is crippling, preventing him from doing the things he loves, and has resulted in him feeling isolated. He is afraid that others are judging him and is constantly worried that he will make a mistake and feel embarrassed.  Fourth session It has been three weeks since the initial counseling session with your client. The client comes to your office for his weekly session and says, ""I tripped on my way here when I got off the subway, and I felt so embarrassed. I'm going to take a cab back to campus. What if people who saw me fall are still in the subway by the time we finish?"" You ask your client to explain this embarrassment and why he thinks people who saw him fall this morning would still be in the station an hour later. He tells you that when he was little, his father always told him, ""Don't do this, don't do that. People are going to think you're stupid. I still hear his voice in my head, telling me what to do. I've spent my whole life trying to live up to his expectations, and I'm tired of it!"" You explore this with your client and use guided imagery to ask him to return to that little boy in his memory. He tells you, ""I can't concentrate right now. The anxiety of remembering my childhood is stressing me out.""    You switch to using behavioral techniques as a way to help him manage his anxiety. You explain that it is important for him not only to challenge his anxieties but also recognize his successes. To ensure that he feels successful and rewarded, you come up with a plan so he can realize progress and be able to measure it. In order for you and your client to monitor his progress, you create charts that will document any positive changes he experiences during the therapy sessions. As part of the plan, your client will commit to engaging in activities outside of the counseling session which are designed with the purpose of calming him down and helping him practice his newly-acquired skills to manage his anxiety.","The client grew up in an authoritarian house where all of his actions and behaviors were scrutinized by his father. His father demanded obedience from his son and would not accept anything but perfection from him. He graduated from high school at the top of his class and has been waiting to attend college to get out from ""under the thumb"" of his father. The client's parents are paying all of his college expenses. The client is experiencing difficulties adapting to college life. He states that he stays in his room because he believes he always says and does the wrong thing, and everyone can see what a ""loser"" he is. He further states that he rarely leaves his dorm room except to go to his work-study position. The client has experienced two panic attacks; one occurred when he was required to give a presentation in class, and the second happened when he was required to meet with a small group to discuss his input for their group project. The client has missed many classes in which he is expected to participate or present projects. He is currently failing three classes. The client is in danger of losing his work-study job on campus due to frequent absences. He is competent and conscientious when his job does not require customer interaction. Personal/Social Relationships: The client is interested in exploring social relationships but is anxious as his father never allowed him to interact with his peers. As a result, his level of social functioning is relatively low. He has talked with a few students in his dorm and classes when required, but he feels extremely uncomfortable and inept. The client has not developed any friendships because of his anxiety. ",What is the optimal time to elicit your client's active involvement with their treatment plan?,During the initial session,Once he has gained insight into what is causing his anxiety,After he has successfully demonstrated progress by implementing one coping strategy,After his anxiety levels have stabilized,"(A): During the initial session
(B): Once he has gained insight into what is causing his anxiety
(C): After he has successfully demonstrated progress by implementing one coping strategy
(D): After his anxiety levels have stabilized",During the initial session,A,"The optimal time to elicit a client's active involvement with their treatment plan is as soon as they start attending sessions. Starting the therapeutic process by establishing an individualized treatment plan that functions as a roadmap for progress can help create structure and trust in the therapeutic relationship. Additionally, it can help ensure that both you and your client have clarity on what is expected of them, as well as their desired outcomes. Therefore, the correct answer is (C)",treatment planning
1611,"Name: Rick Clinical Issues: Referred for emotional and behavior issues Diagnostic Category: No Diagnosis Provisional Diagnosis: No Diagnosis Age: 18 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: Korean Marital Status: Single Modality: Group Therapy Location of Therapy : Community Center  ","The client is slouched over in his seat and appears withdrawn with a flat affect. He keeps his head down. The client plays with his shirt sleeve, twisting the material and pulling at it. You cannot see any cuts on his arms as reported by the mother. He does not appear to be angry at this time, which was also a symptom reported by his mother. He responds to your questions with one-word answers. He seems uninterested. The client denies any suicidal and homicidal ideation. The client mumbles, ""I don't want to talk about anything here.""","First session You work as both an individual and group therapist at a community center that primarily sees adolescents with emotional and behavioral issues. Rick is a senior in high school and lives with his mother and two sisters. Rick does not want to participate in individual or group therapy, but his mother insists that he get help. During the intake, you work to establish rapport with Rick. You also gather information to determine if he is an appropriate candidate for one of the groups you are preparing to start, along with a co-facilitator. You suspect he may have trouble trusting females as he expresses anger when talking about his mother, sister, and ex-girlfriend. Since his father left, Rick says that his mother has been ""in his business"" all the time, and he does not feel like he has any real privacy.    You remain patient with Rick, listening to his story and validating his feelings. You empathize with him, letting him know it is understandable to feel frustrated about not having much privacy. You explain that you are here to help him, not to control him and that you are interested in learning more about him.    You explain to Rick that you are planning to start a group therapy session with a co-facilitator and that you would like to see if it would be a good fit for him. You explain that the group will provide an opportunity for him to talk about his experiences in a safe space with others who may have gone through similar situations In addition, you share that it could be an excellent way for him to practice expressing himself and developing trust in others.    You also explain to Rick that individual therapy sessions could be beneficial in addition to group therapy. You discuss the possibility of one-on-one sessions that would give him a chance to talk more deeply about his experiences in a safe, private setting You emphasize that this could be an excellent way for him to explore his feelings and learn how to cope with them in a healthy way.","The client is a first-generation American whose parents immigrated from Korea. He has an old sister who, based on Korean culture, is his superior whom he must obey and be subservient to. His parents have high expectations for him and are very controlling, expecting him to study every night and attend tutoring sessions on the weekend. They have arranged for him to marry a daughter of a prestigious family in Korea after he completes medical school eight years from now, with the intention that he and his wife will live with them and provide financial support. However, this plan has drastically changed.    Seven months ago, the client's father moved out after his mother had an affair. The client became sullen, angry, and withdrawn after this event. Four months ago, while doing laundry, the client's mother saw dried blood on his shirt sleeve. She also noticed that he was wearing long-sleeved shirts all the time. She waited until he was getting dressed, walked in on him, and found he had cuts up and down his arms. The client does not speak to his father much since his parents separated. The client expresses a lot of anger toward the women in his life, specifically his mother, sister and ex-girlfriend. The client is a senior in high school. His grades have been suffering lately, and he is currently failing his math and science classes. Personal/Social Relationships: The client had been concealing his romantic relationship with a girl from his Saturday tutoring class, but following his father's abrupt departure from the family, he chose to discontinue the relationship and cease attending the class. He has since refrained from any communication or contact with her. His mother's affair has caused him to feel overwhelmed with anger, leading him to develop a dislike of all women. ","Rick, from his current experience living at home with his overprotective Korean mother, is afraid that she will want to know everything that goes on during your counseling sessions. What would you say as a clinician to Rick regarding what she has access to?",Explain to Rick that his mother will not have access to the conversations that take place in the counseling session.,Explain to Rick that his discomfort concerning his mother is part of his diagnosis and begin to unpack his feelings and motivations.,Explain to Rick that he can disclose what he wishes to his mother but that his mother cannot contact you directly.,Explain to Rick that it is his mother's right to know what is discussed in the counseling session since he is in high school and lives at home.,"(A): Explain to Rick that his mother will not have access to the conversations that take place in the counseling session.
(B): Explain to Rick that his discomfort concerning his mother is part of his diagnosis and begin to unpack his feelings and motivations.
(C): Explain to Rick that he can disclose what he wishes to his mother but that his mother cannot contact you directly.
(D): Explain to Rick that it is his mother's right to know what is discussed in the counseling session since he is in high school and lives at home.",Explain to Rick that his mother will not have access to the conversations that take place in the counseling session.,A,"Though the client is still in high school and living at home, he is 18 and considered an adult. His mother will not have access to the conversations that take place in the counseling session. Therefore, the correct answer is (D)",professional practice and ethics
1612,Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1),"Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam","You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.","The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process","Once a core belief is identified, which cognitive restructuring technique would you select to help reduce psychological distress?",Role reversion,Identify the “three basic musts”,Shame-attacking exercises,Ask exception questions,"(A): Role reversion
(B): Identify the “three basic musts”
(C): Shame-attacking exercises
(D): Ask exception questions",Role reversion,A,"Cognitive therapists use role reversion to challenge negative cognitions, therefore reducing psychological distress. Role reversion works by instructing clients to switch roles with the counselor and argue against the client’s hypothesis associated with distorted thinking. Shame-attacking exercises are REBT techniques designed to be performed in public to reduce the need for others’ approval. The theory behind shame-attacking exercises is that by reducing the need for approval, there is also a reduction in catastrophic thinking that fosters feelings of inadequacy. Identifying the three basic musts, or irrational beliefs, is an REBT technique. The three basic musts include (1) believing one must perform in a manner that others affirm or else one is void of self-worth, (2) believing one must be treated in a manner that the client finds affirming or else one is labeled “no good,” and (3) believing that one must get what they think they are entitled to or that one’s life is unacceptable. Exception questions are a solution-focused technique used to explore times in the client’s life when the problem did not exist, thus creating optimism, hope, and the potential for recreating those experiences. Therefore, the correct answer is (C)",counseling skills and interventions
1613,"Name: Alexei Clinical Issues: Substance use/addiction issues Diagnostic Category: Substance Use Disorders Provisional Diagnosis: F10.99 Unspecified Alcohol-Related Disorder Age: 32 Sex Assigned at Birth: Male Gender and Sexual Orientation: Male, Heterosexual Ethnicity: German American Marital Status: Married Modality: Individual Therapy Location of Therapy : Private Practice  ","A 32-year-old German American man confidently enters your office. He is tall and slender and appears older than his stated age. His physical appearance is unkempt. The client's voice quality is strong and loud, and his command of English is minimal. His posture and gait are limp and unsteady at times. He is slurring his words and appears to be actively intoxicated. He portrays no accountability or responsibility for his actions with substance use. He denies any current thoughts of homicidal ideations. The client lacks insight, and his thought processes are not logical or appropriate.","First session You are a psychoanalytic therapist in private practice and often work with clients who struggle with substance use issues. You believe these issues often arise from unresolved conflicts and the inability to manage emotions. Today, you are seeing a 32-year-old German American male named Alexei, who was referred to you due to occupational disciplinary issues related to alcohol use. Alexei was referred to you by his employer, where he works in a manufacturing plant in the Midwest. His supervisor noticed marked changes in his behavior and productivity over the last few months and was concerned that Alexei might be dealing with a drinking problem. The supervisor initially suggested an employee assistance program, but Alexei was adamantly opposed to talking to anyone involved in his workplace.    You introduce yourself and explain to Alexei that this is a safe and confidential space where he can discuss whatever is troubling him. You reassure him that the only people who will know about the details of this session are himself and yourself. Then, you begin to ask open-ended questions to assess Alexei's current state of mind and identify his current challenges. You are particularly interested in understanding his thoughts and feelings about his substance use and the occupational problems it has created. You notice that Alexei seems excessively relaxed as you establish the confidentiality of the session. As you delve deeper into his thoughts and feelings, you ask him to describe his relationship with substances, particularly how they have affected his daily life and work performance. Alexei hesitantly opens up, admitting that his substance use has become a coping mechanism to deal with mounting stress and anxiety. You listen empathetically and validate his emotions while gently probing into the factors that have contributed to this pattern of behavior.    Alexei tells you that his boss has never liked him and is trying to get him fired. He reports that he sees nothing wrong with having a few drinks in the morning and after lunch. He has been late to work ""only a few times"" because of a hangover. Alexei states that he needs help finding a new job. You ask Alexei if he can tell you more about his drinking habits. He says he usually starts drinking around 9 am and has been drinking more in the past few weeks. He also admits to drinking at work a couple of times. He looks at you suspiciously, wondering why you need to know this. You explain that it is important to understand his drinking habits and the context of his behavior to provide the best care.    As the session continues, you observe that Alexei's cognitive functioning appears impaired, as he struggles to maintain focus and has difficulty recalling important details. He expresses frustration and anger when discussing his work situation but minimizes the impact of his alcohol consumption on his professional life. Alexei's denial of his alcohol-related problems and the escalating pattern of his drinking behavior indicate a potential substance use disorder. Furthermore, his physical symptoms, such as sweating and slurred speech, suggest that he may be experiencing acute effects of alcohol during the session. It becomes evident that addressing Alexei's alcohol use and its consequences is crucial to provide appropriate care and support for him in his current situation.","The client grew up in Germany and recently immigrated to America with his wife and mother. Both parents have a history of alcohol abuse and divorced when he was five. After his father left, his mother's enmeshment with her son intensified. She made him spend time with her rather than his school friends and used the threat of leaving him in an orphanage to control his behavior. Whenever he became upset or anxious, she would cuddle him and give him sips of whatever alcohol she consumed.  The client was recently arrested for driving under the influence. The client's wife is contemplating separating because of her husband's continued drinking. He identifies a couple of bartenders as ""friends"" but cannot recall anyone he knows in an alcohol-free context. He has also been late or missed work due to hangovers and will likely lose his job. His co-workers have often complained that he smells of alcohol. Previous Counseling: The client has had suicidal thoughts thrice, all of which were recent. The initial occurrence was after a DUI incident, followed by a write-up at work, and the third after his wife proposed a separation. The client has shared that he has a specific plan in mind for ending his life, which involves either ingesting pills or cutting his wrists.",How could you ask the client if substance use is a problem and demonstrate a non-judgmental stance at the same time?,"""Substance use is not your fault; it is a medical condition you should not be ashamed of.",What leads you to believe that you are incapable of controlling your drinking?,"""How could substance use possibly play a role in your current situation?""","""In order to tackle your drinking issue, where do you suggest we begin our treatment?""","(A): ""Substance use is not your fault; it is a medical condition you should not be ashamed of.
(B): What leads you to believe that you are incapable of controlling your drinking?
(C): ""How could substance use possibly play a role in your current situation?""
(D): ""In order to tackle your drinking issue, where do you suggest we begin our treatment?""","""How could substance use possibly play a role in your current situation?""",C,"This is not accusatory nor is it judgmental. It is also open-ended, allowing for multiple options as answers. It gives the client a chance to think about the issue and then respond with a more thoughtful answer without being on the defensive. Therefore, the correct answer is (B)",counseling skills and interventions
1614,"Name: Amy Clinical Issues: Hopelessness/depression Diagnostic Category: Depressive Disorders Provisional Diagnosis: F34.1 Persistent Depressive Disorder (Dysthymia), Severe Age: 15 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: White Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client appears in your office with loose clothing and a thin physical frame. She has inconsistent eye contact and portrays a drowsy level of consciousness. Her speech rate is slow, her volume is soft yet monotone, and her fluency and rhythm are unclear and hesitant at times. She talks about how much she hates her life. Her mood is depressed and discouraged, while her affect is flat and sad. The client has been previously hospitalized for suicidal ideation. Her thoughts are slowed, and she is easily distracted. Her concentration is impaired with frequent lapses in attention. She is unable to follow a long line of thought or argument. She also reports difficulty making decisions. Her insight and judgment are limited. The client's emotional state is characterized by a pervasive sadness, irritability, and feelings of hopelessness. She exhibits difficulty in concentrating, making decisions, and expressing herself coherently. Additionally, she is experiencing disrupted sleep patterns, including insomnia and excessive daytime sleepiness, and has reported a diminished appetite with subsequent weight loss","First session You are licensed as a mental health therapist working on a post-doctoral thesis related to depression and have been working with several clients diagnosed with Persistent Depressive Disorder. One of your new research participants is a 15-year-old client who arrives at your office with her mother after being released from the hospital. Before beginning the session, you ask to talk with the mother and daughter separately. When interviewing the mother, she tells you about her daughter's ongoing behavioral difficulties, experimenting with drugs and alcohol, and getting involved with a ""bad group of kids."" The client's academic performance has also been affected, with teachers reporting a notable decline in grades and participation in class. This behavior has been ongoing for approximately six months and appears to be intensifying.    The strained familial relationships that the client is experiencing are a constant irritation to the entire family. The father's instability may have contributed to the client's current emotional distress, exacerbating her depressive symptoms. The client's mother, while providing primary care, struggles to maintain any bond with her daughter due to the increasing social withdrawal and lack of communication    Next, you interview the daughter. You ask her questions about school, friends, and activities she enjoys. She states that she is picked on daily at school, has no ""real"" friends, and hates her life. The client sighs heavily, saying, ""Some nights I go to bed hoping that I won't wake up in the morning. There's nothing to look forward to. School is horrible. She explains that she feels like she is ""stuck in a dark hole"" and that she cannot get out. She reports feeling hopeless, helpless, and alone. You summarize what she has told you, and she confirms your understanding of her feelings.    After completing your interview with the daughter, you invite the mother to join you in your office. You continue to gather information about the client's personal and family history, symptoms of depression, and risk factors contributing to her current state. You explore potential triggers for her suicidal ideation and any protective factors in place. The mother reports that her daughter has been struggling with a lack of self-confidence and low self-esteem. You also discuss her current support system and any potential areas for improvement. Through the assessment, you can comprehensively understand the client's challenges and strengths. At the end of the intake, you check to ensure that both mother and daughter clearly understand what you have discussed today. You plan to meet with the client on a weekly basis, and you schedule a session for the following week.","The client's mother reports that the client's father has a history of depression. The client's mother is her primary caregiver, as her father is in and out of psychiatric facilities. When the client was a child, she had a positive relationship with her mother, but as a teenager, she has been withdrawing from her mother and spending most of her time alone in her room. The client has missed many days of school in the past few months. She feels that no one at school likes her; she has tried to fit in by experimenting with alcohol and marijuana, controlling her weight, and staying out late at night. The client is struggling academically and lacks concentration in the classroom. At home, the client is withdrawn and spends most of her time in her room pretending she is doing homework but is actually scrolling through social media posts for several hours. In addition, she is having trouble sleeping and stays up late. ",What would you explore in order to gather information about the client's level of functioning?,Ask the client's mother,Administer an in-depth survey,Explore relationships with her peer group,Engage the client in an in-depth role-play regarding peer interactions,"(A): Ask the client's mother
(B): Administer an in-depth survey
(C): Explore relationships with her peer group
(D): Engage the client in an in-depth role-play regarding peer interactions",Explore relationships with her peer group,C,"The client's level of functioning within her peer group is indicative of her ability to relate in general. Therefore, the correct answer is (B)",counseling skills and interventions
1615,Initial Intake: Age: 20 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents looking appropriate to stated age and with positive signs of self-care related to hygiene and dress.  Mood and affect are congruent, and motor activity is within normal limits. His interpersonal communication is cooperative, open, and forthcoming. His speech is within normal limits with respect to volume, tone, or rate. His thought processes appear within normal limits with insight into his thoughts and behaviors, including concerns others express about his situation. He demonstrates the ability to connect ideas with circumstances and choices. He reports no thoughts of suicide or self-harm.","You are a counselor in a community mental health agency setting.  Your client presents as a 20 year old man with feelings of sadness, discouragement, being overwhelmed, and anxious. These feelings have been present for the past 4 to 5 years. He reports that while in high school, he had planned to commit suicide but did not follow through with it as he did not want to hurt his family and friends. The client tells you that he has moved frequently with his family; living overseas during his last two years of high school then beginning college in the United States. He states that he moved here 8 months ago because he wanted to be independent of his family and start “a new life without so many ups and downs.”   He lives in a house that his paternal aunt left to his family when she died. His mother and father recently separated and his father provides him with financial support. Until recently, he reports having been employed as a server in a restaurant but was fired after being accused of disrespect to a coworker. Your client states that the coworker had never liked him and he had not been disrespectful of her; however, their manager chose to let him go. He is currently attending classes at the community college and is in a mechanical engineering program. He chose this program because he thought he would really like it but he has been struggling with his courses due to his work schedule and now his major concern is making a living so that he can stay in school. He says he’s beginning to doubt whether this is the right path for him. He reports having no friends or anyone to spend time with on his days off.","Family History:
The client is an only child. His parents have moved frequently with his father’s job and have lived in different areas of the world. His mother currently lives across the country and his father lives in the Middle East due to his work. They formally separated three months ago. Prior to moving here, the client lived with his mother but was concerned that she was “spending all our money.” His mother is retired and is supported by his father. He states he doesn’t want to be like her and live off of his father’s wealth.","After identifying his unhelpful core belief, which of the following cognitive behavioral theory (CBT) interventions should be implemented during this session?","Practice the ""empty chair"" to help client challenge his negative core belief","Explore client's ability to challenge automatic thoughts using the ""downward arrow""",Explore client's automatic negative thoughts and cognitive distortions,Practice relaxation techniques to help client reduce anxiety about friendships,"(A): Practice the ""empty chair"" to help client challenge his negative core belief
(B): Explore client's ability to challenge automatic thoughts using the ""downward arrow""
(C): Explore client's automatic negative thoughts and cognitive distortions
(D): Practice relaxation techniques to help client reduce anxiety about friendships",Explore client's automatic negative thoughts and cognitive distortions,C,"Unhelpful core beliefs are supported by automatic negative thoughts and cognitive distortions. Exploring these helps the client gain insight into how his core beliefs are maintained and how he can begin to change them, which will help modify the unhelpful core belief. The ""empty chair"" is not a CBT intervention. The ""downward arrow"" is a helpful CBT intervention that is used to identify unhelpful core beliefs. The belief has already been identified and other interventions are used to begin modifying it. Relaxation techniques can be helpful for clients who are experiencing acute anxiety. This client does not present as anxious during this session so beginning to work on his core beliefs will be most effective at the moment. Therefore, the correct answer is (C)",counseling skills and interventions
1616,Initial Intake: Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Community Mental Health Agency Type of Counseling: Individual,"The client presents appropriately dressed with evidence of positive self-care related to hygiene and appearance. Her mood is stated as anxious about being labeled as “crazy” though you note her affect appears to be angry.  Her movements and speech demonstrate no retardation; she is cooperative, engaged, and forthcoming. She reports past suicidal attempts using alcohol or pills when she was extremely angry at her boyfriend or her parents, but emphasizes she has no current suicidal ideations. She also states she has had past thoughts of hurting others but emphasizes she does not desire to or think about hurting others now.  Her short- and long-term memory appear to be intact, but demonstrates poor insight and judgement in choices.","You are a counselor in a community mental health agency.  The client presents for “an evaluation,” which she states is required by her parents before she is allowed to move back into their home. During the intake session, you learn that your client was married for 18 months and has been divorced for two years. The client states that her husband had an affair during their marriage, which led to the divorce. She states she has a daughter who is five years old and shares custody with her ex-husband, who is now remarried. She reports that she was living with her parents until recently and is now sleeping on a friend’s couch.  The client acknowledges that she has had several traffic incidents related to driving while intoxicated in the past few months. She reports she “totaled” her new car last week but was not arrested, likely because her companion had a felony warrant and the police arrested him at the scene and not her. It was at this time that she says her parents insisted she move out of the house and cannot return until she has sought counseling. She states she wants to “move on from my past,” she misses how things used to be, and wishes that her parents understood her better. The client reports that she drinks at least 20 alcoholic drinks per week and uses marijuana intermittently. She states she takes Adderall to help her clean the house quickly, uses cocaine, and has used Klonopin in the past, but stopped due to a “back experience.”  She states she does not have a problem with substance use but acknowledges it is a stressor in her relationship with her parents. She reports that using substances are the “only way to get to know people” and has found herself angry when attending parties where others were having fun but she was not drinking or high.","Family History:
Client reports that she is the youngest of two children and that her family relationships were terrific until she turned 14 years old and then her parents “went crazy” when her grades in school declined and she was often grounded. She tells you that her parents didn’t like her after that and were always angry at her. On further discussion, the client says that she began dating a 19-year-old male when she was 14 but her parents decided he was too old for her and would not allow her to see him. She admits being furious at him for not taking her out after that and she called him daily to try to change his mind for over two months. She says she can’t stand him now and that he is currently in prison for aggravated assault on a police officer. She also tells you that at 15 years old, she began a long-term relationship with another man, who is now in prison for attempting to shoot someone. She states that he got involved with another girl and your client ended up getting arrested after she started a fight with the girl. Her third relationship was with her husband and with whom she became pregnant. At that time, her parents “kicked me out of the house and I couldn’t even come back inside to get my things.” They divorced two years ago after he called the police after “he said I attacked him when I found out he was cheating on me.”","Based on the information gained in the intake, the counselor should be continually aware of?",Client's manipulation of the counselor,Counselor's inability to remain objective about the client,Client's thoughts of harm to self or others,All of the above,"(A): Client's manipulation of the counselor
(B): Counselor's inability to remain objective about the client
(C): Client's thoughts of harm to self or others
(D): All of the above",All of the above,D,"All of the above are important for the counselor when working with this client. Clients who are mandated to counseling often feel coerced into counseling and tend to be extrinsically motivated in order to achieve their desired outcome, in this client's case, to move back into her parents' home. Externally motivated clients may manipulate by not telling the whole story or playing the victim to increase sympathy from others. Important characteristics of counselors include empathy and positive regard. When working with a client who is manipulative, triggers counselor countertransference or over-sympathizing that impacts the session, or the counselor begins to make character judgements about people in the client's life who the counselor has not met, the counselor has lost the ability to be objective and cannot appropriately counsel the client. As the client has a history of thinking about harming others, poor insight, poor judgement, it will be necessary for the counselor to accurately assess mood, affect, and thoughts of harm during each session. Therefore, the correct answer is (D)","intake, assessment, and diagnosis"
1617, Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual,"The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.","You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.","Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.",Which of the following will be the best tool to help the client find a good fit between her personality and a work environment?,What Color Is Your Parachute,Holland's Self-Directed Search (SDS),Strong's Interest Inventory (SII),Savickas' Career Style Interview (CSI),"(A): What Color Is Your Parachute
(B): Holland's Self-Directed Search (SDS)
(C): Strong's Interest Inventory (SII)
(D): Savickas' Career Style Interview (CSI)",Holland's Self-Directed Search (SDS),B,"Holland's SDS is based on his theory of personality as it relates to career choice. His widely-used theory and test suggest that occupations and work environments have characteristics that appeal to particular personality types. By matching types, the client would be most likely to find an occupation and work environment that matches her personality. The book What Color Is Your Parachute is a best-selling job hunting book, but will not help the client match her personality to an occupation or work environment. The SII was developed as an interest inventory and helps the test-taker to explore their potential areas of study, careers, and leisure interests. It focuses on one's work style, learning environment, team orientation, leadership style, and risk taking. The CSI is a structured interview based on Adlerian and constructivist theories that help clients resolve career problems. It is not meant to match client's personalities to work environments or occupations, but to help clients resolve problems that hinder them in their career. Therefore, the correct answer is (C)",counseling skills and interventions
1618,Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00),"Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam","You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.","The client’s son accompanies her to her appointment today. Since the initial intake, COVID-19 has become a global pandemic and has greatly impacted the client’s anxiety and fear. The client was visibly trembling when she spoke and requested that her son remain nearby. She explained that complying with the statewide mask mandate has been difficult, stating, “Wearing this mask makes me feel like I can’t breathe. It’s the same feeling I get when I’m walking up stairs or taking the elevator.” The client’s internist prescribes alprazolam (Xanax), which she has been taking for years. However, she thinks that it is no longer effective and asks if you can help her discontinue the medication. Given the COVID-19 outbreak, you discuss providing distance counseling to the client.  You search for randomized clinical trials to determine the efficacy of distance counseling for agoraphobia",You search for randomized clinical trials to determine the efficacy of distance counseling for agoraphobia. Which one of the following best ensures that a study’s conclusions are free from bias?,On-treatment analysis,Intention-to-treat analysis,Transactional analysis,Per-protocol analysis,"(A): On-treatment analysis
(B): Intention-to-treat analysis
(C): Transactional analysis
(D): Per-protocol analysis",Intention-to-treat analysis,B,"In addition to randomization, an intention-to-treat analysis best ensures that a study’s conclusions are free from bias. An intention-to-treat analysis uses conclusions based on keeping all subjects in the treatment group they were randomized to, independent of what occurs later in the experiment. In other words, for randomized clinical trials, if half of the subjects dropped out of the study or conditions changed that affected their participation, they were still counted despite deviation from the protocol. A per-protocol analysis is the opposite of an intention-to-treat analysis. A per-protocol analysis excludes subjects who deviated from the protocol. If conducted alone, this analysis is subject to attrition bias. Transactional analysis is a psychoanalytic counseling theory used to analyze social transactions to determine one’s ego state. Unlike intention-to-treat analysis, on-treatment analysis only includes data on subjects who received the treatment they were randomized to—those who deviated from the protocol were not counted. Therefore, the correct answer is (C)",professional practice and ethics
1619,"Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)","Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg","You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.","You arrive at the client’s house for the session, and he decides to meet with you in the family office and brings some toys with him. He sits on the floor, and you decide to sit on the floor with him and engage in play to continue building rapport. While playing, you begin to ask the client about what frustrates him about his parents, and, through processing, you identify that he desires some independence. You meet with the parents after the session and encourage them to give him some choices throughout his day so that he can have a sense of control. You state that they can be choices that may not be consequential, such as the order of the bedtime routine, so that the routine still happens but he has some control over the order of the process.  During the session, the client requests that his parents bring him a snack, and they decline until the session is over, so the client begins to yell and throw a tantrum","During the session, the client requests that his parents bring him a snack, and they decline until the session is over, so the client begins to yell and throw a tantrum. Based on behavioral therapy, which of the following would be considered the function of this behavior?",Escape,Attention seeking,Sensory,Tangible,"(A): Escape
(B): Attention seeking
(C): Sensory
(D): Tangible",Tangible,D,"These terms are often used as part of applied behavior analysis, and, in this situation, the function of behavior is for a tangible item. The client is seeking a snack and was denied one, so his behavior’s function is to push his parents to get frustrated, give in to his behavior, and provide what he wants. The counselor’s response to this would be to encourage more effective and appropriate manners of expressing his wants and needs. The behavior can be rewarded when he appropriately advocates for his wants and needs. It is possible that the request for a snack is to escape the session. However, the behavior was clearly escalated when he was denied the snack, so the behavior was more about being denied the item. The client is not requesting the snack for attention-seeking purposes, demonstrated by his strong reaction to not being able to have one at that moment. Generally, attention-seeking behavior is focused primarily on the attention, rather than the outcome of the request or behavior. In this scenario, the client is already the center of attention in the session. Therefore, the correct answer is (A)",counseling skills and interventions
1620,Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5),"Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam","You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.","The client arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter",What are the ethical implications for seeing both the client and his wife during the scheduled therapy session with the client?,An ethical violation was not committed because there is implied consent due to the client being present with his wife.,An ethical violation was committed because you did not clarify the nature of your relationship with both participants at the outset of counseling.,An ethical violation was committed because the client is the identified patient and has not waived his right to confidentiality.,An ethical violation was not committed since safely de-escalating conflict creates an exception and allows confidentiality to be breached.,"(A): An ethical violation was not committed because there is implied consent due to the client being present with his wife.
(B): An ethical violation was committed because you did not clarify the nature of your relationship with both participants at the outset of counseling.
(C): An ethical violation was committed because the client is the identified patient and has not waived his right to confidentiality.
(D): An ethical violation was not committed since safely de-escalating conflict creates an exception and allows confidentiality to be breached.",An ethical violation was committed because you did not clarify the nature of your relationship with both participants at the outset of counseling.,B,"According to the ACA Code of Ethics (2014):“When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. […] Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both counselors and clients. […] Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; the role of technology; and other pertinent information”The issue of implied consent is valid for collateral contacts and may meet minimal ethical requirements; however, without a signed informed consent delineating your role and relationship with each participant, you may encounter ethical complications. The client initially allowed contact with his wife to obtain collateral information. The wife reported that she wanted to attend couples therapy, but the client was adamant that she did not participate. This brings into question the client’s capacity to provide voluntary consent (ie, it may be given under duress and thus invalid). Since conflict de-escalation in couples therapy is standard practice, this does not create an exception. The counselor did not commit an ethical violation due to the client not waiving his right to confidentiality. The issue lies with informed consent as a whole rather than one aspect of informed consent. Confidentiality is one aspect of informed consent. Therefore, the correct answer is (D)",professional practice and ethics
1621,"Name: Sierra Clinical Issues: Adjustment related to physical loss/injury/medical condition Diagnostic Category: Trauma and Stressor Related Disorders Provisional Diagnosis: F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood Age: 16 Sex Assigned at Birth: Female Gender and Sexual Orientation: Female, Heterosexual Ethnicity: Native American (Cherokee) Marital Status: Not Applicable Modality: Individual Therapy Location of Therapy : Private Practice  ","The client's appearance is slightly disheveled. Her behavior is withdrawn. She has her arms crossed throughout the session. The client's affect is congruent. Her mood is depressed during the initial intake. She reports that she sometimes ""doesn't feel like existing"" when thinking about her injury. She shares that the thought of not being able to dance ever again is ""too much to bear."" Exploration of thought content reveals that she has considered how she might harm herself. She reports that her father has guns locked in a safe, but she knows the passcode. The client denies she would ever act on this impulse and identifies three friends she could contact for support.","First session You are a mental health therapist in a rural private practice setting. A 16-year-old female is referred to you by her pediatrician for concerns about her mood, behavior, and low appetite. She is accompanied by her mother and father. You begin by speaking with all three family members, reviewing the informed consent process and how confidentiality will be handled with the daughter. They all acknowledge and sign the appropriate paperwork.    Next you meet one-on-one with the parents to understand their concerns. They are extremely concerned about their daughter's mental health and wellbeing. They share that their daughter has been crying more often lately and she has become incredibly sensitive to criticism. She is often irritable and ""snaps"" at them over minor issues. She withdraws from social interaction with friends, which is out of character for her. She appears increasingly withdrawn from activities she used to enjoy like drawing and playing the piano. She is also sleeping more and eating less than usual, resulting in weight loss. The parents confirm that they have limited insight into their daughter's actual feelings, as she often refuses to discuss them. The mother tells you, ""She had a ballet injury a couple of months ago, and she seems to be struggling with it. We've been trying to stay positive and supportive, but she's just not getting better. Her physical therapist said that keeping up a positive attitude is really important in the recovery process, but our daughter doesn't seem to care.""    After you feel you have obtained a thorough understanding of the parents' concerns, you ask the parents to wait in your waiting room and invite the daughter back into your office. You begin by expressing your understanding of the situation that lead her parents to bring her in for therapy. You state, “From what your parents have told me, I understand you have been going through a difficult time lately with your physical injury and the changes that it has caused in your life.” After establishing this understanding, you ask her to tell you about her experience with the injury, how it has impacted her life, and how she has been feeling since it occurred. She tells you she has a hard time concentrating at school because she is unable to dance. She becomes tearful when you attempt to find out about how her ballet injury is affecting her. She says her ""life is ruined now"" and ""I will likely never dance again. I'll never be able to fulfill my dream of being a ballet dancer. I hate it. All of my dreams are crushed."" She begins sobbing uncontrollably. You take a moment to de-escalate her intense emotional reaction. You explain that it is common to feel overwhelmed in the aftermath of a major injury, and there are strategies she can use to cope with her feelings. You discuss the importance of staying connected to friends, family, and supportive people during this difficult time. After completing your mental status examination of the client, you note suicidal ideation as an issue to discuss with her parents.  Second session The client presents to her second counseling session in a defensive state. She is upset that you reported her suicidal ideation to her parents because she thought that everything she told you would remain confidential. She says, ""Why should I tell you anything else? You'll just tell my parents."" You tell the client that you understand her frustrations and empathize with her. You explain to her why confidentiality is not always absolute and that as a clinician, it is your responsibility to keep clients safe, even when they don't want you to. You further explain that in this case, you felt it was important for her parents to know about the suicidal ideation she has been experiencing. You emphasize that her parents care deeply about her, and they need to know what is going on with her in order for them to help. She responds by saying, ""Okay, I get what you're saying, but telling them about it has only made things worse."" She reports that her parents now treat her ""differently"" and do not allow her access to any ""dangerous items like kitchen knives"" without supervision. She feels restricted and watched. You nod your head in understanding and reflect that it can be difficult to feel like your parents don't trust you and have put restrictions on things they normally wouldn't. You also encourage her to try and see the situation from their perspective and agree that although the restrictions can be inconvenient, her safety is their top priority. She takes a deep breath and says, ""I guess I can understand why they did it, but it still doesn't feel fair."" You acknowledge her feelings of unfairness and validate that feeling. After your discussion, the client appears to have a better understanding of her parents' motivation for the restrictions and feels less resentful towards them.    You ask her to tell you more about how she has been feeling lately and invite her to share any other issues she is having trouble managing. She tells you that her ballet teacher has invited her to help teach the younger ballet classes, but she is ambivalent about pursuing this opportunity. Though she still loves ballet, she thinks it will be painful to watch other children fulfill the dreams that she can no longer pursue. She says, ""I'm afraid that if I agree to teach, I'll never get over my injury. It will just keep reminding me of what I could have been."" You explain to her that it is natural for her to have these feelings and that it is okay to take time to make a decision. You ask her if she can see any benefits to teaching. She pauses and says, ""I don't know...I've never really thought of myself as a teacher. I've always been the student."" You acknowledge the difficulty of this transition and understand that it can feel risky to try something new. You suggest that teaching could be an opportunity for her to gain a sense of purpose, as well as an activity to help her stay connected to something she loves. You encourage her to try and explore her capacity for teaching and imagine what impact she could have on her students."," The client reports that she is doing ""okay"" in school. Her parents report that she used to make straight A's but is now making C's and D's. She is failing history because she did not complete a project. They share that her teachers have tried to reach out to her, but she has not responded to any of them. The client reports that she smokes cigarettes. She used to smoke once every couple of months while out with friends. Her use has become more frequent, and she is now smoking several times a week. She has tried alcohol (three beers) and smoked a joint at a friend's party, but she reports that she did not like how they made her feel. Pre-existing Conditions: The client fell in dance class two months ago and broke her ankle. There were complications during surgery to repair the break. The client is currently in intense rehabilitation planned for at least one year, but it may take longer. Doctors are unsure if she will ever regain full mobility of her ankle.",Which of the following is the best way to address the client's concerns about confidentiality?,Apologize to the client; assure her that you will never make this mistake again,Empathize and explore the client's emotions; Clearly state why you had to communicate with her parents; Ask the client how you can collaboratively help her resolve this issue with her parents,Acknowledge that there has been a misunderstanding; Empathize and explore the client's emotions and reflect those emotions; Clearly state why you had to communicate the suicidal ideation to her parents,Explain why you had to communicate this issue to her parents; Ask her to imagine the situation from her parents' perspective and how she would want to know if her child was in pain,"(A): Apologize to the client; assure her that you will never make this mistake again
(B): Empathize and explore the client's emotions; Clearly state why you had to communicate with her parents; Ask the client how you can collaboratively help her resolve this issue with her parents
(C): Acknowledge that there has been a misunderstanding; Empathize and explore the client's emotions and reflect those emotions; Clearly state why you had to communicate the suicidal ideation to her parents
(D): Explain why you had to communicate this issue to her parents; Ask her to imagine the situation from her parents' perspective and how she would want to know if her child was in pain",Acknowledge that there has been a misunderstanding; Empathize and explore the client's emotions and reflect those emotions; Clearly state why you had to communicate the suicidal ideation to her parents,C,"This answer is the most comprehensive demonstration of conflict resolution skills. It fully demonstrates excellent the conflict resolution skills of listening to the client, clearly communicating your position, and apologizing for the misunderstanding (the client thinking that ""everything"" she told you would remain confidential). Therefore, the correct answer is (C)",professional practice and ethics