L
According to Maslow, when does a need stop motivating an individual?
a. When the individual gets distracted
b. When the need is mostly satisfied
c. When the individual realizes it won't be fulfilled
d. When the individual skips a need
b. When the need is mostly satisfied.
Explanation: When a need is mostly satisfied, it no longer motivates, and the next higher need takes its place.
Which is NOT one of the stages in the referral process?
a. Clarify the need or purpose for a referral
b. Discuss and select an option for the client
c. Follow up to see if the need was met
d. Research available resources
b. Discuss and select an option for the client
Explanation: Self-determination is primary to counseling values, so clients make their own decisions, when at all possible, not the therapist.
In the first crisis therapy session, the crisis should be:
a. Solved
b. Overwhelming
c. Defined
d. Blamed on the accountable individual
c. Defined
Explanation: Crisis theory is a cluster of principles or assumptions that have received the attention of practitioners and researchers. A crisis is a temporary state of upset and disorganization characterized chiefly by an individual's inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome.
Sue is a group therapist who observes her group membership taking on different roles at different times, rotating leadership depending on the group needs or issues being addressed. Most activity focuses on moving toward group goals, and she has a sense of achievement each time the group ends. She is observing what stage in group development?
a. Norming
b. Cohesion
c. Performing
d. Storming
Correct answer: Performing
Explanation: Stage 4: Performing. The performing stage is not reached by all groups. If group members are able to evolve to stage four, their capacity, range, and depth of personal relations expand to true interdependence. Performing is the stage of group work in which members are actively engaged in the work of the group. No significant issues remain about how tasks will be carried out or who will do them, and sufficient trust is established for sharing and comfort in receiving feedback.
Norming: group moves past conflict/storming stage to establish shared norms, rules, and processes.
Cohesion: a characteristic of the norming stage and the height of the performing stage. A measure of the strength of bonds between group members.
storming: conflict arises as members work through differing ideas and interpersonal differences.
A family member has been given a diagnosis of a terminal illness with less than four months to live. When the hospital social worker visited the family, they were laughing and planning a family reunion in one month. This is BEST an example of:
a. Denial
b. Anger
c. Bargaining for remission
d. Acceptance
Correct answer: Acceptance
Explanation: The family has accepted the diagnosis and is working to bring closure to the family and celebrate the life of the family member while still living, when it matters.
James said, "I don't know how much more of this I can take. My wife's illness is demanding. I love her, but it is hard. I work at least 50 hours each week, then come home and have to do all of the cooking, cleaning, laundry and anything she needs. I feel as though I will break." As a therapist, an empathetic response is to say:
a. "What can you do to make it different?"
b. "You sound overwhelmed with everything required just to get by."
c. "It could be much worse; she could be placed on hospice."
d. "It is hard, but you can do it if you look on the bright side."
Correct answer: "You sound overwhelmed with everything required just to get by."
Explanation: Empathy is about putting yourself in the other's shoes, reflecting what is occurring from their perspective. The best response is, "You sound overwhelmed with everything required just to get by." Problem-solving about what can change cannot occur until addressing how overwhelmed James is, and downplaying what is occurring by saying it could be better or worse is dismissive of James and the situation.
Mary presents for counseling services and reports she was up all night with a gun, contemplating shooting herself in the head. She convincingly denies current suicidality and contracts for safety. What is your best course of action?
a. Refer Mary for immediate psychiatric evaluation to see if hospitalization is indicated
b. Listen to Mary's story and set up a safety plan that includes removal of the weapon from the home and involves at least one trusted friend or family member
c. Engage in counseling; no further planning or steps are needed because she is contracting for safety at this time
d. Set up a safety plans and go with Mary to her home and remove the weapon
Correct answer: Listen to Mary's story and set up a safety plan that includes removal of the weapon from the home and involves at least one trusted friend or family member
Explanation: The best course of action is to listen to Mary's story and set a safety plan in place that includes at least one other trusted friend or family member and involves removal of the weapon from Mary's home.
Denial of substance abuse is common for all ages; however, this denial tends to be ______ in the older adult population.
a. Non-existent
b. Restrained
c. Exaggerated
d. Diminished
Correct answer: Exaggerated
Explanation: Denial of substance abuse is common for all ages; however, this denial tends to be exaggerated in older adults population. This may be due to problems such as shame, memory, pessimism about recovery, and/or the desire to continue the use of alcohol.
A 28-year-old male presents with a history of combat trauma, self-mutilation, and one incident of childhood sexual abuse at the age of 7 or 8 by a boy who was a late adolescent. He is highly reticent to discuss any of the events around the childhood incident that is resurfacing and intruding on his daily life since returning from war. What is your first step?
a. Explain that treatment is not possible without knowledge of the client's history
b. Continue to establish rapport and trust, allowing the client to tell his story in his time, recognizing avoidance is part of trauma work
c. Thank the client for coming and encourage him to return when he is prepared to begin work
d. Order a medical exam
b. Continue to establish rapport and trust, allowing the client to tell his story in his time, recognizing avoidance is part of trauma work.
Explanation: Continuing to establish rapport and trust, allowing the client to tell his story in his time and recognizing avoidance is part of trauma work is the best course of action in early treatment.
Garret, age 6, was removed from his home following discovery of physical abuse perpetrated by his stepfather and an older sibling. Mom is emphatic she can protect Garret now that she is aware of the situation, and the identified perpetrators are demonstrating remorse and a desire to change. To assist in sorting the situation out, a _________ will be appointed to secure Garret's interests.
a. Guardian ad litem
b. Case worker
c. Social worker
d. Family member
Correct answer: Guardian ad litem
Explanation: A guardian ad litem is a lawyer or non-lawyer appointed in court proceedings by the court to represent the best interests of the child or children involved in that case.
Jeremiah, age 7, is the only child of his single-parent mother. They are isolated from other family members, and his mother has a limited number of friends on whom she can rely. Mom is employed full time and has some opportunities for advancement. Child Protective Services is involved following a founded case of neglect. A service delivery plan is to be developed to address risk factors for Jeremiah. What is a key factor in Jeremiah's case?
a. Lack of extended family
b. Potential for increased financial stability
c. Limited prior history of abuse or neglect
d. Involvement with Child Protective Services
Correct answer: Lack of extended family
Explanation: The lack of a support system is likely a central issue to this case. It would be beneficial to investigate possibilities of how to develop a more extensive support system and to provide resources for the mother and her child.
You have a relatively passive client who is going to an assertiveness-training weekend. After the weekend, your client reports back to you that at first, the techniques being practiced and discussed made him feel uneasy, distressed, and unsettled. These feelings would be consistent with:
a. Cognitive dissonance
b. Abreaction
c. Egocentric behavior
d. Assimilation
Correct answer: Cognitive dissonance
Explanation: Cognitive dissonance occurs when what is being advocated and brought to one's cognitive schema does not harmonize with previously assimilated cognitions.
Mr. Xavier presents to you at his company's Employee Assistance Program following a medical crisis secondary to smoking. His physician requires that Mr. Xavier stop smoking immediately, though he is not currently in crisis. What is the first treatment to consider?
a. Individual therapy with the goal of smoking cessation
b. Advocacy to enable him to access services to afford smoking cessation
c. Case management to address both medical health issues and the need for smoking cessation
d. Family therapy to address his recent medical crisis and current medical condition
Correct answer: Individual therapy with the goal of smoking cessation
Explanation: The first type of treatment to administer is individual therapy with the goal of smoking cessation. Family therapy is not indicated, and he has access to medical and psychological services through his employer.
You are called to evaluate a 21-year-old female brought to the emergency room who has a blood alcohol level of 0.13. She is uncoordinated, slurs her speech, and demonstrates memory impairment. What is your first diagnostic impression?
a. Substance/Medication-Induced Depressive Disorder
b. Alcohol Use Disorder
c. Alcohol Intoxication
d. Alcohol Withdrawal
Correct answer: Alcohol Intoxication
Explanation: The diagnosis most consistent with the presentation is alcohol intoxication. She may have a substance use disorder, but there is not enough evidence at time to make that determination.
In group therapy Marie spends 15 minutes describing an event from the previous week, then proceeds to redirect the group back to her event each time a member shares something about their current life situation. She is monopolizing the group and creating tension that needs to be dealt with in one way or another. The BEST way to address the issue is:
a. Verbalize the behavior, ask about the need to maintain the spotlight and inquire about the impact on the group
b. Ignore the behavior to extinguish the behavior
c. For the group leader to point out to Marie she is being a "monopolizer" in the group today
d. For Marie's peer to reflect to Marie she is not "sharing the air" today
Correct answer: Verbalize the behavior, ask about the need to maintain the spotlight and inquire about the impact on the group
Explanation: Clients need to become aware of their defensive behaviors (monopolizing, dependency, intellectualizing, isolating, advice giving, rejecting) and be challenged to go beyond them. This must be done in a caring manner, not labeling them as a "monopolizer" or simply telling them to "share the air" but to explore the specific behavior without blame.
In the initial meeting, a client tells you that he feels jealous and has never been so angry in his life, because his girlfriend of five years is currently seeing someone else. You sense that besides being depressed, your client may suffer from poor impulse control. The first thing you should do in this situation is:
a. Start therapy with the client to determine if he might harm himself or others
b. Talk to the client about confidentiality and what you might have to do depending on his disclosure
c. Excuse yourself and call his girlfriend to indicate what you feel might happen because of your client's state of mind
d. Have the client go through a normal assessment protocol before starting therapy
Correct answer: Talk to the client about confidentiality and what you might have to do depending on his disclosure
Explanation: This would be a good opportunity to discuss the limits of confidentiality with the client.
What is the last step in aiding a family with on-site basic crisis intervention following a natural disaster, once initial safety, mental status, physical concerns, coping skills, and imminent concrete services are met?
a. No further steps are indicated
b. Provide information on how to contact you if mental health services are needed
c. Provide handouts on resources, common psychological reactions, and hotline contact information for follow-up if mental health safety becomes a concern
d. Move on to the next family
Correct answer: Provide handouts on resources, common psychological reactions, and hotline contact information for follow-up if mental health safety becomes a concern
Explanation: The final step in aiding a family is to provide handouts on resources, common psychological reactions, and hotline contact information for follow-up if mental health safety becomes a concern.
An elderly woman refuses to take life-saving heart medication. What is the first thing you should do?
a. Call the family and inform them of her medical condition and choice to die
b. Learn her reasons for refusing treatment
c. Do not intervene because she has the right to self-determination
d. Attempt to get her declared incompetent due to suicidality and force the medication until further mental status can be determined
Correct answer: Learn her reasons for refusing treatment
Explanation: Learning her reasons for refusing treatment will inform what, if any, further intervention is necessary. Treatment may not be mandated under the circumstances (e.g., treatment is risky or experimental, has small chance of success, quality of life will be significantly affected, treatment only postpones imminent death, religious beliefs). Patients may be mandated to receive treatment under some circumstances (e.g., treatment is relatively minor, quality of life would not be adversely affected, treatment would not impose chronic limits or pain following treatment, responsibility for minor children).
John initiates therapy, frustrated by years of arguments with his spouse and says, "Please just fix Jane so we can have a normal life." The social worker's BEST response is to:
a. Discuss realistic goals of therapy with John
b. Ask John what that would look like
c. Initiate bi-weekly couple's counseling
d. Encourage John to be patient with the process
Correct answer: Discuss realistic goals of therapy with John
Explanation: The best response is to clarify what therapy can and cannot accomplish. John does not have a realistic perspective, and focusing on seizing control over something or someone that one does not have control over is an exercise in frustration. Initiating couple's therapy, asking him what he would like, or encouraging patience would be appropriate later in the process.
Jim was recently suspended from school twice for smoking on campus. The school therapist referred the family to you. The family has just moved into the district following dad's job relocation. Jim's grandmother was diagnosed with terminal cancer, his younger brother was caught stealing a video game, and the parents are focused on dealing with the brother's recent theft and truancy issues. What is the best treatment modality?
a. Family therapy to deal with adjustment reactions to the move and the grandmother's illness, addressing Jim's current issue in terms of the family structure and patterns
b. Advocacy with the school to have leniency on Jim, given the current family situation
c. Case management to address the multiple issues with the boys, parenting skills, and needed help with the grandmother's health issues
d. Individual therapy to work toward smoking cessation and better decision-making skills
Correct answer: Family therapy to deal with adjustment reactions to the move and the grandmother's illness, addressing Jim's current issue in terms of the family structure and patterns
Explanation: Family therapy is the best treatment modality to address Jim's recent acting out, clearly in the context of multiple family issues.
Billy is in 3rd grade and is identified as a bully in the school. He has poor social skills, is physically aggressive, struggles with reading and has difficulty paying attention. Billy has not been identified as having special school needs. Billy's social worker is addressing his social skills, anger, and physical aggression. Despite improvements in all of these areas, Billy continues having difficulties with his reading and struggles with math concepts. He is not able to pay attention for any significant length of time. The NEXT step is to:
a. Refer for academic assessment in the school
b. Engage Billy in play therapy
c. Recommend to Billy's parents he have a tutor to increase reading and esteem
d. Treat for attentional issues
Correct answer: Refer for academic assessment in the school
Explanation: Billy needs to be referred for assessment for his academic and attentional issues. Play therapy will not resolve reading, math, and attentional issues. Recommending a tutor is not helpful if there is an underlying learning disability, so testing needs to be completed.
You receive a call from the Human Resources department where one of your clients works. Your client has applied for unemployment compensation, because he thinks that he is entitled to be considered "disabled" due to his psychological condition. Human Resources needs to verify that the employee is currently a client of yours and is really suffering from a mental disorder. In this situation you have to:
a. Indicate to Human Resources that you cannot indicate if this individual is a client of yours
b. Verify whom you are speaking with and only indicate the starting date of treatment
c. Tell Human Resources the diagnosis only and make sure that your client agrees with your DSM-5-TR diagnosis
d. Tell Human Resources that you cannot discuss anything over the phone but are able to send written documentation pertaining to the client's treatment
Correct answer: Indicate to Human Resources that you cannot indicate if this individual is a client of yours
Explanation: Without a signed release by client to specifically provide information to the Human Resources department, no information can be released.
You are providing counseling for appropriate parenting skills to a mother seeking help to best manage her two boys, ages 7 and 9. The mother has been actively engaged in services, making progress and accomplishing goals and objectives. Several months into your work together, the mother reports a "break" in her ability to effectively parent her children; she spanked them the previous evening, leaving welts and one cut on the upper leg of the 9-year-old. She begs you not to report, sighting her extensive work, progress, and ongoing commitment to work. What is your best course of action?
a. Contract with the client for an appropriate safety plan to ensure the children's welfare and monitor follow-through, knowing she will continue to make progress
b. Report the abuse, knowing the therapeutic relationship may be damaged
c. Assess the children, focusing on learning the extent of damage to them
d. Report with her present so that she may see your action is in her best interest
Correct answer: Report the abuse, knowing the therapeutic relationship may be damaged
Explanation: The abuse must be reported, though you suspect the relationship will be damaged. Clients should be notified at the outset of treatment what the limits of confidentiality are. Duty to protect the children outweighs the mother's right to self-determination.
Marcus, a family preservation worker, is assigned to the Redding family. There are three school-aged children in the home, ages 5, 7, and 9, and the findings were for physical abuse and neglect. Marcus has met with the family, developed a case plan, and has a contract with the family. Where will primary services be delivered?
a. Family therapy office
b. Client home
c. Child Protective Service office
d. School
Correct answer: Client home
Explanation: In this example, it would be more effective to provide services to the family in their own home, their environment.
Donna has an extensive history of depressive symptoms she believes started in adolescence. She reports chronic difficulties rising in the mornings, occasional insomnia, poor self-esteem, limited appetite, and a sense of hopelessness that her life will never improve. Donna never remembers feeling particularly happy. What is the best diagnostic impression of Donna's presentation?
a. Persistent Depressive Disorder
b. Major Depressive Disorder
c. Unspecified Depressive Disorder
d. Rumination Disorder
Correct answer: Persistent Depressive Disorder
Explanation: Persistent Depressive Disorder is a mood disorder marked by a depressed mood and at least two of the following symptoms: low energy, poor appetite or overeating, too much or too little sleep, low self-esteem, feelings of hopelessness, and difficulty making decisions or concentrating. For diagnosis, the symptoms must be present for a minimum of 2 years, during which there must be no more than two-month periods of abatement.