Ethical Considerations in Social Work Practice, Exams of Web Application Development

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A group for women experiencing depression has been meeting for 3 weeks. Several group members approach the group leader expressing concern that another group member regularly interrupts and dominates the conversation. What stage of group formation is the group most likely in? A. Forming B. Storming C. Norming D. Performing - Correct answer the correct answer is B: Storming. During this stage it is common for subgroups to emerge, like the one approaching the leader. A social worker has been meeting with a client for two years who is about to graduate from college and move back to her home state. The client wishes to continue therapy with the social worker via teletherapy. The social worker is only licensed in the state the social worker resides. What is the FIRST thing the social worker should do? A. Decline to provide teletherapy because it is illegal to do so across state lines. B. Determine whether the social worker's state board allows teletherapy across state lines. C. Determine whether the state board of the client's residence allows teletherapy across state lines. Continue to provide therapy due to the longstanding relationship established between therapist and client. - Correct answer the correct answer is B: to determine whether the social worker's state board allows teletherapy across state lines. If they do, then we could do C after this (if the social worker's state board does not allow this, then there would be no need to do C, which is why we would do B first). A is incorrect because that is not a true statement as some states do allow this. D is similarly incorrect because it does not acknowledge the fact that some states do not allow teletherapy across state lines. (Even if there is a longstanding relationship). A social worker meets with a 22-year-old woman who reports she is experiencing increased feelings of anxiety, agitation, and irritability. What should the social worker do NEXT? A. Consider a diagnosis of hyperthyroidism B. Refer the client for a psychiatric evaluation C. Complete a bio psychosocial assessment D. Refer the client for a medical evaluation - Correct answer the correct answer is D, to refer the client for a medical evaluation. The client reports increased feelings of anxiety, agitation, and irritability. Before doing anything else, we want to discuss the need for a medical evaluation to rule out a possibly underlying medical reason for her condition. While we aren't expected to know any and every medical condition, we are expected to know that a medical referral for new symptoms is best practice. A is outside of our scope of practice; it wouldn't be our job to consider this specific medical diagnosis, but to refer her to someone who can rule out this and any other underlying biological cause for her symptoms. B is incorrect, because while at some point we may make a referral to a psychiatrist for medication, it is not what we would do FIRST. C could occur after we do D. All of the following statements describe defense mechanisms EXCEPT: A. Conscious behavior used by the client to protect the client from the influence of the therapist. B. Justifying actions or thoughts to make them seem acceptable when unconsciously they are not. C. Rejecting or attributing unacceptable aspects of one's personality to another individual. D. The process of protecting oneself from anxiety, feelings of guilt, or undesirable thoughts. - Correct answer the best answer here would be A. If we look at the definition provided above we notice that B, C, and D all incorporate various aspects of defense mechanisms. On the other hand, A is discussing conscious behaviors or thoughts, whereas defense mechanisms are on a more unconscious level.

That is why as clinicians we need to help client's identify the various defense mechanisms they may use and bring them to a conscious level. A social worker has been meeting with a 28-year-old woman for the past six months to work on issues of depression and suicidal ideation. The social worker observes that on days that she meets with this client, later in the day she spends a lot of time thinking about death and her mood is lower. What should the social worker do FIRST? A. Use her emotional reaction to explore how the client's suicidal ideation may be impacting those around her. B. Seek supervision. C. Begin meeting with an individual therapist. D. Refer the client to someone who specializes in depression and suicide. - Correct answer the correct answer is B, to seek supervision. A is inappropriate because we should not be using countertransference (which is about our emotional reactions as the therapist) in therapy. Although it is possible that the therapist may begin their own therapy (C) at some point, this isn't the FIRST thing we would do. Individual therapy is something that could be discussed in supervision as one way to manage the therapist's countertransference. D is premature, as the therapist and client have been meeting for 6 months and have an established relationship. At this point, there is no need to refer out. A social worker has been meeting with a 28-year-old woman for the past six months to work on issues of depression and suicidal ideation. The social worker observes that on days that she meets with this client, later in the day she spends a lot of time thinking about death and experiences a lower mood. What is this an example of? A. Poor Boundaries. B. Transference. C. Countertransference. D. Trauma Response. - Correct answer the correct answer is C, countertransference. The therapist is having an emotional reaction to what the client is sharing. A social worker meets with a 14-year-old client who shares with the social worker that she is pregnant. She does not want her parents to know she is pregnant. The social worker practices in a jurisdiction where social workers are required to share this information with the parents of a minor child. What should the social worker do FIRST? A. Maintain confidentiality per the client's request B. Maintain confidentiality due to safety issues that may arise if the parents are informed of her pregnancy C. Inform the client that she is required to disclose this information with the client's parents D. Inform the client's parents of the client's pregnancy - Correct answer the correct answer is C. While we may want to honor our client's self-determination and her wishes to have confidentiality maintained (A), the question stem specifies that the social worker practices in a jurisdiction where we must inform the client's parents of her pregnancy. Despite our own beliefs about this, we are required to follow the law. (B) is incorrect because nothing in the question stem states that a safety issue is present regarding telling the parents. While her parents will need to be informed of her pregnancy (D), telling the client about this (C) should come first. Additionally, we should explore with the client how she wants her parents to be informed; she may want to be a part of this rather than the social worker disclosing this on her behalf. A 32 year-old man seeks treatment from a social worker for ongoing problems with both his personal and professional functioning. He reports that even though he has been moderately successful in his career, he continues to feel uncertain about his abilities, feeling as if at any moment he will be exposed as a fraud. When the social worker inquires about his personal relationships, he looks down and says that he doesn't really let anyone get close to him. According to Erikson, this client likely experienced difficulty during which developmental stage?

A. Trust vs. Mistrust B. Industry vs. Inferiority C. Autonomy vs. Shame and Doubt D. Initiative vs. Guilt - Correct answer C, Autonomy vs. Shame and Doubt. The prevailing characteristic that comes through about the client is his lack of self-assurance. We see him doubting himself professionally and perhaps also personally. This may explain his tendency to keep others at arm's length (protecting himself from failure). If the 'building blocks' strategy doesn't work for you, keeping playing with it and find something that does - it's not important why it works, only that it helps you remember and apply the information when you need to! A social work supervisor meets with one of her supervisees for supervision. During this meeting, the supervisee shares they have become sexually involved with a client. They share they want to refer the client to another social worker in order to pursue a relationship with them. What is the FIRST action the supervisor should take? A. Immediately report the social worker to the board B. Assist the supervisee in transferring the client to a different social worker C. Discuss the ethical violations that are occurring with the supervisee D. Terminate her supervisory relationship with the social worker - Correct answer the correct answer is C, to discuss the ethical violations that are occurring with the supervisee. While A, B, and D are all possible actions that the supervisor could take at some point, we should always start by speaking with the social worker first. The social worker is engaging in unethical behavior, so the supervisor needs to address the ethical violations the social worker is engaging in. The supervisor may report the supervisee to their board (A), but it wouldn't occur before talking directly to the supervisee. The supervisee should absolutely end their relationship with the client. Even once that occurs, the client should be transferred to a different social worker (B). But again, this wouldn't happen until first speaking with the supervisee about the ethical violations. If the supervisee isn't willing to engage in ethical practice, they may decide they're unable to continue providing supervision (D). This still wouldn't occur until after first speaking with the supervisee. A woman is referred to a social worker by her EAP. The referral indicates that the woman is frequently absent from work and has difficulty completing projects. During the initial assessment, the woman avoids answering questions about her relationship with her spouse. The woman becomes tearful when asked about her family and social supports. The woman shares that her husband does not "allow" her to go out in the evening or on weekends. She goes on to tell the social worker that she is pregnant, but has not told her husband about the baby. What should the social worker do NEXT? Refer the client to a doctor for prenatal care Suggest couples treatment to address issues of stress around the move Redirect the client back to issues of absence and incomplete job performance Assess the woman for domestic violence and help her create a safety plan - Correct answer in the item above, the strongest answer is D, since the stem provides the test-taker with multiple risk factors for domestic violence. Answer A is incorrect because our priority is to assess for domestic violence. A referral to a doctor for prenatal care would follow risk assessment and safety planning. Additionally, answer A wrongly assumes the woman is not receiving prenatal care. Answer B is incorrect as we would need to rule out domestic violence before considering couples counseling. Couples counseling is contraindicated if domestic violence is suspected. Answer C is incorrect because issues of safety warrant immediate attention and this answer disregards the red flags raised in the vignette. A hospital-based social worker meets with a new client who was admitted following a domestic assault perpetrated by her boyfriend. The woman shares that her boyfriend, with whom she lives, was upset because she was texting with a male coworker and went out for drinks with him after work. She shares that her boyfriend is very insecure and she should have known how this would affect him due to similar instances in the past. She tells the therapist that her boyfriend felt terrible about the incident,

brought her flowers while she was in the hospital, and promised never to hurt her again. What should the social worker do FIRST? Assist client in identifying alternative living arrangements due to risk of additional violence. Provide psych education regarding the cycle of violence and offer resources for victims of domestic violence. Provide client with referral to anger management classes for her boyfriend. Assess the clue - Correct answer the correct answer in this LCSW practice question is B. It is clear that domestic violence exists-the woman was hospitalized following the most recent incident and indicates similar instances in the past. The client appears to be unaware of the cycle of violence. It would be important to shed light on this dynamic so the client has an awareness of the likelihood of future violence and how to identify when it is more likely to occur. In addition, providing resources to the client would allow her to access support on her own terms. Answer A pushes the therapist's agenda, as the client has not indicated a desire to locate alternative living arrangements. Answer C is incorrect because the focus should be on the client, not her boyfriend. Finally, the actions described in answer D could be done after B, but the priority is helping the client understand the cycle she is engaged in with her boyfriend and providing resources. An 82-year-old client was admitted to a hospital after experiencing a fall down the stairs. The client is ready to be discharged from the hospital and wishes to return home where she lives independently despite the fact that she is still recovering physically from her injuries. Both the client's doctors and her adult children want the client to move into an assisted living facility where she can be better supported during her recovery, but the client is adamant about living independently. What should the social worker do? A. Work with the client to determine ways she can support her independence while maintaining safety B. Schedule a competency hearing C. Explain the benefits of assisted living to the client D. Schedule the client's discharge to an assisted living facility for the duration of her recovery - Correct answer the correct answer is A, to work with the client to determine ways she can support her independence while maintaining safety. There is nothing in the question stem that indicates a need for a competency hearing (B). The client has already expressed her desire to live at home, so C and D are both going against the client's self-determination. Answer option A honors the client's self- determination while also addressing potential safety concerns that may arise during her recovery. A local social service agency hires a social worker to address the service gaps within the local community, identifying that Hispanic clients are being served at a lower rate than other populations within the community. What should the social worker do FIRST to advocate on behalf of this community: A. Determine the social service needs of the Hispanic Community B. Identify leaders of the Hispanic community C. Meet with leaders of the Hispanic community D. Form a task force of interested community members - Correct answer the best place to start is by identifying leaders of the Hispanic Community (B). Before meeting with leaders of the Hispanic community (C), we must first identify who those leaders are. Once we identify who the leaders are, we can meet with them. In meeting with them, they may even be able to provide us some information on what the specific social service needs are of the Hispanic Community (A). If not, we could next form a task force (D). Then, with the task force, we could then conduct a needs assessment (using the cultural knowledge and expertise from steps B and C to inform our assessment). A 16-year-old girl and her parents are referred to a social worker by the child's pediatrician for concerns around social anxiety and depression. The family resides in a state where parental consent is required for treatment of anyone under the age of 18. What is BEST practice for the social worker during the initial session with the girl and her parents?

A. Obtain written consent from the parents and discuss with the daughter how confidentiality will be maintained. B. Obtain written consent from the parents, obtain verbal consent from the daughter, and discuss confidentiality considerations with both the parents and daughter. C. Obtain written consent from the parents, obtain verbal consent from the daughter, and discuss with the parents how confidentiality will be maintained due to the daughter's age. D. Obtain written consent from the daughter, obtain verbal consent from the parents, and discuss confidentiality co - Correct answer B is our best answer because it does three important things: 1. it acknowledges that the parents are the ones who need to formally complete consent forms. 2. It also has the daughter provide verbal consent for her therapy. While this is not required, it is best practice.

3. It has the social worker discuss confidentiality considerations with both the parents AND the daughter, which is crucial when working with minors (especially teens!). This discussion can include both what will be kept confidential between the minor and the therapist and what will be shared with the parents and why. When working with minors and their parents, this is always a discussion you want to have at the very beginning of therapy with both parties present so that everyone is on the same page. This way there (hopefully!) won't be any surprises for the parents or the teen when something is (or is not) shared. A social worker has been meeting with a 30-year-old female client for a year. The client enters her most recent session visibly upset. Clenching her fists, the client angrily reports that she found out her boyfriend has been cheating on her with her best friend for the past several months. She states, "Honestly, I could just kill them both right now." What should the social worker do FIRST? A. Inform the client that she must warn the boyfriend and best friend and notify the proper authorities B. Immediately stop the session and call the police. C. Discuss voluntary hospitalization D. Explore whether the client plans to kill them - Correct answer in the question stem, the client made a concerning statement that warrants further exploration. Immediately contacting the boyfriend, best friend, and proper authorities (A) or stopping the session to contact the police (B) is jumping a step too far ahead. We do not yet know if the client actually plans to harm them in any way, or is simply upset about the infidelity. We do not want to jump to action without gathering information first. Nothing indicates a need to hospitalize the client (C). What we want to do FIRST is figure out whether the client actually intends to cause any serious physical harm to her boyfriend or best friend (D). If she does, then we can go ahead and do A. A clinical licensure supervisor is working with a supervisee who utilizes EMDR in her sessions with clients. The supervisor has no training or experience using EMDR, and relies on the supervisee's understanding of the practice to ensure it is being used properly. The supervisor's actions can BEST be described as: A. Unethical, because they are not properly trained and cannot provide adequate oversight or guidance. B. Unethical, because they should be trained in all therapeutic modalities to adequately provide supervision. C. Ethical, because they can utilize the supervisee's knowledge to ensure adequate supervision is provided. D. Ethical, because it is not required for a supervisor to be trained in the modalities utilized by their supervisees. - Correct answer the correct answer is A In order to provide adequate supervision for an unlicensed supervisee, the social work supervisor should have knowledge and experience in the therapeutic modalities their supervisee is utilizing. To have no experience or training in the modality of therapy being used by a supervisee is unethical, as they will not be able to provide the necessary support and oversight to their social worker in training (A). (B) Is incorrect because a supervisor is not expected to be trained in all therapeutic modalities? (C) and (D) are incorrect because providing supervision for a therapeutic modality a supervisor has no training or experience in is not ethical.

A 33-year-old woman has been seeing a therapist for 2 years for treatment of Major Depressive Disorder and Generalized Anxiety Disorder. The client has experienced passive suicidal ideation for her entire adult life. During the most recent session, the client calmly shares that after rationally thinking through the pros and cons, she has made the decision to end her life within the next 48 hours. What MUST the social worker do? A. Honor the client's self-determination, because she is competent to make this decision B. Begin the process of initiating an involuntary hospitalization C. Complete a mental status exam D. Explore voluntary hospitalization - Correct answer the correct answer is D Because the client is actively suicidal, we cannot honor her self-determination (A). There is no indication in the question stem that we need to conduct a mental status exam at this time (nor is it something we MUST do, as the question asks). Due to the severity of what she is saying, we need to pursue hospitalization regardless of her mental status. We always want to explore voluntary hospitalization (D) before pursuing involuntary hospitalization (B). An 80-year-old client meets with a social worker due to recent conflict with his adult children who are urging him to move into an assisted living facility after his wife of 60 years passed and after he began using a cane. His children express ongoing concern that as he ages, he will be unable to care for himself and meet his basic needs while living alone. The client reports that he is just as able to care for his needs now as ever before and states, "there is no way anyone is going to force me into a nursing home." What is the BEST way for the social worker to respond? A. Facilitate a discussion of the pros and cons of living in an assisted living facility and offer a family session B. Discuss the differences between a nursing home and assisted living facility C. Validate the concerns of the client's children and complete an assessment to determine the client's ability to live independently D. Acknowledge the client - Correct answer the correct answer is D Since the question is asking what BEST is, we want to prioritize around importance. A is incorrect because the client stated he does not want to move into a facility. Since there are no details in the question stem that indicate a need for the client to move into an assisted living facility, we want to honor his self-determination. Additionally, the man is our client, not his children. So we want to first help him identify the treatment goals he wants to work on before offering a family session. B is incorrect because again, the client has already stated he doesn't want to live in a facility. So this is not a discussion that would need to take place at this time. C is incorrect because the client is in the room with us, not his children. Further, there is no information that indicates the children's concerns are valid. There is also no reason to complete an assessment to determine his ability to live independently at this time. D is the best answer because it both honors the client's right to self-determination AND acknowledges that he is the client.

1. A therapist is meeting with a client for an initial evaluation. The client reports feeling moody and has been having many headaches. The client states that she lost a lot of weight recently and has noticed a decrease in appetite. The clinician should FIRST: A. Assess the client for sociality B. Refer the client to a psychiatrist C. Complete a mental status exam D. Refer the client to a MD - Correct answer 1. For this ASWB exam practice question, the correct answer would be D. The FIRST thing we need to do is make sure there isn't a medical reason for the client's recent physical symptoms. A lot of people choose A due to the client's report of moodiness. The key word here is what should the therapist do FIRST? It doesn't mean we wouldn't do the other answer options at some point during this session, but we need to first address the client's medical symptoms.

2. A therapist has been conducting a closed 10-week group for men living with AIDS. After the 3rd session, a group member reports to the leader that they are feeling frustrated and disconnected with other members of the group. They question whether or not they want to continue. The social worker should FIRST: A. Initiate an individual session with this group member to address their feelings of frustration and disconnect B. Tell the group member that it isn't possible to leave the group at this time due to the closed nature of the group C. Encourage the group member to bring this up in the next group session D. Use the next group session to explore how other group members are feeling and whether anyone relates to how this group member is feeling in order to encourage cohesiveness - Correct answer 2. The correct answer here is C. When working with groups we want to make sure we keep any issues that come up around the group within the group. So in this case, it's important to encourage the client to address their feelings with the group. A would not keep the issue within the group, and B would not be appropriate because a group member has the right to leave a group. D could be done at some point, but not before we give the client an opportunity to share his own feelings with the group.
3. Studies that collect and analyze data from the whole study population at one point in time is called: A. Single Subject Design B. Cross-sectional Studies C. Retrospective Study D. Case Study - Correct answer 3. This is a recall question based on the ASWB exam. B is the correct answer because cross-sectional studies collect data at a single point in time from participants who are a variety of ages to see how change occurs as a person ages.
4. A father recently noticed an upswing in the amount of gun violence in his neighborhood. As a result he reaches out to other members of the neighborhood to hold a meeting and discuss the impact this is having on each individual, while also looking at the ways that each member can contribute to creating change. This is an example of: A. Advocacy B. Program Development C. Community Organizing D. Social Planning - Correct answer 4. C is correct because community organizing involves engaging with groups, organizations, and communities in order to bring about positive changes within the community and to solve social problems identified by members of the community. For this ASWB practice test question, the key aspect here is that the social problem has been identified by the father, who is a member of the community. A, B, and D would all be described differently.
5. A social worker is developing a program that assists youth who are coming out of the juvenile justice system in finding a job. The social worker has already conducted a needs assessment and identified goals for the program. Which of the following should be the NEXT step? A. Create an action plan along with a timeline for implementation B. Create a planning team which includes identifying key staff C. Put the identified goals in action to ensure they are productive and accurate based on the identified population D. Using the identified goals, implement an action plan and evaluate progress as needed - Correct answer 5. Since the social worker has already conducted a needs assessment and identified the goals for the program, they NEXT need to create a team of people who are able to plan, develop, and implement the program. Therefore, for this ASWB practice question, B is correct. A, C, and D would be done once the social worker has created a team of people who can then oversee that the goals are put into action.

6. A 15-year-old client was recently referred to a therapist at a community counseling center for an initial assessment after throwing a chair at another student at school. The mother reports this is the first incident of this type, but that the client's parents recently divorced a month ago. In order to develop the therapeutic relationship, the therapist must FIRST: A. Go over the limitations of confidentiality with the client B. Complete a bio psychosocial assessment C. Play a game to lessen the stress of the first session D. Get a release of confidentiality from the mother to talk to the client's teacher - Correct answer 6. On this ASWB practice exam, the best answer here is A. It's important for the client to be aware of the limits of confidentiality before starting therapy. B, C, and D would all be options to do NEXT, but not until the therapist has addressed confidentiality with the client.
7. A therapist receives a court order to release the records of a client who is going through a custody disagreement with his partner. The therapist is worried about releasing certain aspects of the record believing that it will be harmful to the client, so the therapist advocates to release only limited aspects of the record. The judge denies the request. The therapist SHOULD: A. Release the records to the court immediately B. Release only aspects of the records that the therapist believes aren't harmful C. Speak with a lawyer D. Speak with the client about the subpoena - Correct answer 7. The best answer here is A. Since the subpoena is coming from a court directly, we must provide the court with the records. The therapist has already advocated for only part of the record to be released and since the request was denied we can't do B. We could do C and D at a later point, but not before releasing the records to the court. Between the times we receive the initial request and advocated for limited release we should have already been discussing with the client the next steps in case that request is denied.
8. During an assessment a client reports a low mood, lack of sleep, and trouble concentrating. The client reports this has been going on for the past three years. The client shares they were sexually assaulted seven years ago, but reports that they, "don't really think about it anymore." The client's MOST likely diagnosis is: A. Major Depressive Disorder B. Persistent Depressive Disorder C. Cyclothymic Disorder D. Acute Stress Disorder - Correct answer 8.The best answer here is B. Persistent depressive disorder is diagnosed when symptoms have been present for at least two years. Cyclothymic disorder C also has a 2 year period, however for cyclothymic disorder to be diagnosed, hypomanic symptoms and depressive symptoms must be present for at least two years which isn't noted in this stem. A is incorrect because the symptoms are not severe enough to give a diagnosis of Major Depressive Disorder. D is incorrect because ASD is only diagnosed when the traumatic event has happened within the last month. Since the event was seven years ago, this would make D incorrect.
9. A therapist is developing a website to promote her private practice. It would be unethical to do which of the following: A. Highlight the therapist's expertise B. Share extensive information about the therapist's training and background. Include information about the therapist's fees and sliding scale D. Collect clients' testimonials highlighting the effectiveness of treatment - Correct answer 9. D is correct because it is unethical for the therapist to collect testimonials for previous or present clients. A, B, and C are all areas that are ok for the therapist to highlight on their website.
10. A social worker is doing a home visit for a family with three kids who recently lost their mother in a car accident. The family was living in a homeless shelter and recently moved into a new home. When the social worker arrives, the social worker sees the father push one of his children on the ground and begins to punch the wall next to the child. The social worker's FIRST response should be to:

A. Call the police B. Make a CPS report C. Intervene with the father D. Take pictures of the event - Correct answer 10. On this ASWB exam practice question, the FIRST option here is A. Anytime immediate danger is happening the social worker needs to call the police. B would be done after A has been done. C would put the social worker in danger and should not be done. D would not be done by the social worker, as the police would take pictures of the event as needed. A new client presents for an intake session with a social worker. The client has a black eye, her arm in a sling, and severe bruising around her neck. When the social worker inquires about the injuries, the client states, "I just tripped and fell. It's not a big deal. I don't want to talk about that." What should the social worker do NEXT? A. Challenge the client that such injuries are not due to a fall B. Safety plan with the client C. Continue the intake assessment D. Provide a DV shelter referral - Correct answer A is incorrect because we are not going to challenge what our client shared with us during an intake session. Safety planning requires the participation of the client. If she is not acknowledging violence is occurring, we cannot safety plan. Safety planning is appropriate when a client is discloses there is violence occurring, but isn't ready to leave the person. C is incorrect because we cannot ignore the safety issue. While we want to respect the client's right to not discuss what happened, we also want to ensure she has the resources needed should she decide to seek help or leave her partner. If someone is in a DV situation, but says they don't want to talk about it (or denies there is a problem), then safety planning or psych education are not options, as they are going against the client's self- determination. When the client is denying there is a problem or says they don't want to talk about it, a DV shelter referral is a good option to address the safety issue (which we can't ignore) without encroaching on their self-determination. A DV shelter referral can be given quickly and discreetly, it provides the client with a resource, and they can choose what they want to do with it (if anything). Charlotte, a 13-year-old girl, initiates therapy at a community mental health agency. The girl informs the therapist that her parents are unaware she is seeking therapy and would not approve if they knew. She also tells the therapist that she is pregnant, but hasn't told the father yet and is not sure if she should. When asked by the therapist about the father, the client appears nervous and begins to cry. Which actions should the therapist take to manage the legal and ethical issues presented in this case? A. Inform Charlotte that her parents must be informed and file a child abuse report due to reasonable suspicion of sexual abuse. B. Discuss the pros and cons of Charlotte's parents being involved in treatment and file a child abuse report due to reasonable suspicion of sexual abuse. C. Provide Charlotte with a medical referral and assess for potential sexual abuse. D. Identify support systems available to Charlotte - Correct answer the correct answer is C. Answer A is incorrect for two reasons. First, we are not required to inform the parents that Charlotte is pregnant. The question stem states that Charlotte is 13-years-old, which means she is old enough to consent to her own treatment and she has a right to confidentiality. Second, we do not have knowledge or reasonable suspicion of child abuse. All we know is Charlotte is pregnant. We do not know the age of the partner nor do we see any clear indication sex was nonconsensual. You might be thinking, "But she is nervous and crying." That, in and of itself, does not point to abuse. She could be crying because the thought of being 13-years-old and pregnant is overwhelming.

Answer B can also be eliminated because, as noted in answer A, we do not have enough information to warrant a report. We've narrowed the answers down to C and D. Since the second part of both answers is the same, we are going to focus on the first part of each answer. You are choosing between identifying support systems and a medical referral. Answer D is not as strong as C. Charlotte has a clear medical issue, so providing a referral would be our priority. Identifying support systems could be done in the future, but medical attention should be the immediate focus. A nursing home social worker works and meets with an 82-year-old woman who is a new resident. Towards the end of their first session, an employee comes in informing the client that her daughter has arrived to visit her. The client becomes upset and repeatedly states "please don't let her in here. Don't let her near me." What should the social worker do NEXT? A. Contact the client's daughter to inquire why she doesn't want to see her B. Inform the daughter she needs to leave and escort her from the premises C. Explore with the client why she doesn't want her daughter to come in D. Make an Adult Protective Services report on suspicions of abuse - Correct answer the correct answer is C, explore why she doesn't want her daughter to come in. We cannot contact the client's daughter to inquire why the client doesn't want her to come in (A), as this would be breaking client confidentiality. Our NEXT step would not be to inform the daughter that she needs to leave (though this could happen at some point), as we would first want to talk with the client about why she doesn't want her daughter there. More so, escorting the daughter off of the premises would likely be unnecessary and outside our role as the social worker. While we will do D if the client reports that her daughter has abused her in any way, we would not make a report just yet. There could be other reasons for her not wanting to see her daughter (for example, an ongoing strained relationship, the client not wanting her daughter to see her in a nursing home, etc.). The best place to start is by inquiring why the client doesn't want her daughter near her. A school social worker meets with a 13-year-old girl who begins crying in session as she discusses an argument she had with her parents last night. She explains that after she talked back to her mom, her dad hit her. She goes on to say that "it hurt really badly." What should the social worker do FIRST? A. File a CPS report B. Determine the type and severity of the punishment C. Develop a safety plan D. Contact the client's parents - Correct answer the correct answer is B. The question stem raises some red flags for abuse. The client says 1. That her dad hit her and 2. That it "hurt really badly." While many people jump to filing a CPS report (A), we actually don't have enough to do so yet. While investigating is not our job, determining the type and severity of the punishment (B) is NOT the same thing as investigating. Investigating involves interviewing the child, parents, etc. to establish whether or not an accusation of abuse or neglect can be substantiated or not. Again, inquiring about the type or severity of punishment a child receives is NOT the same as investigating whether or not abuse has occurred. What we are doing with answer option B is gathering information to determine whether a report needs to be made or not. "It hurt really badly" may or may not warrant a report. We need to find out what happened that "hurt really badly." If the client's dad spanked her with an open hand and it didn't leave a mark, it is not considered abuse-even if it hurt really badly. If we find out her dad hit her and it 1. Left a mark, 2. Was with a closed hand/fist, OR 3. Used any type of object, then we would need to do A and file a CPS report. Developing a safety plan (C) is not where we would start. We need to prioritize determining what type of punishment occurred to figure out whether a CPS report needs to be made.

We would not start by contacting the client's parents (D). This could occur after doing B, depending on what type of punishment took place. If we identify that abuse took place, we would do A before doing D. A couple attended therapy for two years and after achieving their goals they terminated services. The couple has an amicable relationship and is co-parenting their children, but determined it would be best to divorce. The therapist receives a subpoena from the husband's lawyer to release records as part of the divorce proceedings. The husband also faxes the therapist a written authorization to release records. The therapist attempts to contact the wife, but is unable to reach her. Which of the following actions should the therapist take to manage the legal issues involved in this case? A. Release the records since therapist attempted to contact wife and the couple has an amicable relationship. B. Call the husband's lawyer and inform the lawyer that the therapist has not been able to successfully reach the wife C. Call the therapist's professional liability insurance company's legal team for purpose of consultation D. - Correct answer the correct answer is D. The first thing being tested in this question is, who the holder of privilege is. In this case, the holder of privilege is the couple. This means the husband and the wife are equally responsible for deciding how the subpoena will be handled. With this in mind, we can easily eliminate answer A. We cannot release the records without receiving written consent from the wife. This holds true regardless of the relationship between the couple. They could be best friends and have an intact marriage and this would still be the case. Answer B is not as clear-cut. However, we would not make contact with the lawyer and discuss our efforts to reach the wife. We would only respond to the subpoena, in writing, noting that we are invoking/asserting privilege insofar as it exists. We would not even acknowledge the wife was our client! Answer C is another tempting answer, but it's unnecessary at this time. We don't need to seek consultation when it's clear what steps we need to take, which brings us to the correct answer. Answer D is the strongest option available. If we do not know how the holder of privilege wants to respond to a subpoena, we would uphold their right to keep communications privileged. A therapist has been working with a 19-year-old female client who was brought to therapy five years earlier for an eating disorder. When the client began therapy, her parents consented to treatment and engaged in numerous collateral sessions with the individual therapist. The family also participated in ongoing family therapy. Following a sustained period of symptom stabilization, the mother calls the therapist because she is concerned the daughter is exhibiting troubling behaviors. She asks the therapist if the daughter specifically discussed regressive behaviors in recent sessions. How should the therapist respond? A. Inform the mother that the daughter is legally an adult and the therapist must maintain confidentiality B. Inform the mother that the daughter is legally an adult and she can only provide information the client has authorized the therapist to share C. Break the client's confidentiality if the therapies - Correct answer the correct answer is B. You were likely to get the answer down to two, and answer A was probably in the running for the best answer-if not the answer you ultimately chose. However, answer A is incomplete and should be eliminated. The first part of answer A is correct, the daughter is legally considered an adult. However, the parents have historically been involved in her treatment and this answer excludes the possibility of sharing any information-it is too extreme. Answer C is an easier answer choice to eliminate. While therapists are legally permitted to break confidentiality in certain instances, a client engaging in regressive behaviors (too vague a term) is not one of those instances.

Answer D is another possible choice, and it is true a therapist is legally permitted to break confidentiality if a client is a danger to themselves. However, there is nothing in the question stem to indicate safety concerns severe enough to warrant breaking confidentiality. Answer B is the strongest answer choice. The first part of the answer is correct; the client is legally considered an adult and has a right to confidentiality. The second part of the answer acknowledges the therapist may share information with the parents, but disclosures are limited based on the scope of the authorization signed by the client. A social service agency hires a social worker to evaluate the effectiveness of a program the agency implemented last year. The program works with adolescents age 12-17 who are at risk of becoming involved in the juvenile justice system and aimed to prevent entrance into the juvenile justice system. What should the social worker do FIRST in evaluating the effectiveness of this program? A. Set goals and objectives for treatment B. Determine who the target population is C. Share outcome results and recommendations D. Identify what measures were used to determine progress towards goals - Correct answer the correct answer is D. The question stem has already informed us of what the goals of the program are (A) and who the target population is (B). While the process of program evaluation will allow us to share results and recommendations (C), this is generally one of the last steps, not the first. This leaves us with answer option (D). Once we know the target population and what the goals and objectives are, we next want to look at what measures were used to determine what progress has been made towards those goals. For example, was a standardized assessment tool used? Was client self-reporting utilized? Was information gathered from the juvenile justice system's records? A married couple who recently emigrated from Argentina bring their 15-year-old daughter to see a counselor at a community clinic. Neither of the parents speak English; however, their daughter feels very comfortable communicating in both Spanish and English. What are the therapist's responsibilities at the onset of treatment? A. Obtain informed consent from the daughter since she is old enough to consent on her own B. Take additional steps to ensure parents' comprehension of the informed consent contract C. Document in the record the fact that parents do not speak English D. Allow the family to take the informed consent papers home so they can take their time in translating and filling out necessary paperwork - Correct answer the correct answer is B Answer A can easily be knocked out. Only having the daughter consent for treatment would disregard the role of her parents. They are clearly involved and it is always best practice to include parents in the treatment of a minor whenever possible. Disregarding them is both culturally and clinically insensitive. Plus, we would only exclude the parents from the informed consent process with good cause. Answer C is tempting, especially during a law and ethics exam. It is correct to document the fact that both parents do not speak English and we will do so, but that would not be the first or most important thing we do. Initially we must address the issue of informed consent since we are required to obtain it before proceeding with treatment. Answer D is incorrect because it puts the burden of having to translate the documents on the client. It is best practice to send clients home with a copy of informed consent, but only after they have understood and consented to it. Answer B is the strongest answer choice since ethically, it is the therapist's responsibility to provide informed consent in the language the client can understand. Thus, it is up to the therapist to either provide clients with paperwork in Spanish or to secure a professional interpreter.

A social worker is studying the effects of how different doses of an SSRI affect levels of depression as measured by the Beck Depression Inventory. Which of the following is the dependent variable? A. Type of SSRI B. Dosage of the SSRI C. Levels of Depression D. Beck Depression Inventory - Correct answer the correct answer is C. The type of SSRI (A) is not discussed in the question stem. The dosage of the SSRI (B) is the independent variable (remember, this is the variable being manipulated that will then impact the dependent variable). Levels of depression (C) are dependent on the dosage of the SSRI, making this the dependent variable. The Beck Depression Inventory (D) is the type of scale being used to measure levels of depression but is neither the independent variable nor the dependent variable. While meeting with a long-term client, a 28-year-old graduate school student, the therapist learns that the relationship the client is in is abusive. The client tells the therapist that her partner was very warm, communicative and kind at the beginning. With time, however, he became increasingly jealous, possessive, and began belittling her. Eventually their fights became physical in nature. "I am so confused," states the client, "I know he is a very good person underneath. I know his behavior is unacceptable; he is just wounded and I know he means well. All my family and friends want me to leave him, but I care for him so much. I am so confused. What do you think I should do?" Taking into account a strong and trusting relationship, what action should the therapist initially consider? A. Educate the client on the nature of partner relational violence and develop a comprehensive safety plan B. Acknowledge the difficult - Correct answer the correct answer is B. This is a perfect example of a clinical situation where as therapists we might feel compelled to offer our own opinion and guide a client in a certain direction. This is especially likely since the client is asking for advice. However, ethically, we must not push the client in any given direction. So, the best answer here would be (B). In answer (B), the therapist acknowledges how tough the situation is and explores the client's feelings about loving this person, yet not being OK with his behaviors. Answer (A) is a little bit premature. We can certainly educate the client on the nature of partner relational violence, but we need a bit more information before coming up with a safety plan. So we would do (B) before we would do (A). Even though answer (C) has the therapist gently focusing the client's attention towards her friends' and family's feelings, it can be easily perceived as pushing the client to leave her partner. Since there is a strong and trusting relationship between the client and therapist, it's important to be extra mindful of impact our words can have on a client. The same can be said for answer (D). The client can easily perceive it as encouraging her to stay and work on this relationship. And such a decision would not be up to us to make. A social worker meets for an initial session with a court mandated client. The client seems closed off and suspicious in communication and states "I'm not going to share anything until I know everything will be kept confidential between us." What should the social worker do FIRST? A. Show the client how files are kept locked B. Explain that because of his court-mandated status, everything he communicates will be shared with the courts C. Review what the social worker is required to share with the courts and discuss the limits of confidentiality D. Encourage the client to share as he is ready - Correct answer the correct answer is C: to review what the social worker is required to share with the courts and discuss the limits of confidentiality. A is incorrect because it doesn't address the limits to confidentiality or what the social worker is required to share with the courts. B is incorrect because it is generally not true that everything the client shares will be reported back to the courts. D is incorrect because like A, it doesn't address the

very real limits to confidentiality nor does it address that there are things the social worker is required to report back to the courts about. A client has been meeting with a social worker for 6 months around issues of anxiety and depression. The client has met all of the agreed-upon treatment goals and the social worker brings up the topic of termination. The client becomes tearful and states that she doesn't want to end therapy as she is sure her life will go back to how it used to be. What is the BEST course of action for the social worker to take? A. Validate the client's concerns and continue therapy until the client is ready to terminate B. Honor the client's self-determination and create new treatment goals C. Normalize the client's concerns and discuss gradually decreasing the frequency of therapy D. Normalize the client's concerns and schedule a final termination session - Correct answer the correct answer is C: to normalize the client's concerns and gradually decrease the frequency of therapy. A and B are incorrect because they do not acknowledge that this is a normal reaction to therapy, nor do they work to move the client towards termination in a clinically appropriate way. D is incorrect because best practice would be to gradually decrease the frequency of therapy to build the client's sense of competence, not just to have one final session. A therapist is working with a 43-year-old Caucasian male who has a diagnosis of schizoaffective disorder. The client regularly exhibits symptoms of disorganized thinking, delusions, depressed mood and hallucinations. The therapist belongs to a multidisciplinary team consisting of the staff psychiatrist, a social worker and a rehabilitation specialist. Together they aim to provide wraparound services to the client. Which of the following actions are important to carry out when developing a treatment plan for this client? A. Identify client's ability to regulate and follow through with a treatment plan Delineate roles and responsibilities of each member of the multidisciplinary team Set up a monthly meeting between all staff members involved B. Identify client's ability to regulate and follow through with a treatment plan Delineate roles and responsibilities of each member of the multidisciplinary team Discuss methods - Correct answer the correct answer is C. Both answers A and B begin with identifying client's ability to regulate and follow through with a treatment plan. While that step is important, it is not going to be at the top of the priority list. We would first want to clearly identify treatment goals for this client and solidify our understanding of how the team will work together. Thus, we would quickly eliminate both answers A and B. In addition, the third part of answer B is concerned with triggering client's paranoia, and the stem does not indicate that the client has any symptoms of paranoia. Once we narrow it down to C and D, we can see that both of those answers are identical. The only thing that is different is the third line in each answer. If we were to put these answers in order and identify the first thing we would do, it becomes clear that we would first discuss how various duties will be carried out and then set up a monthly meeting. Thus, answer D is out and we are left with answer C. A therapist receives a call from an individual who explains that the court recently appointed them conservator of their 35-year-old sister. The conservator explains that the sister has a history of mental health issues, including major depression with psychotic episodes. The conservator notes a desire to attend therapy sessions with the sibling to ensure treatment is beneficial. What are the legal responsibilities of the therapist in this case? A. Request a copy of the court documentation to determine the type of conservatorship and powers granted to conservator. B. Schedule an initial session with the conservator and conservative to receive informed consent and begin family therapy. C. Schedule an initial session with the conservator and conservative to receive informed consent and explore most appropriate modality of treatment.

D. Schedule an intake session for family therapy and request court documentation to deter - Correct answer The correct answer is A. The question is specifically asking about legal responsibilities. Therefore, you can easily eliminate any answers that are ethical in nature. Answer C includes an ethical component, "explore most appropriate modality of treatment," and can be eliminated. Answers B and D assume family therapy will be the modality of treatment. This is incorrect. Regardless of the type of conservatorship, a conservative still has a right to engage in the decision- making process regarding modality of treatment—whether or not they want family members or their conservator to attend sessions. The best answer is A. The option provided in Answer A will often be the best starting point when working with a conservatorship. Court documents will provide the therapist with a clear understanding of the conservator and conservative’s rights. The court documents will clearly indicate if the conservator can make health decisions for the conservative, if they are responsible for fees, and their level of involvement over the course of treatment. Parents of a six year old boy come to therapy seeking emotional support. Both of them are overwhelmed and tired. They share how hard it has been to care for their son. Ever since their son was very little, he has struggled with transitions. They share that he throws significant tantrums whenever there are even slight changes in his routine, such as changes to his diet. He doesn't make eye contact, doesn't respond when his name is called, and often doesn't know when it's time to switch topics or adjust his tone of voice. "It is also so hard since he is incredibly sensitive to noises," his mom adds. "We can't flush the toilet, for example, without him covering his ears and crying. Everyday sounds that we were not even aware of are now a big deal in our household." Based on the symptoms described, what is the most likely diagnosis for their child? Social Communication Disorder Language Disorder Disruptive Mood Dysregula - Correct answer the correct answer is D. Even though a persistent deficiency in social communication is something the boy described in the vignette has, he also has symptoms pointing to restrictive, repetitive patterns of behavior. Thus, answer A does not account for all symptoms described in the stem. Language disorder in answer B also does not account for all of the symptoms. For instance, his sensitivity to noises and difficulty with transitions are not going to be explained by a language disorder, so this answer is out. Yes, this little boy has tantrums, but he also has difficulty making eye contact, great sensitivity to sound, and an inability to adjust his tone and respond to his name. Other than tantrums, disruptive mood deregulation disorder does not account for any of the above mentioned symptoms, thus C is incorrect. Answer D is the only one that takes into consideration all of the symptoms the little boy exhibits. In the stem we can see that he has difficulty with social communication and exhibits restrictive, repetitive behaviors. Thus, autism spectrum disorder is the most likely diagnosis. A therapist has been meeting with a client for individual therapy for a year. The client has been in a long-term relationship with a partner who struggles with Major Depressive Disorder. The client's partner has a history of attempted suicide and substance abuse. During a session, the client shares that she believes her partner has increased use of alcohol in recent days and is suicidal. She is scared and uncertain what she should do. What should the therapist do in this case? A. Inform the client that the therapist must break confidentiality to manage their partner's safety risk. B. Inform the client that the therapist must break confidentiality because of their duty to protect. C. Inform the client that the therapist will maintain confidentiality and offer resources for the client's partner. D. Maintain confidentiality since the therapist's duty to protect is only triggered when it is their client who is at risk. - Correct answer the correct answer is C.

When it comes to duty to protect, a therapist is only obligated to intervene when their client is the one who poses the danger to self or others. In fact, the therapist can only break confidentiality if it is their client who presents as a danger to self. Therefore, answers A and B can be eliminated. We are left with answers C and D. It's important to consider what the question is actually asking when deciding on the strongest answer. If the question asked about our legal obligation, the correct answer would be D. Legally, we would maintain confidentiality. However, the question is broader and therefore our answer should encompass more than just our legal obligation. Answer C includes the therapist's legal obligation, which is to maintain confidentiality. Answer C also addresses the clinical issue that is raised by the client's expression of fear and uncertainty by providing her with resources. A therapist working at a community mental health agency is meeting with a 43-year-old Caucasian male. The client reports he is unemployed and can only afford treatment with a sliding scale. In addition, he shares a history of traumatic abuse and loss, both in his childhood and young adult years. During the initial interview, the therapist notices that client appears to have a runny nose, dilated pupils and his mood appears to be dysphonic. The client complains that he is feverish and his muscles are aching. Based on the presenting picture, what interventions should the therapist consider? A. Inquire whether client is going through an amphetamine withdrawal and refer him to a detox facility if the answer is affirmative B. Inquire whether client is going through an opioid withdrawal and refer him to a detox facility if the answer is affirmative C. Inquire whether client is going through an amphetamine withdrawal and re - Correct answer the correct answer is B. Physical symptoms described in the stem are a better fit for the opioid withdrawal, not amphetamine withdrawal. Thus, answer A is not a good fit. Answer B is correct, since the symptoms the client is experiencing point to an opioid withdrawal. If this is what the client is going through, the immediate action to take would be to refer him to a detox facility. Answer C is incorrect, since we have determined that the client is likely going through an opioid withdrawal. A detox facility would be a better referral than an intensive outpatient in this case, since opioid withdrawal can be dangerous and should be done under supervision. Intensive outpatient treatment facilities focus more on long-term recovery, which would be an important step, but only after a detox facility. Answer D correctly identifies an opioid withdrawal problem; however, as noted above, a detox facility would be a better referral than an intensive outpatient in this case. A therapist meets with a new client who was referred for treatment by his primary care physician. The client presents as agitated and tells the therapist that he believes the government is spying on him. He shares that he's noticed a man standing near his apartment for the past few days and intends to confront him and make sure he knows he's "messing with the wrong guy." What action should the therapist initially take in this situation? A. Refer the man to a psychiatrist since he appears to be exhibiting symptoms of paranoid B. Conduct a risk assessment to determine if the therapist should engage law enforcement C. Conduct a comprehensive assessment to identify the goals of treatment D. Challenge the client's understanding of the situation to determine if his thinking is based in reality - Correct answer A therapist working with incarcerated adults is meeting with a 54-year-old male client. This client has been sentenced to fifteen years in prison for an aggravated assault charge. His file demonstrates that he has a history of engaging in illegal activities. During the first session the client appears agitated, restless, and sweaty. He does not look the therapist in the eye and offers short answers to any

question he is asked. Which of the following actions should the therapist take to develop a treatment plan? A. Refer client for medical exam to rule out organic contributors to his behaviors and gather history of client's aggressive and illegal behaviors B. Consult with criminal justice officials regarding client's psychosocial history and gather history of client's aggressive and illegal behaviors C. Refer client for medical exam to rule out organic contributors to his behaviors and assess client for appropriateness - Correct answer the correct answer is A. Answer A reflects proper actions to be taken in this case. Since this client presents with physical symptoms, the therapist ought to send him for a medical evaluation to rule out the presence of a medical condition. For instance, people with untreated hyperthyroidism often appear agitated, restless and sweaty. In addition, we should gather more information regarding this person's history in order to better understand the focus of treatment e. Answer B can be ruled out since it does not contain the step of a medical referral. Answer C is correct in the referral for a medical evaluation, however, it is jumping the gun with assessing for the appropriateness of psychotropic medication. There is no indication for this in the stem. It is also not in our scope of practice to assess for medications. Answer D can also be ruled out since it does not contain the step of medical referral and it is out of our scope of practice for assess for medications. A therapist meets with the wife of a 90-year-old man. The wife informs the therapist that her husband is spending several weeks in a skilled nursing facility's rehabilitation unit following a massive heart attack. The client is concerned that her husband is not receiving adequate care because he appears weak and unclean. She shares that his bedpan overflowed a few days earlier and the nurse did not bother to clean up the mess until several hours had passed. The client would like to have him discharged and hire in-home care. How should the therapist proceed? A. Honor the client's self-determination and assist her in identifying in-home care. B. Assess further for potential elder abuse to determine if a report is required. C. Inform the client a report is mandated and provide verbal and written report to both law enforcement and the local ombudsman. D. Consult with colleagues to determine if this information rises to t - Correct answer the correct answer is C. Answer A is incorrect because it is not the priority in this case. This may be done eventually, but it does not address our legal mandate of reporting elder abuse and neglect. Answer B is incorrect because the therapist needs "reasonable suspicion" when determining if a report is mandated. In this case, the client shared that her husband was unattended to for hours while sitting in his own urine. This rises to the level of neglect; we do not need to assess further. Answer D is incorrect for a similar reason as B; we have enough information to warrant a report, so consultation is not required. Answer C is the correct choice. The information shared by the client provides the therapist with reasonable suspicion that her husband is being neglected. Since the abuse has taken care in a long- term care facility, and does not constitute physical abuse, the therapist must report to law enforcement and the local ombudsman. A therapist is meeting with a family of five. The father, Darren, is a 45-year-old African American lawyer, who has two children from his previous marriage, Aaliyah, 15-years-old and Nia, 9-years-old. The mother, Akko, is a 38-year-old Japanese entrepreneur who also has a child from her previous marriage, a 10-year-old boy named Rikki. The family states that it has been a little over a year since they moved in together and in that time the step-siblings never got along. "They fight and pick on each other all the time", said mom, "and they compete to get our attention." In addition, Aaliyah has been caught drinking and smoking marijuana at school. In response, her dad took away all of her privileges for an indefinite period of time. Akko does not agree with that approach and is trying to work with him

on implementing a plan where Aaliyah gets to earn her privileges back. Moreover, Rikki continues to struggle with going - Correct answer the correct answer is A. Answer A covers all of the issues affecting the family that are clearly mentioned in the vignette. Thus, it is the best answer. Answer B has the "grief and loss" part in it, which was not expressed in the stem Answer C mentions cultural differences, and while the question stem notes the parents are different ethnicities, the issue is not mentioned in the description of the issues discussed by the family Answer D lists the development of new relationships, an issue that did not come up in the stem A therapist has been meeting with Nadine, age 36 and Bruce, age 37 for a month. The couple has been together for three years, during which time they felt mostly connected and able to get along. Recently, however, they have been growing further and further apart. "We have been bickering and barely spending any time together," states Nadine. "It seems like Nadine is working all the time," notes Bruce. "It's like she does not want to be alone in the room with me anymore," he adds while looking down. A few days after the session, a therapist receives a phone call from Nadine asking the therapist to set up some time to talk privately. During such call, Nadine tells the therapist that she has been having an affair, but she would not want Bruce to know since it is "going to break his heart". Which of the following actions should the therapist take based on the case presented? A. Acknowledge Nadine's dilemma and maintain con - Correct answer the correct answer is B Answer A can be eliminated because the information Nadine shared is clinically relevant, thus, according to the "No Secrets Policy" will not be kept confidential. Answer B is the best answer since we would certainly first validate Nadine's desire to protect Bruce, yet we would need to be honest with her and remind her of the "No Secrets Policy". Since the therapist has been meeting with this couple for a month, it is safe to assume that the therapist went over this policy at the onset of treatment. Answer C, might seem like a good answer, except the information provided in the stem tells us that Nadine's discloser is clinically relevant. There is no need to determine such relevance any further. Since the couple's presenting complaint is lack of closeness, Nadine's affair is most certainly relevant to clients' treatment and is therefore, to be brought up in the session. Answer D is another answer that might seem tempting, however, there is a step that we are going to take before bringing this information up in the session. And that is talking to Nadine about the fact that the therapist cannot keep this information secret and it would need to be revealed to Bruce. A therapist is meeting with Gary, a 33-year-old event manager. Gary shares that he is at a loss as to how to communicate with his girlfriend. "Nothing I do is good enough for her. She gets mad if I tell her how I feel. She gets mad if I shut down. I clearly need tools to learn how to talk to her better," he states. In addition, Gary tells the therapist that he has had a history of depression throughout his adult life. Recently, however, it has gotten worse and he is barely able to get out of bed. Gary reports having a psychiatrist and taking Lexapro for the past few years. In order to stay within their scope of practice, the therapist should make which of the statements? "It seems like your medication dose needs to be increased. Why don't you talk to your psychiatrist about it?" "It seems like you are on the right dosage of medication and the problem lies in you being relationally unhappy." "It might be best for you - Correct answer the correct answer is C. Let's take a look at the answers: Since the question is asking us to stay within our scope of practice, it is important to remember that offering advice regarding psychotropic medication is outside of our scope of practice. Only a licensed MD is able to do so. Thus, we have to refer our client back to his psychiatrist and not render any of our own opinions regarding medication in the process. The only answer that does so is (C). In answer (A) the therapist talks about a possible medication increase and that lies outside of our scope of practice.

In answer (B) the therapist states that the client is on the right dose, which is also not within our scope of practice. In answer (D) the therapist talks about the client's possible tolerance to Lexapro, with him potentially needing another medication. Since we are not medical professionals, we cannot make such determinations or even such suggestions. Thus, the only legal reply we can make is (C). A 46-year-old man who emigrated from Ecuador eight years earlier has been in therapy for several months to address symptoms of anxiety and difficulties with sleep. During the first month of treatment, the therapist developed a good rapport with the client and collaboratively identified goals for treatment. The client's chief complaint is that he is up most evenings with his mind racing about finances, and his family that is still in Ecuador, including his inability to care for his aging parents who are so far away. The client shares that due to the lack of sleep he has been exhausted at work and is constantly scared he is going to lose his job. Which of the following actions would a Cognitive Behavioral Therapist utilize in the middle stage of treatment? A. Practice diaphragmatic breathing in sessions with the client and discuss how he can integrate these skills into his daily routine to decrease anxiety levels. B. U - Correct answer the best answer in this situation is answer B. Answer (A) is something a CBT therapist would do and it is an appropriate intervention to use based on the presenting issue, but this would be more suitable to earlier stages of treatment. Remember, by the middle stage of treatment we've already laid the foundation for making change happen. This means we already would have identified ways for the client to integrate relaxation techniques into his daily routine. Answer (D) is wrong for a similar reason. Again, this is an intervention that would likely be used by a CBT therapist and it makes sense based on the information shared in the vignette. However, by the time you are in the middle stage of treatment, the client should already have an understanding of cognitive distortions. Answer (C) is wrong for a different reason. Similar to answers (A) and (D), this intervention would properly address the client's anxiety, but it is more closely associated with Solution Focused therapy, not CBT. Answer (B) is the best option available. The client would have learned how to use an automatic thought record at the onset of treatment, and would continue to utilize it through the middle stage of treatment. This intervention addresses the client's chief complaint, it is strongly linked to CBT, and it would be used in the middle stage of treatment. There are three parts to the question being asked (actions, CBT, and middle stage) and this is the only answer option that correctly addresses all of them. A social worker has been meeting with a couple for 6 months to work on issues related to physical intimacy. During a recent session, one partner shares that during recent arguments she has slapped her partner, but notes that it has never left a mark. What should the social worker do? Develop a safety plan Explore what is leading to the physical aggression Continue seeing them as a couple and refer the abusive partner for individual therapy Refer each of the clients to individual therapy - Correct answer the best answer is D. Answer (A) sounds like a good idea, but this is not something you would do if both the victim and perpetrator are present. Safety planning is something you would want to do individually with the victimized partner. Answer (B) is also not something you would do with the perpetrator present. This could also easily lead to victim blaming if you try to identify what the victimized partner did that "made" the other partner engage in physical aggression. When physical violence is present, we do not continue seeing the couple until the physical violence has fully stopped occurring. So, it would not be appropriate to continue meeting with the couple while the abusive partner receives counseling (C).

As soon as any physical (or emotional) abuse is reported between a couples, we want to refer each member of the couple to individual counseling with two separate therapists. If and when the physical violence cases, the couple can return to their couples therapist to continue couples counseling. A therapist is meeting with a 14-year-old client who was brought to therapy by her parents. The parents inform the therapist that they are concerned for their daughter's well-being and suspect she is self-harming and has a history of suicide attempts. They inform the therapist that their daughter has met with a therapist in the past and was taking medication for depression and anxiety. The therapist conducts an assessment by asking the client about her current symptoms and goals for therapy. The therapist completes a suicide assessment and decides it is unnecessary to communicate with the client's treating psychiatrist or the former therapist. The therapist's actions are considered: Below the standard of care because it is important to collaborate with the treating psychiatrist and gather information from the former therapist. Below the standard of care because the law states it is the therapist's responsibility to c - Correct answer The best answer to this question is A. The situation described falls below the standard of care because a reasonable and prudent therapist would recognize the need to communicate with the psychiatrist, and as part of a thorough assessment would want to gather information from the former therapist. While this is always the case, the added risk of suicide makes it all the more important. Answer B may be tempting, because it also notes this is below the standard of care. However, there are no specific laws or regulations that spell out the need to collaborate or confer with other professionals. Answer C is incorrect because the therapist did not complete a comprehensive suicide assessment. Part of assessment can, and often will, include gathering information from other professionals currently and previously involved in providing care to a client. In this case, the therapist would want to speak with the psychiatrist as well as the former therapist. They will likely have information and guidance to share based on their work with the client. Answer D is incorrect because it implies that standard of care is based on legal requirements, which is an inaccurate description of the concept. A social worker meets with a new client who was referred for issues of depression and anxiety. During the assessment, the social worker discovers the client has a long history of binging and purging multiple days per week and is actively engaged in these behaviors. The social worker has never worked with clients with eating disorders, but thinks it is an area she could be interested in learning more about. What must the social worker do? Treat the client, consulting relevant literature and receiving consultation as needed Meet with the client for depression and anxiety issues and refer her to a separate therapist for eating disorder treatment Refer the client to someone with experience treating eating disorders Wait to begin treatment with the client until the client obtains appropriate training in the treatment of eating disorders - Correct answer the best answer for this question is C. The social worker has no experience in treating clients with eating disorders, so consulting literature and receiving consultation as needed (A) is not enough for the social worker to be considered competent in treating eating disorders. Additional training and experience beyond this would be needed for the social worker to become a competent clinician for clients with eating disorders. A social worker should not meet with the client to treat one issue while referring them to a separate therapist for eating disorder treatment (B). Having one therapist is going to be in the best interest of the client, so referral is a better option than having the client see two separate therapists concurrently. Because of the the social worker's lack of experience in this area, the best option is to refer the client to someone with experience treating eating disorders (C) to ensure the client gets the treatment she needs.

The client is in need of treatment now. It would be unethical (and not in the client's best interest) to have the client wait to receive treatment until the social worker obtains the necessary training to effectively treat her (D). Karl, a 46-year-old retail store manager, comes to therapy at the suggestion of his best friend. During the initial assessment, Karl tells the therapist that he is happily married to his wife Nicole and they have two children together: Nina, 9 and Taylor, 16. The reason Karl is seeking help is due to his ongoing frustration with his son. "He never listens to me or my wife. All he wants to do is hang out with his friends, be on his phone, and stay locked up in his room," Karl states. "At this point, we are ready to pull our hair out. Nothing we do works," he adds while requesting new techniques to help deal with Taylor. What initial intervention should the therapist consider in this case? A. Normalize Taylor's behavior as part of a normal adolescent stage of development B. Invite Karl's wife and son to come to therapy since both of them are such a large part of his presenting complaint C. Acknowledge Karl's struggle a - Correct answer the best answer is C. (A) Sounds very tempting, doesn't it? After all, there is a good amount of normalizing that we do as therapists and Taylor seems to be exhibiting normal adolescent behavior. It is a good answer indeed, yet picking it would mean that we miss our client's feelings entirely. Our client is telling us how frustrated he is with his son. Telling him that his son is being a typical teenager might make our client feel a bit bad, which is not clinically sound. (B) is also very tempting. It makes a lot of sense to invite his wife into the room with him, since it is the two of them that are having trouble dealing with their son. Inviting Taylor also makes sense, since the whole issue is about him. Wouldn't we want to include him in treatment? Perhaps yes, but not quite yet. This is a step that might come in the middle phase of treatment, but it is not suited for an initial intervention, since again, we miss the client that is sitting right in front of us. (C) Is the answer that finally meets our client where he is? It is clear that he is very frustrated with his teenage son, and that is exactly where we are going to connect with him. Such connection will allow us to build rapport and to help the client feel understood and not judged. Bingo! That is a great place to start. It is out of that connection that the future interventions will flow. (D) Is putting the cart before the horse. Here we miss the client's personal feelings and rush into making suggestions. You know how the security message on the airplanes encourages us to put the oxygen mask on ourselves first, and only then help those dependent on us? Connecting with Karl would be putting that oxygen mask on the father first. And that, in turn, will help him take better care of his family. Once Karl's feelings are attended to, he and the therapist can com A social worker is a vocal supporter of a local politician running for office. The social worker makes several posts on her personal social media page that speak negatively about the opposing candidate and his party. A client that the social worker has been meeting with for several months leaves a voicemail referencing these posts and exclaims, "I didn't know I was being counseled by some left wing nut job." What should the social worker do to avoid future situations like this? Modify their social media settings so clients are unable to see their personal/political posts. Discuss their political views at the outset of therapy to ensure they align with their clients' values. Trust that clients should not be viewing their personal social media pages. Acknowledge that this is an unavoidable occurrence and address it on a case by case basis. - Correct answer the best answer for this question is A. The COE states that social workers should be aware that posting personal information can cause harm to clients. Social workers need to be cognizant of what they are posting that could be seen by clients and could subsequently damage the therapeutic relationship. Personal social media posts should be kept on private settings (A). It is inappropriate for the social worker to discuss their political views with clients (B). We cannot control what our clients choose to search on social media sites (C). It is important to keep in mind that anything we post publicly online could be seen by a client.

This is not an unavoidable situation (D). While we cannot keep our clients from searching for us on social media, we can control what we choose to post privately vs. publicly and should be mindful of what we post. A social worker has been meeting with a local client using a combination of in-person and teletherapy for the past six months. The client is moving across the country and wishes to continue teletherapy with the social worker. Teletherapy is legal in the state the social worker and client are currently residing in, but not in the state the client is moving to. What must the social worker do? A.Continue therapy because it is legal in the state the social worker is licensed. B. Continue therapy because not doing so would be considered client abandonment. C. Discontinue therapy and help connect the client to services where she is moving. D. Allow the client to determine whether or not she wants to continue therapy. - Correct answer the best answer for this question is C. The question is asking what the social must do. We cannot continue therapy with the client simply because teletherapy is legal in the state the social worker is licensed (A). The Code of Ethics 1.04(e) states that we must comply with laws governing technology not only in the state we practice, but in the state the client is located as well. This would not be considered client abandonment (B), as the client is the one moving and it is illegal to offer teletherapy because of the local laws in the state the client is moving. We must discontinue therapy services (C) based on our Code of Ethics and the local laws in the state the client is moving to. We can still help the client get connected to local resources to ensure continuity of care. We cannot allow the client to determine whether or not she wants to continue therapy with us (D), because continuing therapy is not a legal or ethical option given local laws and our Code of Ethics. A newly licensed social worker has been meeting with a client for two months. The social worker is concerned with some patterns of disordered eating the client reported and is unsure of how to proceed. The social worker invites her supervisor who specializes in eating disorders to sit in on the next session. The client does not express any concern upon seeing another person in the room. The session is conducted and the therapist and supervisor then meet to explore a treatment plan and appropriate interventions. Having the supervisor sit in on the session can be described as: A. Ethical, because it was in the best interest of the client to have a specialist involved in her treatment B. Ethical, because it was recommended by the supervisor C. Unethical, because the social worker should not be treating a population she does not have experience with D. Unethical, because the social worker did not obtain the client's cons - Correct answer the best answer for this question is D. While it may be beneficial for a specialist to be involved in the client's treatment (A), it is unethical to do so without the client's informed consent. Treatment options, including bringing in a specialist (or referring out to a specialist) should be discussed with the client. It does not state anywhere in the question stem that the supervisor recommends this (B). Further, even if the supervisor recommended sitting in on the session, to do so without the client's informed consent is still unethical. While it may be unethical to treat a client population that the social worker is not trained to treat (C), this is not what makes the scenario presented in the question unethical. Also, while the question stem states that the social worker is unsure of how to proceed with her client who is reporting disordered eating patterns, it does not state that the social worker has no experience treating clients with eating disorders. Having the supervisor sit in on the session is unethical because the social worker did not get the client's informed consent for this to occur (D). The fact that the client "does not express any concern" with the supervisor's presence in the room does not make this treatment decision ethical. If the social

worker felt this would be a beneficial step, she should have presented this option to the client and obtained his or her informed consent. A social worker has been meeting with a 24 year old woman for the past two months. The client presented with issues of anxiety, depression, and "ongoing relational difficulties." The client is closed off and shares very little in session and the social worker is struggling to get the necessary information to complete the client's bio psychosocial assessment. What should the social worker do FIRST? A. Continue meeting with the client and gather information as the client is ready to share B. Address the client's resistance in the next session C. Do a Google search of the client to gather pertinent information necessary to complete the assessment and continue meeting with the client and gathering information as she is ready to share it D. Terminate services with the client as it is unethical to continue treating a client you are not making progress with - Correct answer the best answer for this question is B. The question specifies that the social worker has been meeting with the client for two months without making progress. It is unethical to continue meeting with her as is (A), assuming things will change without addressing her resistance. If this were the first session or two, answer A could be an option, but given that it has been two months, her resistance needs to be addressed. The question is asking what we would do first, so you want to put the answers in order of operation. We want to begin by addressing the client's resistance that is keeping therapy from progressing (B). Once we explore this dynamic with the client we would have a better sense of how to proceed. This is a topic that was discussed during the NASW's webinar last week. Doing a Google search of a client without their consent is unethical, as it does not honor their right to privacy. If we plan to include a Google search as part of our assessment of the client, this would need to be reviewed during the informed consent. While we would not want to continue providing services to a client who is not progressing, there are several steps we would take before jumping to termination -premature termination would constitute client abandonment. There isn't a reason to terminate yet! We would want to start by addressing the issues or consulting with colleagues before moving to termination. A social worker has been meeting with a 15 year old female for the past two years around issues of anxiety and depression. The social worker learns that her client's mother, who suffered from Bipolar Disorder and saw her own therapist, recently committed suicide. The social worker posts on a public Facebook group for social workers, "A teenage client lost her mother, Cassandra, to suicide on October 21st. Cassandra suffered from Bipolar Disorder and saw a counselor herself. This serves as a reminder of the work that still needs to be done to prevent these tragedies. My heart is heavy today." This use of technology is: A. Both legal and ethical B. Illegal and unethical C. Legal, but unethical D. Illegal, but ethical - Correct answer the correct answer is B, both illegal and unethical. There are several legal and ethical issues presented in this scenario that are of concern. First, this is posted in a public Facebook group, so anyone could see it, including the client and her family. Second, the social worker provided a good bit of identifying information: the mother's first name and the date of her death. That, coupled with the likely ability to identify what state the social worker practices in, is enough to do a Google search and identify the person. On top of that, we know the person saw a therapist and suffered from Bipolar Disorder. This is private information, which is not the public Facebook world's business! Further, once you identify who the mother is, it would be fairly simple to find out who the client is as well (especially given that most obituaries list the deceased's surviving children by name). A therapist meets with the parents of a 16-year-old boy who was recently suspended from school after being caught with alcohol on campus. The parents share that their son has been fighting and abusing alcohol for several years. The father cries as he expresses his sadness and frustration, noting his

son's behavior has caused a serious strain in his relationship with his wife and that is why they are seeking therapy. The wife nods in agreement, sharing their lack of intimacy and constant arguing that she hopes to address through therapy. The wife states, "Our son had a difficult childhood because his sister was constantly sick and he didn't get the attention he needed. My husband is too hard on him, he treats our son terribly." Which of the following goals should be included in the treatment plan for this case? A.Improve problem solving and conflict resolution between parents; Refer parents to Al Anon; Increase intima - Correct answer The best answer for this question is A. The question is asking which goals should be included in the treatment plan for this case. This question is not only testing your ability to identify appropriate goals for therapy, but also is ensuring you are able to understand who comprises the treatment unit. The parents are in the room and although they are having problems with their son, he is not part of the therapy and thus goals should not focus on him. The issues presented by the parents include arguing, lack of intimacy, and conflict due to their son's behaviors. Answer A directly addresses the parents expressed concerns about their relationship and a referral to Al Anon, a support group for family members coping with loved ones abusing alcohol, would help them to understand how alcohol abuse affects their family and their relationship. Answer B and C both include referrals for the son, which is inappropriate since the son is not part of the treatment unit. Answer D includes a focus on improving communication within the family, but again this is incorrect because the entire family is not working with the therapist. A therapist worked with a couple for several years following mutual infidelity. The couple separated after two years in treatment and is in the midst of divorce proceedings. The husband requests access to his records. What actions should the therapist take to address the legal issues presented in this case? a. Inform the husband that the records belong to both the husband and wife and would require a release of information from both. b. Request a written release from the husband and turn over all of the records, but redact information deemed detrimental to the wife's well-being or therapeutic relationship. c. Determine how access to records would affect the therapeutic relationship and the wellbeing of the husband and wife. d. Inform the husband that records belong to both the husband and wife and request the wife sign a release. - Correct answer the best answer to this question is A. The husband is requesting records, but the client is the couple and the therapist would need both members of the treatment unit to authorize release of records before doing so. Answer B is too limiting in what would be redacted. Without a release from her, the therapist would need to redact all information for the wife, not just information that could be detrimental. Answer C would be an option if an individual were requesting records, but that is not the scenario provided in this question. Answer D is incorrect because the therapist is requesting the wife sign a release, which is inappropriate. Answer D would be better if the answer had the therapist asking the wife what she would like to do in response to the request, but the therapist should not request the wife sign a release. A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non-suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST? A. Discuss voluntary hospitalization with the client B. Teach the client coping skills to utilize in moments of intense emotion C. Explore the thoughts and feelings that preceded the client's self-injury

D. Refer the client to an MD to take care of the client's injuries - Correct answer the correct answer is C. Answer A: does the client need to be hospitalized? Not at this time. Nothing in the question stem indicates that the client is having suicidal thoughts or is a risk to herself. The question stem specifies that the client engages in non-suicidal self-injury, meaning, she is engaging in self-harm without the intent of killing herself. Further, the cuts are on her forearm and are described as shallow and healing normally, so there is no medical emergency that would indicate a need for hospitalization. Especially for therapists inexperienced with self-injury, seeing a client's self-inflicted injuries can be alarming and upsetting. From a place of concern and wanting to make sure our clients are safe, we can jump to too extreme of interventions, such as unnecessary hospitalization. Answer B: does the client need concrete coping skills to help her cope during moments of intense emotion? Definitely. This is something you would want to do, but is not necessarily what you would do. Answer C: should we explore the thoughts and feelings the client had before engaging in self-injury? Yes! This answer option allows us to stay in the moment and respond to what the client has shared. Exploring her thoughts and feelings leading up to her self-injury will help us gain a better understanding of the precipitating factors and triggers for this behavior. From there we could discuss various coping skills for the thoughts and emotions that triggered this behavior (B). Answer D: does the client need a medical evaluation? Probably not. The question indicates that the cuts were shallow and healing normally. Nothing else in the question stem indicates a need to seek medical attention. A 50-year-old male client meets with a therapist on the advice of his husband. The client shares that he has been out of work for almost a year, losing his job after his company completed mass layoffs. He reports feeling discouraged by his job prospects, feels lost without a place to go each day, and feels increasing hopelessness with each passing month he is unemployed. He states, "I feel completely useless and am questioning the point of it all. I feel completely dependent on my husband and I know he's sick of being the sole breadwinner." Which of the following actions should the therapist take to assess this client? A. Explore job history, identify existence of somatic concerns, and identify familial coping patterns B. Explore job history, determine current risk of self-harm, and explore support systems C. Explore mental health history, identify existence of somatic concerns, and explore coping mechanisms D. Explore mental he - Correct answer the best answer for this question is D. The question is asking which actions the therapist should take to assess this client. With this type of question, it's possible several answer options include items we would want to assess, but we need to prioritize what is most important in this case. We've already noted that the client's expressions of hopelessness and helplessness should raise red flags regarding danger to self. The client is expressing thoughts and feelings that are indicators of potential sociality. Client safety is our priority and we must immediately assess for risk of harm to self. If an answer does not include a focus on the client's risk of self-harm or sociality, we can eliminate it. Therefore, answers A and C can be ruled out. This leaves us with answer B) Explore job history, determine current risk of self-harm, explore support systems, and D) Explore mental health history, determine current risk of self-harm, and explore coping mechanisms. A strong consideration when assessing risk is the client's prior mental health as well as the coping mechanisms available to the client. These two items included in answer D would help the therapist better understand the client's level of risk based on prior mental health AND help the therapist identify strategies to manage safety. While there is nothing inherently wrong with answer B, the client's job history is not as important a factor to consider, making it the weaker answer choice between B and D. A 66-year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep, decreased appetite, and increased feelings of agitation and restlessness after being laid off from his job. He goes on to tell the social worker that "things just seem to keep going downhill since my wife died a year ago." What action should the social worker take FIRST?