Ethics
A 16-year-old client asks you not to tell anyone about occasional marijuana use. What factors determine whether confidentiality can be maintained?
Safety concerns, legal requirements, agency policy, parental rights, and state laws.
Clue #1: Elevated mood.
Clue #2: Decreased need for sleep.
Clue #3: Increased goal-directed activity.
Bipolar Disorder
How long must symptoms be present for a diagnosis of Major Depressive Disorder?
At least two weeks.
Clue #1: The therapist reflects ambivalence.
Clue #2: Change talk is encouraged.
Clue #3: The therapist avoids arguing with the client.
Motivational Interviewing (MI)
Clue #1: Grandiose sense of self-importance.
Clue #2: Requires excessive admiration.
Clue #3: Limited empathy for others.
Narcissistic Personality Disorder
A student discloses suicidal thoughts but denies a plan or intent. What should be your next step?
Conduct a risk assessment and document findings before determining the level of intervention.
A note says:
"Had a good session."
Why is that insufficient?
t doesn't describe interventions, client response, or clinical progress.
What's one feature that helps differentiate Generalized Anxiety Disorder from Adjustment Disorder?
GAD is excessive anxiety occurring more days than not for at least six months.
Clue #1: The therapist uses unconditional positive regard.
Clue #2: The client directs the session.
Clue #3: Empathy and genuineness are central.
Person-Centered Therapy
Clue #1: The client's emotional expressions may appear exaggerated relative to the situation.
Clue #2: Relationships are often perceived as more intimate than they actually are.
Clue #3: Approval and attention from others are highly valued.
Histrionic Personality Disorder
You discover a client attends the same gym as you. What is the most ethical response?
Maintain professional boundaries and discuss expectations if needed, without initiating a social relationship.
Clue #1: Excessive focus on mistakes.
Clue #2: Repetitive checking occurs.
Clue #3: Thoughts feel intrusive and unwanted.
Obsessive-Compulsive Disorder
Which adolescent diagnosis is frequently overused when trauma, grief, environmental stress, and developmental issues have not been adequately evaluated?
Oppositional Defiant Disorder.
Clue #1: The therapist explores automatic thoughts.
Clue #2: The therapist examines cognitive distortions.
Clue #3: Homework is assigned between sessions.
CBT (Cognitive Behavioral Therapy)
Clue #1: Intense fear of abandonment.
Clue #2: Unstable relationships.
Clue #3: Emotional dysregulation and impulsive behaviors are common.
Borderline Personality Disorder
What is the difference between confidentiality and privileged communication?
Confidentiality is an ethical obligation; privilege is a legal protection against disclosure.
Clue #1: Avoids social situations.
Clue #2: Fear centers on embarrassment or judgment.
Clue #3: Anxiety decreases when evaluation is removed.
Social Anxiety Disorder
A student experiences depression immediately following a major life stressor and symptoms do not meet full criteria for MDD. What diagnosis may fit?
Adjustment Disorder with Depressed Mood.
Clue #1: The therapist often observes interactions live.
Clue #2: Caregivers wear an earpiece or receive coaching in real time.
Clue #3: The focus is improving the parent-child relationship and behavior management.
PCIT
Clue #1: Avoids relationships due to fear of criticism or rejection.
Clue #2: Desires social connection but feels inadequate.
Clue #3: Often mistaken for social anxiety.
Avoidant Personality Disorder
A client gives you an expensive holiday gift. What is your response and what do you do?
Follow agency policy and explain why I cannot accept the gift but show your gratitude.
Clue #1: A student struggles to interpret social cues and maintain reciprocal conversations.
Clue #2: The student becomes distressed when routines change unexpectedly.
Clue #3: These patterns have been present across settings since childhood, even before mental health concerns emerged.
Autism Spectrum Disorder
A 14-year-old presents with: Chronic irritability, Frequent verbal outbursts, Symptoms for 18 months, No episodes of elevated mood
What diagnosis should be considered before Bipolar Disorder?
Disruptive Mood Dysregulation Disorder (DMDD).
Clue #1: The therapist says, "Both things can be true."
Clue #2: The client feels invalidated by opposites.
Clue #3: Acceptance and change are emphasized together.
DBT
Clue #1: Persistent distrust and suspicion of others.
Clue #2: Assumes others have harmful motives.
Clue #3: Reluctant to confide in people.
Paranoid Personality Disorder