Ethics & Boundaries
A client sends you a friend request on social media. What should you do?
Decline it and discuss boundaries in session if appropriate.
Name one grounding technique for anxiety.
5-4-3-2-1, box breathing, etc.
What does SOAP stand for?
Subjective, Objective, Assessment, Plan.
What's the first priority if a client reports suicidal ideation?
Assess safety and risk.
What does "rule out" (R/O) mean in a diagnosis?
More information is needed before confirming the diagnosis.
What are the four main exceptions to confidentiality?
Danger to self, danger to others, abuse/neglect of a child, elder, or vulnerable adult, and court order (depending on state laws).
What is cognitive restructuring?
Identifying and challenging unhelpful thoughts.
Should a progress note include every detail discussed?
No—only clinically relevant information.
What's the difference between passive and active suicidal ideation?
Passive = wishes to be dead; Active = thoughts of killing oneself.
Name one screening tool for depression.
PHQ-9.
A client brings you an expensive gift. What should you consider before accepting it?
Agency policy, ethics, cultural context, therapeutic impact, and boundaries.
Give one DBT distress tolerance skill.
TIP, ACCEPTS, self-soothing, etc.
What's an example of objective language?
"Client became tearful."
Name one protective factor.
Family, faith, future goals, pets, etc.
Name one screening tool for anxiety.
GAD-7.
You see your client at the grocery store. What is the most ethical response?
Do not initiate contact. Allow the client to decide whether to acknowledge you to protect their confidentiality.
What is the purpose of psychoeducation?
Increase understanding and normalize experiences.
Why avoid judgmental language?
Maintain professionalism and factual documentation.
A client says, "I don't think I can keep myself safe." What's your next step?
Complete a risk assessment and follow agency crisis procedures.
A client says, "I have anxiety," during an intake. What additional information should you gather before diagnosing an anxiety disorder?
Explore the type of anxiety (worry, panic, fears, obsessions, trauma-related), triggers, frequency, duration, physical symptoms, avoidance behaviors, impact on functioning, medical/substance factors, and whether symptoms meet diagnostic criteria.
A former client asks you to write a recommendation letter. What ethical concerns arise?
Dual relationships, competence to evaluate, boundaries, agency policy.
A client is dissociating. Name three interventions.
Orient to room, sensory grounding, breathing, cold object, etc.
Why document safety assessments?
Clinical continuity, risk management, and legal protection.
When is hospitalization considered?
When there is imminent risk and a lower level of care is insufficient.
A client reports hearing voices. What are important assessment questions to ask before assuming the client is experiencing psychosis?
Assess what the voices are like, frequency, content, level of distress, insight, cultural/spiritual context, trauma history, sleep, substance use, medical factors, and safety concerns.