Domain: Intake, Assessment, and Diagnosis

Based on the narrative, which of the following symptoms most affirms this client's PTSD diagnosis?

Domain: Intake, Assessment, and Diagnosis

Which of the following are not criteria for Posttraumatic Stress Disorder?

Domain: Intake, Assessment, and Diagnosis

Based on the information in Part One, which of the following best specifies the severity of the client's Tobacco Use Disorder?

Domain: Professional Practice and Ethics

Which of the following is not considered a standard aspect of the therapist's role in counseling?

Domain: Counseling Skills and Interventions

You suspect that one of your clients has a history of abuse, but you decide to wait to see if the client brings it up. When in the therapeutic process is the client most likely to bring up abuse?

Part Two

First session, one week after initial intake session

The client discusses recent nightmares in detail and buries his face in his hands when he pictures the scene in the dream. In his latest dream, he finds himself waiting in line at an amusement park with his late wife when all of a sudden an announcement comes over the loudspeaker that the ride they are waiting on will be closed for the rest of the day. He begins to feel his frustration grow inside of him, his face turning red as he notices his fists squeezing tight. He turns to his wife to lament the time they have wasted in line, but no one is next to him. He spends the rest of his dream searching through the crowd of people who are trying to get out of line, all talking about what a waste of time waiting in line was. “I don’t know what it means,” he confesses, “but I can’t handle that thought of wasting all that time and then her not even being there when I try to do something about it. It really messes with me.” He describes feeling nervous nearly all of the time, including when he is in your office. You lead him in a guided imagery exercise to reduce anxiety and the client gives you mixed feedback about the exercise. He again takes a smoke break in the middle of the session. When he comes back, he states that he feels helpless and that he misses his wife greatly. You lead the client in a breathing exercise and encourage him to practice it to reduce distress between sessions.
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Domain: Treatment Planning

When your client gave you mixed feedback about the guided imagery intervention, which response would be best to continue building rapport with the client?

Domain: Intake, Assessment, and Diagnosis

You decide to assess (client) for risk of suicide. Which of the following is not an established risk criteria?

Domain: Intake, Assessment, and Diagnosis

From a Rogerian Therapy approach, what could you say to the client before moving into the guided imagery exercises?

Domain: Counseling Skills and Interventions

Which of the following techniques would best address the client’s PTSD?

Part Three

Second session, three weeks after initial intake session

The client comes to session stating that he tried practicing the breathing exercise you gave him, however it was too painful to breathe, given the state of his lungs. “That breathing stuff just throws me into a coughing fit. It’s not going to work for me.” You respect the client’s observation and offer to change directions. He puts a folder of x-ray film on your desk. “I brought you this in case you didn’t believe me. These are my latest x-rays. The doctor seems to think I could be at risk for lung cancer, can you believe that?” he asks between coughs. You tell him that you believe him, and he doesn’t have to do any therapy techniques that are too painful for him. He urges you to hold the films up to the light, though, pointing out the same spots the doctor pointed out to him a few weeks before. “The tests are all inconclusive as of now, and my doctor wants me to quit smoking, but I know what’s best for me.” Your conversation eventually takes a turn towards client’s nightmares that take place where his wife passed away. You help the client make a list of negative thoughts he often has as a result of the events that took place in the woods. You help him brainstorm positive phrases that could replace them. He becomes frustrated, stating that there is nothing positive about what happened. You take some time to provide psychoeducation about the exercise, and the client states that he understands and is willing to give it a shot as long as it doesn’t have to do with deep breathing. The client resolves to put notes around his house with the positive phrases so he can read them on a daily basis. The client ends the session after 45 minutes stating that he needs to go outside to smoke.
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Domain: Core Counseling Attributes

How would you reflect the meaning of the client’s recounting of his smoking habits?

Domain: Intake Assessment and Diagnosis

Which of the following statements best reflects how Motivational interviewing could be used to address the client's smoking?

Domain: Counseling Skills and Interventions

Which of the following cultural factors is least likely to lead to PTSD symptoms?

Domain: Counseling Skills and Interventions

You have a different client, a 43 year-old Asian female, who has come in for her final session. She brings a small framed card with a picture of a crane on it as a token of gratitude to you. What do you do about this gift?

Case 2

Part One

Age: 17
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: School clinic
Type of Counseling: Individual
Presenting Problem: Failing grades and fights with the other students
Diagnosis: Conduct Disorder

Presenting Problem:
You are a school counselor in a public school system and receive a new referral for a 17-year-old, Caucasian, Heterosexual, male. Client presents in therapy after three suspensions and is at risk of expulsion. During your initial intake, you learn that client was recently suspended after stealing from multiple classmates and skipping class to smoke cigarettes on the basketball court. His grades are slipping from “C’s” to “D’s” and his teachers have complained that he interrupts lectures and engages in bullying of other students. His parents beg you to help him, as they express fear that he is going to run away from home and not return.

Mental Status Exam:
Client presents in therapy with sweatpants and a sweatshirt. He laughs that he violated the school dress code by wearing a sweatshirt with a beer logo on it, “I don’t give a crap about this school. They told me if I don’t see you, I’ll get expelled, but I don’t even care about that!” Client selects a seat close to the door and makes intermittent eye contact with you. He presents with symptoms of aggression, hostility, anxiety, and difficulty concentrating. You observe that he is playing with his Nintendo Switch under the desk. He rolls his eyes when you inquire about his relationship with his parents and states that he does not want to talk about it. He denies thoughts of suicide and homicide, though he admits that he would not care if his parents ended up dead one day.

Vocational history: The client got a job at a local take-and-bake pizza shop two years ago and has maintained steady employment. He tells you that he has memorized the combinations of toppings for each of the pizzas the shop offers. One of his responsibilities is to be sure the customers are aware that the pizzas have to be baked before they are consumed. The process involves handing the customers a recipe card and answering questions they may have. He talked with his boss, the owner of the shop, about adding the step of broiling the pizza right at the end to ensure a crispy layer of cheese. His boss was so impressed with his initiative and keen pizza prowess that he told him he could become manager at the age of 18. Your client says that he enjoys his job and fears that his parents will force him to quit if he doesn’t get his schooling under control.

Family History
Client resides with his two parents and younger sister in Maryland. His younger sister attends the same school and is a straight “A” student. Client was placed in several extracurricular activities growing up, including soccer, basketball, and drums. They described him as a calm child with a “normal” upbringing. His parents inform you that client had an older brother whom he was extremely close with. They tearfully share that he was in a car accident five years ago. They express that client has not been the same since and his behavioral problems began a few months after his brother passed away.
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Domain: Core Counseling Attributes

What nonjudgmental response would you make after the client’s refusal to talk about his parents?

Domain: Counseling Skills and Interventions

What are the essential elements of cognitive restructuring?

Domain: Core Counseling Attributes

Which of the following is false about empathy?

Domain: Counseling Skills and Interventions

How could you use 'Wise Mind' from Dialectical Behavioral Therapy to try to help this client self-evaluate?

Domain: Counseling Skills and Interventions

You notice that your client has all of a sudden gotten withdrawn and has crossed his arms and slumped down on the couch. You state, “Hey, I notice you’ve kind of checked out and your body language has gotten more closed. Did something happen that you’d like to discuss?” What is this interaction an example of?

Part Two

First session, two weeks after intake

Client arrives to your first session at the school clinic about ten minutes late. He smells of cigarettes and you observe large bags under his eyes. Client expresses that he has not been sleeping well because he stays up all night playing video games. He shares that he continues to not do his homework or engage with the other students, “I could care less about them! No one is my friend!” You utilize active listening and eventually client shares about the loss of his brother. You continue to observe that his tone is irritable with rapid speech. You gently begin to explore how client’s thoughts are impacting his behaviors at school and with his parents. He tells you about a girl who sits next to him in math class who asked him to stop talking to her. “How do you expect me to have positive thoughts when people don’t even want me to talk to them?” He speculates that she asked him to stop talking to him because she just got a new boyfriend. Even though they would work on group projects together, he suspects that her boyfriend told her to stop choosing him as a group member. He expresses anger towards the boyfriend for being so controlling, and frustration with his classmate for not standing up for herself. You ask him if there is anyone else in his math class that he feels comfortable with, and he says that he’ll have to figure something out so he doesn’t have to do double the work on the next project. At the end of the session, client shares that he is not sure if he can trust you, but you schedule an appointment for three weeks.
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Domain: Counseling Skills and Interventions

From a transtheoretical perspective, how would you use a simple reflection in response to the client saying, “My brother died. You wouldn’t get it.”

Domain: Intake, Assessment, and Diagnosis

You choose to administer the Outcome Questionnaire 45 (OQ-45) to your client. The primary purpose is to:

Domain: Treatment Planning

How would you interpret the client stating, “No one is my friend!”?

Domain: Core Counseling Attributes

Which clinician coined the term “unconditional positive regard?”

Part Three

Second session, three weeks after first session

At the onset of the session, client shares with you that he is playing basketball again and has gotten his grades up from “D’s” to “C’s.” He expresses that he still does not want to engage with the other students and his parents note that he continues to steal at home, though the stealing and bullying at school has stopped. You made progress in your last session with exploring alternative behaviors that client can engage in to reduce rage, including playing basketball and going for walks. He says that one of the moments that made him proud this week was when he got to train a new employee at the pizza place. Right when he was telling him about the importance of explaining the last step, to broil the pizza on high for 8 minutes, to the customers, his boss chimed in and gave him full credit for adding that step to the method. He tells you that he felt recognized and respected by his boss, and he feels like he really clicks with the new employee. He shares with you some additional plans he hopes to share with the pizza shop owner when he becomes manager in a few months. He is thinking about adding a new white sauce in addition to the red and spicy marinara they offer for the pizzas. He would also like to add a shredded pepper jack cheese to the list of toppings to eventually create a “volcano pizza” for those who like spicy food. He talks about how he wishes he could share these accomplishments with his brother, who loved take-and-bake pizza. You begin to provide client with a referral for a grief/loss support group when client becomes escalated, “you know nothing about my brother! Stop talking about it!”
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Domain: Professional Practice and Ethics

When you take the client to the waiting room at the end of their session, you are met by their mom and mom's friend. Mom's friend hangs back and asks if they can share some information regarding the client in private. What would be your best response?

Domain: Treatment Planning

How would you best respond to the client's outburst when you mention the support group referral?

Domain: Counseling Skills and Interventions

From a Reality Therapy perspective, how would you summarize this client's progress?

Domain: Counseling Skills and Interventions

You have a different client who is an undocumented immigrant from Somalia who tells you that her US citizen boyfriend whom she lives with has been getting increasingly verbally and physically abusive. She states that she would like out of the relationship but does not want to get deported. Her boyfriend often threatens that he will call immigration on her. What is your best course of action?

Case 3

Part One

Age: 31
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: African American
Relationship Status: Single
Counseling Setting: Prison Clinic
Type of Counseling: Individual
Presenting Problem: Frequent health complaints
Diagnosis: Illness Anxiety Disorder, Care-seeking type

Presenting Problem: You are a clinician at a municipal jail, and your client is a 31 year-old African American male who has been in recent arguments with his case worker about his medical care. The client has been spending two hours each day checking his body for signs of leukemia. He frequently requests to see the nurse and has been, according to her, “begging” to see a specialist. The client states that the prison medical staff has not taken his needs seriously. He states that he has never found any physical signs of cancer, but he is worried that he has acquired it and it will get progressively worse as time goes on.


Legal History: A year and a half ago, the client made a trip to Mexico to stock up on pain medications so he would be ready “once the leukemia really starts to get bad.” He was stopped for a routine inspection while crossing the border and was arrested for possession of a controlled substance. The client is currently mid-way through a 2 year sentence for the charge. He states that he never took the medication, but wanted to have a supply on hand just in case.

History of Condition: The client has had anxiety about having acquired leukemia after receiving a blood transfusion after a surgery two years ago. He states that the idea of having someone else’s blood in him makes him feel nauseous and has opened himself up to all kinds of diseases. According to his medical records, there is no indication that the blood he received was contaminated.

Health History: Client’s health history is not significant. Two years ago he had a surgery to repair a hernia, but due to complications the client had to receive a blood transfusion.

Psychosocial and Family History: The client has two twin sisters who starred on a television show when they were kids. The show was about a group of kids who solved mysteries on their school playground during recess. The show ran for three seasons, but was canceled by the television network. Although the client did not star in the show, he was part of two episodes where he played minor roles. He tells you that it seems as though his parents were always more proud of his sisters, even though they insisted that they didn’t play favorites. He tells you the name of the episodes he was in and urges you to look them up when you go home after work. You thank him for the information and think about whether or not it would be ethical to look up the show your client was in as a child. You wonder how this may affect your objectivity and ability to see his presenting concern clearly.
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Domain: Professional Practice and Ethics

You are informing your client about exceptions to standard confidentiality. Which of the following is not considered an accepted exception to confidentiality?

Domain: Intake, Assessment, and Diagnosis

All of the following would be helpful assessments for evaluating Illness Anxiety Disorder except which?

Domain: Counseling Skills and Interventions

According to the information disclosed in Part One for this client, Which of the client's symptoms is most indicative of Illness Anxiety Disorder?

Domain: Treatment Planning

Regarding a different client with complex concerns of housing, mental health, and food scarcity, which type of professional is most likely to help this client reach their goals?

Domain: Professional Practice and Ethics

From a transtheoretical perspective, what statement below best emphasizes choice and control as you help the client define his goals for counseling?

Part Two

First session, 2 weeks after initial intake session

The client comes to session describing all of his frustrations with the prison medical staff. He states that he is frustrated that no one believes him. He tells you that racial inequality is playing a role in the professionals’ decision-making, and questions your own behaviors that he has observed. He says that he hasn’t felt like anyone has listened to him, and people are just acting like they agree with him, only to go behind his back and “slap another diagnosis on.” He asks you if you are on his side or not, and whether or not you would have forced him to get a blood transfusion like the other doctor did. “I just don’t feel heard,” he groans, placing his face in the palm of his hands. The officer outside your door looks in when he hears your client exclaim, makes eye contact with you, and rolls his eyes. Your client looks up and says, “Do you even know what it’s like to have someone else's blood pumping through your veins every day and every night?” You listen to his thoughts about blood transfusions and ask him about information he has received from doctors about them. He shares that he does not agree with what doctors say, and that there is no way to know if another person’s blood is safe or not. The client states that he feels like he did not have control over the decision and he was at the mercy of others. You provide empathy statements and reflective listening to build rapport with the client.
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Domain: Intake, Assessment, and Diagnosis

All if the following are included in the Biological Sphere of a Biopsychosocial Assessment except which?

Domain: Counseling Skills and Interventions

What question would be most appropriate to inspire this client to move towards change?

Domain: Intake, Assessment, and Diagnosis

Which of the following assessments utilizes a combination of direct and indirect data gathering?

Domain: Core Counseling Attributes

Which of the following is a product of positive regard?

Part Three

Second session, 3 weeks after initial intake session

The client comes to session frustrated that you have not provided him with a referral to see an oncologist. You provide information on the counseling process and discuss with him some goals he has in mind that fit into your scope of practice. The client states that too much of his day is taken up checking his body for signs of leukemia. You help him identify the negative cognitions that come up throughout the day, and you show him how to fill out an automatic thought record. When you ask him to identify how true the thoughts feel, he tells you that the thoughts about his illness feel 100% true. Then, after reading through some of the ways to combat cognitive distortions, some of the thoughts he identified decreased to 75% true, and another decreased to 60% true. You review a thinking errors packet with him, and he supplements some of the evidence on his thought record worksheet. “So, adding more of these helps the truth level go down on these thoughts, right?” the client asks. “I think I’m beginning to see how remembering some of these might help.” You review with the client how to identify the thinking errors, and label the thoughts as intrusive thoughts. The client reports the truth to his anxious thoughts is decreasing. He tells you that the one about his blood transfusion is still at 100%, however he would be up for doing this activity next session with some other topics. You go over a few examples and encourage him to keep track of additional thoughts that come up throughout the day and to weigh the evidence supporting the thoughts.
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Domain: Counseling Skills and Interventions

How would you best introduce an automatic thought record for this client?

Domain: Counseling Skills and Interventions

You have a different client who states that he is terrified to go in an elevator, and since his new job is on the 21st floor of a building, his anxiety is getting the best of him. What therapeutic approach would you implement to target his anxiety?

Domain: Intake, Assessment, and Diagnosis

Which of the following statements is incorrect regarding the intersection of culture and psychology?

Domain: Core Counseling Attributes

Which of the following least impacts therapy outcomes?

Case 4

Part One

Age: 16
Sex: Female
Gender: Female
Sexuality: Heterosexual
Ethnicity: Latina American
Relationship Status: Single
Counseling Setting: School
Type of Counseling: Individual
Presenting Problem: Disordered eating, excessive sadness at school
Diagnosis: Bulimia Nervosa, Acculturation

Presenting problem: You are a clinician working in a school setting. Your client is a 16 year-old Latina who states that she is not happy with how things are going. After about ten minutes of intentional rapport building, you find out that the client, along with her family, moved to the United States from Ecuador two years ago. The client states that she feels as though she does not fit in in the US and has no desire to make friends here. She states that she tried to keep in touch with her friends from Ecuador, but after a few failed video conferences, she stopped communicating with them. She states that her classmates in the US don’t like the same things she does, and they all seem so “cold.” She does not like her life here and would rather go back and live with family in Ecuador. She also tells you that she has not been eating how she would like to be eating.

Legal History: The client’s dad came to the US five years ago as an undocumented immigrant. He was detained at the Mexican border and deported twice, however the third time he was able to cross successfully. He got employed at a meat packing plant, working long hours in sub zero temperatures, and was eventually able to save enough money to send for the rest of the family. Her dad initiated immigration proceedings after the family arrived because his lawyer told him that it would be less likely, but still possible, that he would get deported if he could prove the family would endure hardship if he were separated from them. As a result, he wears an ankle monitor that he cannot take off—not even to swim or shower. Your client does not wear an ankle monitor, but will be meeting with the family lawyer next week to assess their next steps in immigration proceedings.

Mental Status Exam: The client comes to session well groomed with good hygiene. The client appears slightly overweight. The client denies any hallucinations or suicidal ideation. Her speech and affect are normal, however at times the client was tearful during session, resulting in quieter speech.

Family History: The client comes from a large family with many aunts, uncles, and cousins who all live in the same neighborhood in Ecuador. The client currently lives with both parents and her 7 year-old twin brothers. The twins have stopped speaking Spanish at home and prefer to speak English, which bothers the client because she fears that forgetting Spanish will result in less of a connection with family abroad. The client feels pressured to teach her siblings Spanish, however they have begun to call her the “Spanish police” and have not wanted her help.

History of Condition: The client states that she eats too much food after she gets home from school. She states that often she feels as though she cannot stop eating once she’s started. She explains that once she finishes, she looks over all that she has eaten, and not wanting to gain any more weight, she has resorted to throwing up. She states that since she usually spends about two hours eating, she worries that her body has already started to digest some of the food, so she has resorted to laxatives to compensate. She states that she does this about three times per week, and this has been going on since the beginning of this school year (about four months).
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Domain: Intake, Assessment, and Diagnosis

You are conducting a diagnostic interview with your client using a structured interview format. Which of the following is not reflective of structured interviews?

Domain: Counseling Skills and Interventions

How would you reframe the client's eating pattern as disclosed in the “History of Condition”?

Domain: Professional Practice and Ethics

At a professional development seminar, you encounter the term 'Null Hypothesis'. This refers to which of the following?

Domain: Counseling Skills and Interventions

In Mindfulness-based Cognitive Therapy, the term “decentering” means:

Domain: Intake, Assessment, and Diagnosis

What baseline data would best inform you about the client’s current level of functioning?

Part Two

First session, 1 week after initial intake session

The client comes to your office stating that she has felt uncomfortable in her body for as long as she could remember and wonders out loud why she feels such a lack of control when she eats after school. She states that she remembers feeling self conscious for the first time when her family went on vacation to the beach in Manta, Ecuador when she was eight years old. It was the first time her mom let her buy a two piece bathing suit. Your client says that when she saw her shadow in the sand, wrinkled with hundreds of footprints from the day’s crowds, she couldn’t help but think that she looked misshapen. Her shadow didn’t look like anyone else’s for some reason. She tells you she refused to swim for the rest of the trip, and wouldn’t take her sweater off even in the hot sun. “My mom tried to talk to me about it, but I was too embarrassed to tell her that I couldn’t be walking around looking so misshapen and different from everyone else. She definitely wouldn’t understand,” she states as she looks out the window at a bird on the tree outside. You assign her the task of tracking her antecedents, behaviors, and consequences related to her eating behaviors. You also provide her with a Spanish to English vocabulary list of emotions, and she shows enthusiasm and gratitude that you would think to acquire the list for her.
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Domain: Treatment Planning

Why did you choose the vocabulary list intervention at this time for the client?

Domain: Intake, Assessment, and Diagnosis

The assigned task from Part Two belongs to which technique?

Domain: Core Counseling Attributes

Your eye contact, nods, mirroring body language, and encouraging verbalizations are part of which basic counseling skill?

Domain: Counseling Skills and Interventions

You give the client a worksheet to begin identifying the client’s emotions regarding a recent fight at school. The client states that she does “not want to get into that.” Given the client's push back, what therapeutic approach would you implement to target her resistance?

Part Three

Second session, 2 weeks after the initial intake session

The client comes to session with a notebook of observations in Spanish about thoughts and feelings that have emerged throughout the week. She states that the food in the United States is not like the food in Ecuador, so she tries hard to find something that will satisfy her in that way, but there is nothing at home that tastes like her grandma’s home cooking. Back in Ecuador, cooking was a family affair. Nearly every holiday, family would travel from near and far to her grandma’s village to gather at the house that has been in the family for many generations—even before there was plumbing and electricity in that part of the mountains. Her grandma would always recount the story about how she learned how to cook on an open fire and how her mom would send her to the river to fetch weather to wash dishes after each meal. Nowadays, it’s a lot easier to cook a meal for everyone in the family. A gas stove was installed in the mountain home a few years ago, along with pipes that carry water to grandma’s part of the village, and the family got together to celebrate. She states that the abnormal eating cycle starts when she starts comparing the Mac and cheese in the pantry to the food she misses. She just keeps eating until she cannot stop anymore. You praise the client for her good insight and for putting forth the effort to complete her assignment. You brainstorm with the client ways to start a new chapter in the US without losing the appreciation she has for previous chapters. The client brainstorms ideas with you while you provide empathy and unconditional positive regard.
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Domain: Treatment Planning

When is not the most appropriate time to discuss termination?

Domain: Professional Practice and Ethics

You encounter a former client at a community event. It has been 20 months since their counseling concluded. The former client asks if you would like to meet up for a drink. What would your best response be?

Domain: Professional Practice and Ethics

Regarding a pre-screen phone call, which of the following is appropriate information to gather?

Domain: Counseling Skills and Interventions

You have a different client who has expressed sadness and shame about a recent job loss. He reports feeling depressed and unmotivated. What therapeutic approach would you implement to best target his hopelessness?

Case 5

Part One

Age: 29
Sex: Female
Gender: Female
Sexuality: Homosexual
Ethnicity: Asian American
Relationship Status: Married
Counseling Setting: Community clinic
Type of Counseling: Individual
Presenting Problem: Work difficulty due to mood swings
Diagnosis: Cyclothymic Disorder with Anxious Distress

Presenting problem:You are a counselor at a community mental health agency and today a 29-year old Asian American female comes in to discuss some distress the client has been having at work. The client is an 11th grade English teacher who just had parent teacher conferences, and many of the parents told her that the students are afraid to approach her in class because the students are unsure how she might react on a day-to-day basis. The parents told the client that their children have described her as irritable and snappy at times and other times excited and motivated to help the students. Your client has noticed some increased frequency in conflict with her students, but she always thought the students were being too sensitive. Now she wonders if there is something she needs to work on to provide a more stable classroom atmosphere. Ever since the conferences, the client has been nervous around her students and second-guessing how to respond to their questions in class.

Mental Status Exam: The client comes to session well dressed and presents as tearful and sad. Affect is mostly flat and speech is rational and slow. Client denies presence of suicidal ideation and plans. At one point in session, client hid her face in her hands and apologized for “being emotional.” Client is oriented to person, place, and time.

Social History: The client belongs to a bowling league at the local bowling alley, and was elected president of the organization last year. She assessed the data of each league member’s bowling average to design tournament brackets. She was recently featured in the local newspaper for bowling her second 299 game this season. Your client has many friends at the bowling alley and is a point of contact for the employees to communicate with the league regarding scheduling, finances, and organization of the awards banquet that takes place at the end of the year. She is thinking about taking a step back from her leadership position in the league next year, but plans to continue bowling to get the coveted 300 game ring that many of her friends have earned in previous seasons. Although she has been an avid bowler nearly her whole life, she has yet to score a perfect game.

Work History: The client has worked at the same high school for the past five years. She received positive feedback from students, staff, and parents her first year of teaching. During her second year, however, she had some trouble motivating herself to grade papers and tests. Her grades always got turned in on time and she was never disciplined, but she noticed some “lagging” in energy and motivation. Other times the client felt slightly more energetic than normal and was excited to develop new lessons and projects. This year, the client’s boss has expressed some concern not only about the client’s interactions with students, but about how the client would abandon lesson plans for a couple of days at a time and put on a movie for students and just sit at her desk.

Family History: The client has been married for seven years and does not have any children. The client states that her marriage is good, however her wife has made a comment that she has some slight mood swings most of the time and has asked her why she can’t just “be normal for once.” The client reports that she had a great childhood, always got good grades, and was supported by her parents throughout all of her endeavors. She states that she can count on her family, but is too ashamed to discuss her recent negative feedback at work. She states that her older sister experiences more drastic mood swings than she does, and she worries that she could become like her.

History of Condition: The client began having these light mood swings starting four years ago. She has never had any suicidal ideation or instances where she has been hospitalized for mental health reasons. She says that she has never engaged in irrational behavior or erratic spending, but has experienced slight fluctuation in the amount she needs to sleep depending on her mood.
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Domain: Core Counseling Attributes

While assessing client strengths, your client states that she adheres to Cao Dai, a religion that you have never heard of. Which statement best demonstrates cultural competence?

Domain: Intake, Assessment, and Diagnosis

Which of the following are criteria for diagnosing Cyclothymic Disorder?

Domain: Intake, Assessment, and Diagnosis

You decide to administer a Biopsychosocial Assessment. All if the following are included in the Social Sphere of a Biopsychosocial Assessment except which?

Domain: Professional Practice and Ethics

For a child who is in foster care, who holds the right to make medical decisions for the minor?

Domain: Professional Practice and Ethics

You live and work in a small town. One of your clients joins an opposing team within your bowling league. Which of the following would be your best course of action?

Part TwoFirst session, two weeks after the initial intakeThe client comes to session stating that she does not understand what brings on her mood swings. She states that she feels as though she cannot follow through on any plans she sets because how she will feel in a few days is completely unpredictable. For example, last Saturday she had plans to go see a movie with her friend, Veronica, after bowling. The two had been planning for two weeks to go to the movies and eat popcorn with snow caps mixed in. Veronica chuckles and says, “It’s not every day you find someone who likes the same strange snack combinations as you.” The night before the outing, Veronica texted your client saying, “T-minus 14 hours until showtime!” Your client looks down at her folded hands and laments, “I don’t know what happened. I was really looking forward to going, but all of a sudden I didn’t want to go. What does all of this mean? How can I all of a sudden feel that way?” She explains that her friendship with Veronica hasn’t been the same since, even though she paid her back for both tickets since it was her fault for canceling last minute. You answer her questions and normalize her experiences. She stated that since your last session she has experienced five crying episodes before she goes into work. She states that just imagining interacting with the students makes her hands shake and she gets close to calling off work during these episodes. You ask her what stops her from calling off work. She says her career is important to her and knows she can push through the day. You praise her perseverance and lead her through a progressive muscle relaxation exercise and discuss times when the exercise might be useful.
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Domain: Treatment Planning

Which of the following is most needed to monitor the client’s progress?

Domain: Counseling Skills and Interventions

From a transtheoretical perspective, how would you use reframing to respond to the client’s statement of “I keep thinking about unintentionally hurting my students by snapping at them. They don’t deserve that.”

Domain: Intake, Assessment, and Diagnosis

All of the following would be helpful assessments for evaluating Cyclothymic Disorder except which?

Domain: Counseling Skills and Interventions

Which metaphor is most appropriate to describe the client’s diagnosis?

Part Three

Second session, four weeks after the initial intake

The client comes to session in a good mood, stating that she noticed less anxiety before work than in previous weeks. She stated that, “Now that all of this has a name, it doesn’t seem as unpredictable.” You lead her in guided imagery exercises in which she first imagines herself getting anxious in front of her students and then practices utilizing relaxation techniques to overcome the anxiety. She provides you with an update about her friendship with Veronica as well. After your last session, and after doing some research about her disorder, she invited Veronica to some practice rounds of bowling where she told her everything—about going to therapy, learning about herself, and processing what happened when she canceled their outing to the movies. Between turns, the two sat in the bowling circle discussing their thoughts and feelings about this new information, and Veronica expressed her gratitude for the client’s openness with her. “We have plans to try to go to the movies tomorrow, and I’ve resolved to go no matter what. I can probably use some of these techniques we’ve talked about if I feel anxious last minute,” she states optimistically. You help her explore how she can also use some of these techniques before the parent-teacher conferences in the Spring.
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Domain: Core Counseling Attributes

Which of the following is not typically viewed as a multicultural counseling skill?

Domain: Counseling Skills and Interventions

The technique employed in the second session after intake is an example of which of the following?

Domain: Counseling Skills and Interventions

You hand your client a worksheet that has columns on it, one column with a question asking the client a percentage pertaining to how true the client’s thought is. What is this worksheet called?

Domain: Professional Practice and Ethics

In your final session, the client presents you with a Japanese tea set as thank-you gift, explaining that this is common practice in her culture. How should you respond?

BREAK TIME! Look at your clock and take a 15 minute break. The exam clock will not stop but your start time included an extra 15 minutes for this break. You should have 123 minutes remaining on your exam clock as you begin Case 6. Select answer 'A' when you are ready to continue.

Case 6

Part One

Age: 17
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Latino American
Relationship Status: Single
Counseling Setting: Community Clinic
Type of Counseling: Individual
Presenting Problem: Lack of motivation, academic concerns
Diagnosis: ADHD, Cannabis Use Disorder

Presenting Problem: You are a counselor at a community mental health clinic. Your client is a 17-year-old Latino American male who comes to counseling at the request of his adoptive parents. His parents state that the client has a history of not being able to focus in school. He was placed on a 504 plan in fourth grade to give him additional time to complete tests, and has continued to have a 504 plan on file through the current school year. Recently, the parents were notified that the client is in danger of failing his junior year. He has not turned in hardly any homework this semester. The client states that he is unmotivated and would rather hang out with his friend than go to school. The parents hope that counseling can help the client focus more and become more responsible with school work and daily tasks.

Mental Status Exam: The client comes to session poorly dressed and makes limited eye contact. He appears inattentive during session and asks you to repeat questions numerous times. He fidgeted with his hands in session and interrupted numerous times while you were asking his parents questions. The client denies hallucinations or delusions. The client denies presence of suicidal or homicidal ideation.

History of Presenting Problem: Client has had problems with focusing in school and at home since client was 9 years old. Client has never been in danger of failing, however, until this year. His parents caught him with marijuana in his book bag about two months ago, and were unaware of his smoking habit up until that point, however the client states that he has been smoking regularly for the last two years, but feels that the habit has gotten out of control over the past year. He had a part time job, but was fired a month ago because he did not show up to work twice in one week. The client stated that both times he got high a few hours before his shift and was too afraid to drive to work.

Vocational History: The client explains that he was working at a local home improvement store as of last month. He expresses regret over getting fired because he loved his job responsibilities, his coworkers, and even his managers. When his manager called him in to break the news to him that he could no longer work there due to the company’s policies, his manager told him that he could count on him for a letter of recommendation if needed in the future because he worked hard during his time there. The manager said that, from what he could tell, the client is going through a rough patch and things will get better soon if he starts taking care of himself. Your client spends half of his day at the local career center in the automotive wing where he learns basic mechanics skills. Next week he and his parents have a conference with the technical director to assess whether he will stay in the program or go back to typical high school classes all day.

Family history: The client was adopted from the foster care system at two years old. Not much is known about his biological family, but his adoptive family has always been supportive of his endeavors. In recent months, there has been some relationship strain at home. The client’s mom states that the client has been careless with his responsibilities and left his guinea pigs without food or water for three days because he “kept forgetting.” The client does not have any other siblings, and is spending less time at home than in the past. When he is not at school, he spends time with his friend at the friend’s house where they smoke marijuana most nights.

History of Substance Use and Addictive Behaviors: The client states that he first smoked marijuana at age 14, and did not smoke it again until a year later. Over the past year, his marijuana use has increased to the point of smoking most nights out of the week. He states that he does not know how he got to the point of spending hundreds of dollars on marijuana, but it seems like he cannot function without it, and has over time needed to consume more to get the desired effect.
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Domain: Treatment Planning

Which of the following would you say to build a therapeutic alliance with this client?

Domain: Professional Practice and Ethics

You are educating one of your clients on their responsibilities as a client. Which of the following is not considered part of standard client's responsibilities?

Domain: Intake, Assessment, and Diagnosis

Based on the information disclosed in Part One, which of the following symptoms for this client is most indicative of a diagnosis of ADHD?

Domain: Counseling Skills and Interventions

This client’s clinically significant Cannabis Use Disorder would best be addressed by which of the following techniques:

Domain: Treatment Planning

Which of the below is an appropriate short-term goal for a client with ADHD?

Part Two

First appointment, 2 weeks after initial intake session

At the beginning of the session, you spend a brief time educating the client and his parents on his diagnoses and answer any questions that they have. You spend some time building rapport with the client and allow him to freely communicate about his goals for counseling. You assess his stage of change, and determine that he is in the preparation stage. He states that he is sick of spending all of his money on marijuana when it does not make him feel as good as it used to. You discuss with the client some goals that he has and you help him outline the goals into smaller, measurable steps. He sets a goal for the next session to finish the essay that he was assigned at school today by working on it for 20 minutes per night this week. You casually ask him what his essay is about, and his eyes light up as he talks about interior design theories, and the ones he is most passionate about. He goes into detail about crown molding types, and their various methods of application. He pulls his phone out of his pocket to show you some virtual paint swatches he has been compiling and arranging on an art file. “The teacher said we could choose any topic we wanted as long as it relates to art, so I chose interior design. I used to work in the paint department down at the home improvement store, you know. I think I’m going to try to swing by there after this and pick up some of the interior design brochures they have sitting there. Man, I miss that place and I can’t believe I ruined it.” You use immediacy to point out client’s level of excitement as he discusses this topic. You also reinforce his goal of spending 20 minutes per night on his essay.
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Domain: Intake, Assessment, and Diagnosis

Which of these client statements helped you conclude that the client is in the preparation stage of change?

Domain: Counseling Skills and Interventions

Which group of clients is least likely to experience exposure techniques in therapy?

Domain: Counseling Skills and Interventions

How would you best reframe for this client his current marijuana usage?

Domain: Core Counseling Attributes

You have a philosophy of, “If it’s a crisis for my client, it’s a crisis for me.” Which counseling attribute is embodied in this philosophy?

Part Three

Second appointment, 3 weeks after the initial intake session

The parents check in to discuss a recent appointment they had with the pediatrician, who determined that it is in client’s best interest to go back on the medication that helped him while he was in middle school. His parents have been reluctant to put him back on this medication because they believe it stunted his growth as a child, although his height and weight are within normal limits for a person his age. They explain that their doctor discussed with them the potential side effects of the medication. “This time,” his mom says, “we’re not going to go online and look at every possible side effect and read all of the horror stories out there. It’s just not helpful for us. What I’m worried about is how we’re going to remind him to take his medication every day. You know what happened with the guinea pigs, and he gets so tempermental when we mention something like medication. We’re going to have to find a way, though, especially if it’s supposed to help all of this. Please talk with him about taking his meds, will you?” she asks. You check in with the client about how his goal-driven activities went. He states that he finished his essay in two days when he thought it would take the whole week, so he used the twenty minutes per day he set aside to do other homework, and was surprised that the homework assignments did not take as long as he imagined they would. He states that it was helpful for him to break things up in smaller, more measurable goals. You reinforce the client’s progress and use motivational interviewing to identify other areas in which the client can apply goal setting.
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Domain: Counseling Skills and Interventions

Which technique would best help this client alleviate their ADHD symptoms?

Domain: Intake, Assessment, and Diagnosis

Therapists use formal and informal observations in order to:

Domain: Professional Practice and Ethics

When introducing a new group of clients to the expectations commonly found in group therapy. Which of the following is not a common group expectation?

Domain: Core Counseling Attributes

You have a different client who comes to session in a regressed state. Which form of attunement would be most beneficial?

Case 7

Part One

Age: 33
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: Private Practice
Type of Counseling: Individual
Presenting Problem: Heightened anxiety, fear of panic attacks
Diagnosis: Panic Disorder

Presenting Problem: Your client is a 33 year-old Caucasian male who is the pastor of a local church. He comes to counseling because two months ago he was speaking at his church and was overtaken by what he describes as a heart attack. He had increased heartbeat, sweating, trembling, dizziness, and shortness of breath. He felt like he was going to die. He had to crawl off the stage and one of the church members called 9-1-1. By the time he got into the ambulance about 10 minutes had passed, along with his symptoms. He went to the hospital, however there was no indication that the client had had a heart attack. The doctors encouraged him to seek counseling at that time to manage stress. Over the past two months, he has been unable to go into the church building for fears that another episode will happen. He asks for you to help him as he feels like he is losing control of his life.

Family History: The client is a third generation pastor. He went to the same university both his father and grandfather went to, and got ordained in the same denomination as the other pastors in his family. The family members regularly get together during the holidays and on weekends, and your client describes his childhood as happy and warm, expressing gratitude for his mom’s patience with him and his three brothers. He met his wife in their first year at Bible college, and married that summer. She became pregnant and dropped out of school before the couple’s Sophomore year began. His wife is a stay at home mom to their 4 children, and is supportive of the client seeking counseling. None of the children were present for the client’s latest episode because they were all in their Sunday School classes as they normally are when the client preaches. He remembers someone calling for his wife from the back of the sanctuary while he was having trouble breathing.

History of Condition: The client states that he experienced some increased anxiety in college, but it never reached an unmanageable level. He laughs and says, “They say some anxiety is good… it keeps you on track and all that.” The client never experienced these kinds of symptoms until two months ago and they have been increasing in frequency.

Relationships: Most of the people the client associates with are members and staff of the church where he pastors. The client states that his social life has suffered quite a bit since the first attack happened. He expresses concern that people think he is broken, or that he went crazy.

History of Substance Use and Addictive Behavior: The client states that the last time he drank was over ten years ago when he got a DUI. He states that that turned his life around and that experience led him to study to be a pastor. He successfully completed a 12-step program and continues to be a sponsor of newer members. He denies having ever ingested illegal substances.
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Domain: Intake, Assessment, and Diagnosis

Which of the following is not a symptom of panic attacks?

Domain: Professional Practice and Ethics

You encounter some friction and resistance with your client in session. You decide to explore this dynamic. The primary motivation for this exploration is which of the following?

Domain: Counseling Skills and Interventions

Panic Disorder would best be addressed by all of the following techniques except:

Domain: Counseling Skills and Interventions

What therapeutic metaphor would you use to describe the beginning of therapy for this client?

Domain: Intake, Assessment, and Diagnosis

Which of the following tools best provides a broad overview of the client's reality?

Part Two

First session, 2 weeks after initial intake session

The client comes to session reporting that he has had eight panic attacks since the last time he saw you. He states that each time a panic attack strikes, he feels as though he is going to die which makes it worse. The most recent panic attack struck, ironically in the stairwell of a local hospital where he was going to visit an elderly member of his church who had fallen ill due to a history of gout which complicates their diabetes. “I was just jogging—kind of—up the stairwell, and all of a sudden it hit me. I felt dizzy and grabbed onto the railing and thought no one was going to help me. No one knew that I was in the stairwell, and I found out the hard way that employees only take the elevators, apparently.” Your client spent over 15 minutes trying to breathe through his panic attack alone in the stairwell. He described the event as terrifying and jarring, yet manageable. Although his wife is supportive of his recent struggles, and although he considers her to be a key player in his support system, he tells you he doesn’t feel comfortable calling her in moments like those. You discuss the nature of his diagnosis with him, stating that a common symptom of the diagnosis is that the individual often thinks they are dying, however panic attacks are hardly ever lethal. You provide psychoeducation about the diagnosis and encourage him to read an informational pamphlet about the diagnosis.
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Domain: Treatment Planning

Which of the following is not an accurate long-term goal for a person with panic disorder?

Domain: Counseling Skills and Interventions

You challenge the client to ask the question, “Am I right to think that this panic attack will kill me”. What technique are you using?

Domain: Core Counseling Attributes

What is a core attribute of empathic attunement?

Domain: Counseling Skills and Interventions

You notice that a different one of your clients has increased amounts of guilt and frequently says things like, “I should be earning more money than I am,” and “I should have already written a book by now.” What intervention would benefit this client?

Part Three

Second session, 4 weeks after initial intake session

The client reports that he had seven episodes since the last time he saw you. He states, “Hey, that’s one less than the last time, so I’ll take it!” He discusses doing some research on the internet about his diagnosis, commenting that he joined an online support group where he found other people who undergo the same symptoms that he experiences. He tells you that one of the stories that stood out to him from the online forums was that of a forklift driver who thought he would lose his job due to having panic attacks, but the warehouse put him in a program where he would only be assigned shifts that had other forklift drivers available, that way if he could not control his panic attack, one of the other drivers could step in. The person in the support group stated that just knowing that there were other options for people who could step in for him made a world of difference, and he noticed that his panic attacks reduced because there was less pressure to perform. You engage in Socratic questioning with your client to assess and identify similarities between the forklift driver's situation and his own. You help him brainstorm a list of 3 people from his church and social circle that would be most supportive of him. Without being prompted, he sets a goal to have a conversation with at least one of them this week.
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Domain: Treatment Planning

How would you, as a non religious counselor, help the client process why he has been avoiding his church building?

Domain: Professional Practice and Ethics

'Duty to Warn' is a legal term that refers to which of the following?

Domain: Treatment Planning

What is the most appropriate plan for addressing clients in crisis after hours?

Domain: Counseling Skills and Interventions

You have an intake with a client who is from Iran and just moved to your area three years ago. You are unfamiliar with the Iranian culture. What should you do?

Case 8

Part One

Age: 66
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Latino American
Relationship Status: Divorced
Counseling Setting: Community clinic
Type of Counseling: Individual
Presenting Problem: Unemployment, alcohol use
Diagnosis: Alcohol Use Disorder

Presenting Problem: You are a counselor at a community mental health clinic. Your client is a 66 year-old Latino man who comes to counseling to discuss his career goals. The client has worked for different companies throughout the years and has not saved up any money for retirement. He recently attended his twin brother’s retirement party, and felt feelings of jealousy that he will likely never have the opportunity to retire. The client states, “I feel like I'm getting so old and I'm just not ready”. He states that he started to feel more and more bitter about working as a toll booth operator and he quit his job all of a sudden. He states that he is looking for a job that is easy to do, keeps him interested, and will help sustain him throughout his elderly years.

Legal history: The client discloses that he does not currently have a driver’s license because he has had 3 intoxicated driving charges within the last two years. He states that he has done the required programs and mandatory stays in jail, but none of it has made a difference. He states that the prosecutor told him that if he gets another charge having to do with intoxication that he will have to spend even more time in jail. Given the client’s age, he worries about a long-term jail sentence.

Health History: Diabetes runs on both sides of the client’s family. Both parents and both sets of grandparents have been diagnosed with diabetes at some point in their lives. When the client got a job as a toll booth operator, well-meaning family members from all sides of the family gave him advice for how to stay active while working at a sedentary job for most of the day. The first year he worked as a toll booth operator he got a smartwatch that tracked his steps, and many days he would only accumulate about 2,000 throughout the whole day. With no time to increase his step count, he quickly lost motivation and tried to manage his health with diet only. Since he didn’t have access to a refrigerator, however, he had to rely mainly on packaged foods for two out of three meals per day. His blood work has been within normal range over the past year.

Substance Use: The client states that he can drink about 12 cans of beer per night. He states that he has tried to cut down on his alcohol consumption numerous times, however the guilt he feels about the drinking often results in him drinking more. He states that he has lost a few of his jobs due to coming to work smelling like alcohol. He explains, “I feel like I can’t get the smell off of me. It has to be coming out in my sweat or something.”

Family History: The client tells you that he got divorced three years ago. He says that his wife used his drinking as an excuse, but he thinks she just got bored of him. The client has four adult children and eight grandchildren. Two of his daughters have stated that they will not bring their children over to the client’s house until he gets his drinking under control. They have made comments that his house reeks of alcohol and they do not want the children around his sometimes unpredictable drunken behavior. His other two children live out of state and only come to visit at Christmas.
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Domain: Core Counseling Attributes

Your client begins to discuss some racial prejudices he experienced at different jobs. You find yourself internally taking the side of your client’s coworkers. What area do you need to address in your clinical skills?

Domain: Intake, Assessment, and Diagnosis

Based on the narrative from Part One, which of the following alternate diagnoses would most be worth considering?

Domain: Intake, Assessment, and Diagnosis

Which assessment is best known for its direct adherence to the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria?

Domain: Professional Practice and Ethics

You describe many of the potential benefits of counseling to (client) during informed consent. What is the primary purpose of this?

Domain: Treatment Planning

What is the best long-term therapeutic goal for this client?

Part Two

First session, two weeks after the initial intake session

The client comes to session smelling of alcohol, however he does not exhibit any signs of impairment. He discusses filling out some job applications throughout the past two weeks, but has only heard back from one job, which is at a local warehouse store and his duties would include restocking merchandise. Without a forklift operator’s certificate, however, he would be on the crew that would manually lift and stock the merchandise, which is not ideal at your client’s stage in life. He tells you that he is on the fence about going in for an interview because he knows that that job would be physically demanding. He explains to you that, due to his poor driving history he would likely not be able to obtain a forklift license, and he is concerned that the company’s background check policy would hinder him from moving forward in the process anyways. He tells you that it’s important to keep all of his options open, even if he feels like there is a small chance of actually getting the job. The client discloses that he misses working in the toll booth because he got to meet many people who were passing through on road trips, which he enjoyed. You discuss other jobs that the client has enjoyed in the past, as well as jobs that the client thinks he would enjoy. You use motivational interviewing to encourage the client to set goals to cut down on the amount he drinks. He discusses knowing that smelling like alcohol would not be good for a job interview, and you reinforce his observation by pointing out his good insight. You administer the Self Directed Search (SDS) in session and go over the results with the client and answer any questions that he has. The client discusses information gleaned from the assessment.
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Domain: Treatment Planning

While setting goals, your client states that he would like to work on his sobriety. Which is the most important concept to keep in mind as you discuss his goal?

Domain: Intake, Assessment, and Diagnosis

The purpose of the assessment that was utilized in the first session after intake is to:

Domain: Counseling Skills and Interventions

Which of the following techniques would not likely help address the client’s Alcohol Use Disorder

Domain: Intake, Assessment, and Diagnosis

Psychasthenia is a psychological disorder characterized by all but which of the following?

Part Three

Second session, three weeks after the initial intake session

The client provides an update on the jobs he has applied for since the last time you talked. He discusses how the list of professions on the SDS opened his eyes to some job possibilities that he never considered. You go over the list of jobs that he highlighted to indicate interest. He discusses his passion for sales and his success with working at a car lot in the past. He wonders out loud about a job listing he saw recently. You point out his job experience, and encourage him to keep applying so that he can reach his goal. You use motivational interviewing throughout the session. The client discloses that he has started meeting with an AA sponsor who has a similar driving history as he does. The sponsor also got divorced due to his drinking, and your client is coming to terms with the fact that that factor was more detrimental to his marriage than he was previously willing to accept. Ironically enough, both of the sponsor’s parents, and both sets of grandparents, have also been diagnosed with Type II Diabetes as well. Your client states that his sponsor has added some fuel to client’s fire regarding engaging in physical activity, and the two have been taking frequent walks around the local park as they discuss their sobriety and health in general. Your client states that he is grateful for his sponsor and he feels he can talk to him about anything, especially since he understands. Your client asks about your driving record, and you redirect the client to discussing his goals as well as communicating how proud you feel of the client for maintaining participation in his 12-step program. You provide unconditional positive regard and reflective listening.
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Domain: Core Counseling Attributes

Which therapeutic skill is likely to be demonstrated by a counselor who is focused on being genuine?

Domain: Intake, Assessment, and Diagnosis

Based on the information disclosed in the second session after intake, from a transtheoretical perspective, what stage is this client currently in?

Domain: Counseling Skills and Interventions

Which of the following is not typically included on a genogram?

Domain: Counseling Skills and Interventions

Which statement would you make as you intentionally use motivational interviewing with this client?

Case 9

Part One

Age: 40
Sex: Female
Gender: Female
Sexuality: Heterosexual
Ethnicity: African American
Relationship Status: Single
Counseling Setting: Private practice
Type of Counseling: Joint Mother/Daughter
Presenting Problem: Single mom having frequent conflict with 15-year-old daughter
Diagnosis: Parent-Child Relational Problem

Presenting Problem: You are a clinician in private practice and receive a referral via insurance for a 40-year-old, single, African American female with her 15-year-old daughter. The mother reported that she divorced client’s father two years ago and since then her daughter has been “acting out.” She endorsed that she is a nurse at a nearby community clinic and works late hours. When she returns home, her daughter is out with friends and returns between 3:00AM-4:00AM smelling of alcohol. The mother expressed, “any time I bring up the late-night partying, it’s a huge fight and she storms out. I don’t know what to do anymore.” Her daughter’s grades are slipping, and she is at risk of failing the 10th grade.

Family History The mother-daughter duo is from Brooklyn, NY. She met the daughter’s father in nursing school and they were married for 12 years. After the mother had an affair, the father left and has intermittent contact with his daughter. The daughter was sexually assaulted by a peer 1 year ago and is an only child. She attends a public school in the city and is involved in several peer groups.

Legal History: The client reported her sexual assault to the school, where the events transpired, and the school counselor recommended that the client and perpetrator speak about the assault in peer mediation, which is an in-house resource where students are provided training to help other students work out differences and arrive at a common understanding. When the client told her mom that the school was having the client participate in this program with her aggressor, her mom opened a lawsuit against the school district alleging that it was impeding her daughter from getting the help she needed, as well as for withholding information from a parent or guardian. The school district quickly dissolved the peer mediation proceedings, and assisted the client in making police reports to press charges against the other student. Her school counselor received disciplinary action as a result, and the client has not seen the counselor at school since.

History of Alcohol and Substance Use: The mother reveals that she was an alcoholic prior to going to nursing school and expresses concern that her daughter is traveling down the same path. The mother reports that she has been sober for 5 years, “I blame my affair on the drinking! But no one will forgive me. I don’t even know if I forgive me.” The daughter reluctantly reveals that she drinks malt beer after school with friends and smokes cannabis joints on rooftops.
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Domain: Counseling Skills and Interventions

Based on the information disclosed in Intake, what reframe regarding their conflicted relationship would be most beneficial in starting to build the therapeutic alliance?

Domain: Intake, Assessment, and Diagnosis

Which of the following are fields found on the Cultural Formulation Interview?

Domain: Counseling Skills and Interventions

You have a different client who tells you that before session, she had intense suicidal ideation. The client states that she has no current plans of suicide, but would like to be prepared in case the thoughts arise again. What would you include in the safety plan you make with her?

Domain: Professional Practice and Ethics

All of the following represent potential risks of therapy except which?

Domain: Counseling Skills and Interventions

The Parent-Child Relational Problem represented in this scenario would best be treated by all of the following techniques except:

Part Two

First session, two weeks after intake

The family arrives for their session five minutes late. During the session, you make gradual progress in the mother-daughter engaging with each other. You initiate a discussion surrounding the family’s strengths. The daughter smirks and states, “we have no strengths! That’s why we’re here!” The mother becomes tearful and proclaims, “I just want her to love me again.” You reflect that their relationship is in a difficult place and that hope is possible for reconciliation. The daughter softly admits that her mother has demonstrated strong work ethic, “she taught me never to give up when she went back to nursing school. She was just a clerk before.” The client goes on to discuss her admiration for how her mom got their old house on the market, remembering her mom’s gentle instructions when they were working to get it ready to sell. The client reflects on the hours they spent together painting the home and making trips to the hardware store to make small, affordable upgrades to their house. Once the house was finally sold, the client states that she wanted to stay there a little longer to enjoy the improvements that they had made to the property. Mom nods as she reflects on the details that came to her mind as the client revisited that chapter of their lives. The daughter asks her mom if they could make a trip across town to visit the property for old time’s sake. Mom stated that she would love to, and fixing up that house was one of the most harmonious times of her life. At the end of the session, you practice psychoeducation and summarization to reflect the family’s strengths explored in session and the significance of establishing a foundation of empathy and respect.
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Domain: Intake, Assessment, and Diagnosis

From a transtheoretical perspective, how would you use agreement with a twist in response to the daughter’s statement of “We have no strengths! That’s why we’re here!”

Domain: Intake, Assessment, and Diagnosis

Which of the following is not found in the Cognition Domain on the Mental Status Exam?

Domain: Treatment Planning

How would you interpret mom’s statement of, “I just want her to love me again!”

Domain: Core Counseling Attributes

Which of the following concepts does not form part of person-centered counseling?

Part Three

Second session, two weeks after first session

The family arrives on time for their session. You notice the daughter is wearing jeans and appears to have gained weight since the first session. The mother is also wearing jeans and laughs that she is attempting to create a “work-life” balance. In the first session, you made progress in exploring the maladaptive communication patterns and family strengths. When you inquire about the daughter’s drinking and cannabis use, she becomes irritable and shutdown, “I don’t want to talk about it.” The mother becomes frustrated and shares that her grades have improved but she is still out late. The daughter explains that she has been spending time with a friend whose parents are currently going through a divorce. “She needs to get out of the house!” the daughter exclaims, “What do you want me to do? Say, ‘tough cookies for you,’ when she calls me crying? I’m just trying to help her,” the client insists. Mom gently discusses with her daughter why she is so concerned with the two staying out so late. She pulls up newspaper articles from the past week about gang violence and drug activity that takes place near the city’s reservoir, where young people tend to hang out. The daughter rolls her eyes and says if her mom cared at all she would at least try to understand her friend’s perspective. Mom opened up about her own experience about being a child of divorced and asked her daughter how she can support her and her friend. You gently explore substance use referrals for treatment and coach the mother on skills to become more involved in her daughter’s life and coordinate with school officials in a supportive manner. The daughter expresses she will think about substance use treatment and you schedule their next family session.
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Domain: Treatment Planning

How would you help the daughter understand her resistance to discuss her substance use?

Domain: Professional Practice and Ethics

You are supervising an intern therapist. Which of the following are not accepted standards regarding informed consent when the acting therapist is under supervision?

Domain: Treatment Planning

When working with minors in general, which scenario would most warrant school principal involvement?

Domain: Counseling Skills and Interventions

Which model of counseling is the empty chair technique from?

Case 10

Part One

Age: 35
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Asian American
Relationship Status: Married
Counseling Setting: Agency
Type of Counseling: Individual
Presenting Problem: Relationship Issues
Diagnosis: Delusional Disorder, erotomanic type, continuous

Presenting Problem: You are a licensed counselor at a private practice. Your client is a 35 year-old Asian American who works as a nurse practitioner at a local hospital. His wife urged him to come to counseling because she has perceived some relationship instability and incoherent thinking. In session he states that about three months ago, a candidate for state governor put up a billboard near his home and he took it as a sign that she wanted to get in a relationship with the client. He has written numerous letters to her campaign office to extend his support. He expresses to you that he needs you to keep all of the information shared in session confidential, because no one can know that she is in love with him and is including hidden messages in her commercials on TV.

Mental Status Exam: The client comes to session in his work uniform, complaining of being tired after having worked a 10-hour shift. His thought process is delusional, speech is coherent, and mood and affect are appropriate during session. At times he speaks in hushed tones about “confidential information.” You assess for hallucinations, and determine there is no presence of hallucinations.

Work History: The client is very successful at his job and has been leading teams of interns and medical assistants for the past year. He is well respected by his colleagues and by the students at a local community college where he works as an adjunct professor. He states that one of his goals is to go back to medical school to become a doctor, but is holding off on these plans until after the upcoming election.

Current Living Situation: The client, his wife, and their two children live in a five-bedroom home in the suburbs. The client volunteers for the board of his home owner’s association (HOA), and attends monthly neighborhood crime watch meetings. He and his wife have placed a Safe House sign in their front window so community members in distress can seek help with them. They say that this is a small way to give back to their community. No one has ever actually come to their house for support, but they take pride in leaving it up because it may help someone when they least expect it. They take continuing education courses in crisis management once a year to remain part of the Safe House network. Instead of volunteering for the HOA next year, your client states that he is contemplating dedicating that time to political lobbying activities.

Relationship History: The client has been married to his wife for 10 years. His wife is also a nurse practitioner, but not at the same hospital. She has noticed the client spending up to an hour a night writing email drafts and letters to the political candidate. The client told her within the last two weeks all of his thoughts, which led his wife to encourage him to set up a counseling appointment. She stated that he was very excited about his new love interest, as well as the messages she has been sending him, and that he has no other choice but to divorce his wife after the upcoming election. His relationship became strained recently when the client donated $2,000 to the campaign. He stated that he felt compelled to do so when he saw a city bus drive by with the candidate’s picture on it. He stated, “She planned for that bus to drive by right at that time to ask me for her support with the campaign. When someone loves you enough to reach out like that, how can you say no?”
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Domain: Professional Practice and Ethics

In assessing competency to provide informed consent, which of the following is not an essential criteria?

Domain: Treatment Planning

What would be the most appropriate short-term goal for this client?

Domain: Core Counseling Attributes

The ability to understand one's own motivational patterns and the ability to use them productively in the helping relationship best best enhances which of the following:

Domain: Counseling Skills and Interventions

Which technique would be most therapeutic to treat this client’s Delusional Disorder?

Domain: Treatment Planning

During therapy you ask the client how he is feeling about treatment thus far. This is done to:

Part Two

First session, two weeks after initial appointment

The client comes to the office to discuss recent developments and messages the client has received from the political candidate. One of the “messages” came in the form of fine print at the end of a television commercial. The fine print said “Paid for by this candidate’s campaign team. All rights reserved,” and your client explained that the inclusion of the word “team” on this specific commercial was direct communication to him that the candidate is thinking about his future position in her family. “She sees us as equals, you see, like a husband and wife,” he states proudly. He also discusses the subtle meaning in the phrase “all rights reserved,” although the connection with the campaign isn’t as clear. He speculates that she is saying that she has a spot reserved for him in her life, however he plans to ask for clarification once the election is over. He tells you he is planning on donating another $500 to the campaign if his wife is willing to give him a check since she has locked the checkbook in a safe in the attic for the time being. You respond with unconditional positive regard and reflective listening to build rapport with the client. You provide a non-judgmental environment for the client to express thoughts and feelings.
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Domain: Intake, Assessment, and Diagnosis

Which of the following is not an original domain scale on the Minnesota Multiphasic Personality Inventory 2 (MMPI-2)

Domain: Counseling Skills and Interventions

During the session, why did you ask, “What do others in your family and your community think is causing your problem?”

Domain: Core Counseling Attributes

In your first session with a different client and you notice on your client’s paperwork that your client identifies as non-binary. Which of the following would be the most appropriate question to ask?

Domain: Professional Practice and Ethics

Which of the following is not an accepted practice for when counseling records are being audited by a third-party?

Part Three

Second session, three weeks after the initial appointment

Client comes in to session distraught and confused over a restraining order that client received after client approached the political candidate at a rally in town. The client was escorted away by security after refusing to leave the candidate’s personal space. The client expresses confusion about all of the signs that client has seen in recent months and wonders why the politician would “publicly reject him.” You make a list of all of the signs the client has interpreted as direct communication. The client ranks each item on a likert scale of how likely a person is to contact another person by that means of communication, however the client shows an extreme lack of insight by indicating that all of the means of communication are very probable and typical. You help the client go through the list using other criteria, such as whether the client has previously witnessed another person using such means to communicate with others. The client becomes slightly agitated, asking you to “just listen for once,” and “entertain the possibility that you potentially don’t know anything.” There is a moment of silence in the session before you apologize to the client for offending him and explain that it is your job to help him entertain all potential possibilities. He thanks you for the apology and discusses how he plans to tell his wife about the restraining order. He tells you he hopes his work doesn’t find out because he tries to avoid being the subject of any type of gossip among his coworkers. You discuss with the client potential consequences of breaching the restraining order, to with the client responds “I would never put my career in danger, and I now see that she wants our communication to be one sided. I’ll watch the news tonight to see what else she has to say.”
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Domain: Counseling Skills and Interventions

You notice that your client draws a lot of his conclusions about the world around him from typical thinking errors. You provide him with a worksheet to increase insight about thinking errors. Which model is this technique derived from?

Domain: Counseling Skills and Interventions

How should you respond to the client’s disclosure about the incident that happened at the rally?

Domain: Intake, Assessment, and Diagnosis

The Scale utilized in the second session after intake is intended to:

Domain: Core Counseling Attributes

What is a key component of an empathic response?

Case 11

Part One

Age: 13
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Latino American
Relationship Status: Single
Counseling Setting: School Counseling
Type of Counseling: Individual
Presenting Problem: Fighting at school and home
Diagnosis: Disruptive Mood Dysregulation Disorder

Presenting Problem: You are a counselor in a school setting. During the initial counseling session, a 13-year-old boy is sent to your office and states that he hates school and “homework sucks!” His teacher reported that he is talking back in class and has a bad attitude. He is struggling in all of his classes and has been fighting with some boys on the playground and then in class.

Mental Status Exam: Client presents as angry and frustrated. He is appropriately dressed. He is somewhat cooperative, with no eye contact and appears sad. He denies suicidal ideation and is alert to person, place and time.

Social History: Client has struggled socially in middle school. He states that this year started OK, but mid-way through the last semester, he started hanging out with a girl that he liked. It turns out that another boy also liked this girl. Unfortunately, the other boy was very popular and didn't like the fact that client was “hitting on his girl”. So, the other boy started making fun of the client on Instagram, which eventually lead to a fist fight on the playground during recess. Since the client threw the first punch, he was the one who received a three day suspension. After that, the girl in question let the client know that her parents instructed her to stop hanging out with him since they felt like the client was a “Bad influence”. Client states, “That loser was so lame, she would have been much better off with me!”

Family History: Client lives with his grandmother. His parents are divorcing and he has 4 siblings, two younger brothers and two older sisters. He has been fighting with his to younger brothers, creating problems at home.
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Domain: Counseling Skills and Interventions

At this stage, what could you say to this client, using CBT, to build therapeutic alliance?

Domain: Intake, Assessment, and Diagnosis

Which of the following assessments utilizes a combination of structured tests and unstructured observations?

Domain: Professional Practice and Ethics

You are having lunch with a psychological colleague. During lunch you observe them having several alcoholic drinks. You observe what appears to be some impairment. They have informed you that they have a counseling client coming after lunch. What course of action should you pursue.

Domain: Counseling Skills and Interventions

You are considering using Flooding with a different client. Why should a therapist use caution when implementing the flooding technique?

Domain: Intake, Assessment, and Diagnosis

If you become concerned that the client may be having suicidal thoughts, what is your best course of action?

Part Two

First session, 3 weeks after intake session

Client enters your office for the next session acting annoyed and says that he doesn’t know why he is angry all the time, but he got into a fight this morning and “it wasn’t his fault!” You ask the client if he would be up for engaging in an activity. You get magazines out and have the client cut pictures out that represent his interests. You then assist him in making a collage out of the clippings, and ask questions about the images he chose which include cars, computers, and favorite foods. Client discloses that he is especially interested in cars and would love to learn more about fixing them. He says that he used to watch his father work on the family car, but since his father left he is no longer able to do this. You ask him if he can work on cars with his father during paternal visitation, but the client explains that since his folks “split”, his mother got the car and his father is not able to afford one. You affirm the client for his interest in automotive mechanics and wonder out-loud if perhaps this may be an interest that he could pursue in the high school automotive department. You also mention that learning how to master his temper would be needed if the client wanted to be allowed to use the dangerous tools that are utilized in shop class.
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Domain: Treatment Planning

Which of the following activities or tools would best contribute to the maintenance of therapeutic progress (once progress is obtained) for this client?

Domain: Core Counseling Attributes

What was the purpose of the collage activity you engaged in at the end of the session?

Domain: Counseling Skills and Interventions

Which of the following techniques would best address this client’s Disruptive Mood Dysregulation Disorder?

Domain: Core Counseling Attributes

______ is discrimination against people with disabilities.

Part Three

Second session, 4 weeks after the intake session

Client arrives for the next session stating “why do I have to come here all the time? I didn’t do anything!” You use your calm voice, modeling how much you care about him and tell him that you are here to help him. During this session you continue to work on goals to help him have better behavior at school. You ask him how his week went at school. Client discloses that he had another “run in” with the “loser” who was involved in the client's earlier three day suspension for fighting. This time, the client was in the bathroom when the other boy started teasing him about his jacket. “He thinks he is so cool because he wears H&M. But that doesn't mean he's cool, it just means his parents are loaded. So I called him a 'spoiled little rich boy' and left”, client states. You affirm the client for not allowing himself to get pulled into another fight and comment on how much progress he is making, specifically highlighting his increased ability to control his temper and to consider adverse consequences. “I'm so glad that you had the smarts to just walk away. It would have been a real drag to let yourself get manipulated into another suspension”, you say.
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Domain: Treatment Planning

Which is not affected by client resistance?

Domain: Intake, Assessment, and Diagnosis

Which of the following would preclude a client from being diagnosed with Disruptive Mood Dysregulation Disorder?

Domain: Intake, Assessment, and Diagnosis

From a Gestalt Therapy approach, what could you say to the client to help the client to take responsibility for a recent fight?

Domain: Counseling Skills and Interventions

You have a different client who comes to session distraught over having gotten in a screaming match with her boss at the restaurant where she works. You ask her about the antecedents, behaviors, and consequences of what happened. Which technique is being used here?