Domain: Intake, Assessment, and Diagnosis

From a Logotherapy perspective, what could you say to engage this client at the start of therapy?

Domain: Counseling Skills and Interventions

What would be an appropriate paradoxical intervention to suggest for this client?

Domain: Professional Practice and Ethics

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

Domain: Counseling Skills and Interventions

This client’s Social Anxiety Disorder would best be addressed by all of the following techniques except which?

Domain: Intake, Assessment, and Diagnosis

Criteria for Social Anxiety Disorder (Social Phobia) include all of the following except which?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Two

Second session, two weeks after the initial intake session

The client discloses that she is upset about the bad grades but just can’t get up in front of the classes to speak. Last year she had done a presentation on Hamlet in English, and some friends had teased her about it afterward, calling it lame and boring. This was very hurtful for her, especially since she worked extra hard on creating props and visual aids for the presentation. She was ashamed that she lugged additional art supplies to, from, and around school so that she could work on this project during all of her study halls, and it didn’t amount to much. Her teacher even wrote on the rubric that she was excited to see her presentation, but it fell short of her expectations. A lot of the kids in her class say that this teacher is hard to please, but at the same time most of the kids got good grades, while your client fell behind despite her efforts. She tells you that hardly anyone else planned out their projects as much as she did, and no one was seen carrying around near the amount of supplies she had. She was sure that her visual aids would push her project over the top. This year, she also worked hard on her presentations. She expressed feeling very nervous for days before they were due, almost panicky. She couldn’t eat or sleep and had a strong fear of how others would respond to her presentations. She was worried about being judged or mocked, especially if they noticed how shaky she was or if she choked on her words. Skipping class seemed like her only option. You express understanding of how hard and scary these situations must feel and ask her if she has any tools she uses to try to help herself when she feels so anxious.
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Domain: Core Counseling Attributes

During a session, you state, “I will always be real with you and tell you the truth.” What is the purpose of this?

Domain: Core Counseling Attributes

How would you reflect the meaning of the client’s recounting of her fears of public speaking?

Domain: Intake, Assessment, and Diagnosis

Based on the client's new disclosures from Part Two, which of her symptoms are most indicative of Social Anxiety Disorder?

Domain: Counseling Skills and Interventions

How would you use empathy to engage with the client about what happened in her English class last year?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Three

Fifth session, five weeks after the initial intake session

The client reports that she has started noticing what happens in her body when she is anxious. Her heart begins to beat quickly, she gets flushed and breaks out in a sweat. She thinks about others judging her or somehow offending someone unintentionally. You go over cognitive distortions with her and ask her to self-report which of these she does most often. She chooses jumping to conclusions, mental filter and labeling as thinking patterns. You help her identify the recent times that she has jumped to conclusions, and she talked about a time that she was working on a math problem at the board in front of the class, when she heard a group of boys laughing behind her. She was convinced that they were laughing at the black and red plaid shirt she was wearing, which caused her to reach back and tug on the back of her shirt to make sure it was in place. She then looked down to smooth out the front of her shirt, and noticed that there was taco sauce on the front of it. “They must be laughing at me,” she thought. She felt her face turn red and looked back at the board, only to realize that she had lost her train of thought. The teacher’s timer went off, and she walked backwards to her seat so no one would see the stain on the front of her shirt. She sat down to watch the teacher complete the problem as the students graded each other’s homework assignments.
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Domain: Treatment Planning

Which of the following questions is most important when establishing a treatment plan?

Domain: Treatment Planning

You decide to schedule a team meeting for the client. Which of the following individuals is least likely to be included in this meeting?

Domain: Intake, Assessment, and Diagnosis

Based on the client's disclosures in Part Three, what is the most likely alternative diagnosis for consideration?

Domain: Intake, Assessment, and Diagnosis

The client describes how during her periods of intense anxiety, she sometimes gets a strange 'pins and needles' feeling in her extremities. This is called ______

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Case 2

Part One

Age: 12
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: School Counseling
Type of Counseling: Individual
Presenting Problem: Frequent fights at school
Diagnosis: Disruptive Mood Dysregulation Disorder

Presenting Problem: You are a counselor in a school setting. During the initial counseling session, a 12-year-old boy is sent to your office and states that he doesn't want to be there. His teacher reports that he is frequently getting into verbal fights with other students. School records show that this problem has been present for over 12 months. When he isn't fighting, his general mood is grumpy.

Social History: Last summer, the client went to a neighbor’s birthday party, and the birthday boy’s parents had to call your client’s mom because he was holed up on the trampoline and told the other kids that he would push them off the trampoline if they tried to get in his space. The kids took him up on his threat, and your client pushed four of them off the side, resulting in injury. The host of the party sat him down in one of the bedrooms and told him that he would have to wait there until his mom came and picked him up. He complained that no one listened to his side of the story and that he was entitled to his personal space. His mom arrived and apologized to the neighbor, who said that the party was ruined. He reluctantly walked home with his mom to receive his consequence.

Mental Status Exam: Client presents as angry and frustrated. He is appropriately dressed. He is somewhat uncooperative, with poor eye contact. His speech patterns and content appear to be within normal limits. He denies suicidal ideation and is alert to person, place and time.


Family History: Client lives with his parents who are both professionals. He has one older brother and one younger brother with approximately two years between each sibling. He has been fighting with his brothers, creating problems at home. When asked about this, the client states that it is never his fault. The parents report that the client is often 'grounded' due to poor behavior.
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Domain: Intake, Assessment, and Diagnosis

You say to your client, “It must be a bummer getting in trouble all the time due to fighting. Did you know that sometimes we let our feelings take control and sometimes we totally shut our feelings down. But the secret is to learn how to balance the two.” This refers to which of the following Dialectical Behavioral Therapy teaching?

Domain: Intake, Assessment, and Diagnosis

Which of the following would be appropriate assessments for diagnosing Disruptive Mood Dysregulation Disorder (DMDD) for this client?

Domain: Intake, Assessment, and Diagnosis

According to the information revealed in Part One, for this client all of the following are indicative of DMDD except which?

Domain: Intake, Assessment, and Diagnosis

What question would you ask the client to affirm his diagnosis?

Domain: Professional Practice and Ethics

You are reviewing your policies regarding managing group therapy. Which of the following is not a standard rule for clients within group therapy?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Two

Second session, 2 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!” He explains that he hit his younger brother after his younger brother had called him 'bucky'. His parents grounded him for 3 days for hitting his brother. Client states, “That isn't right! He knows I hate the name bucky. My parents should have grounded him and not me!” You explore with him what the name Bucky means to him, and he tells you that it was the name of a hamster the kids had when they were younger. They called him Bucky because of the way he chewed on his food pellets and because of the noise his teeth made when he gnawed on the plastic house he lived in. Your client tells you to look at him and to see if there is any resemblance to a hamster at all. “And the worst part is,” he states, “is that we couldn’t even pick Bucky up without him biting us. If he calls me Bucky again, I might do just that and bite him if he comes near me.” You wonder whether or not he would actually bite his brother, and validate his emotions that he had about feeling made fun of and disrespected. You begin to help him to look at his 'here and now' actions involved in the fight with an eye to how he can make better choices in the future that will be more likely to satisfy is goals.
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Domain: Treatment Planning

Which of the following is considered abandonment in the therapeutic relationship?

Domain: Intake, Assessment, and Diagnosis

The technique that you employed in the second session after intake belongs to which model of therapy?

Domain: Counseling Skills and Interventions

The client's statement in Part Two regarding his punishment is an example of which thinking error?

Domain: Counseling Skills and Interventions

When engaging in crisis intervention, when must clinicians assess and ensure safety?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Three

Third session, 4 weeks after the intake session

Your client’s mom calls you before the client’s session to notify you of some recent behavioral problems the school has reported to her. She is tearful, stating that she isn’t sure that therapy is working, and isn’t sure what to do at this point. You pull up some past notes and read to her the progress you have noticed so far. “I wish there were some way to somehow speed up this process. It’s so humiliating for me to walk into that school time and time again and hear what a terror he’s being. It’s one thing if he’s like this at home, but to be like this around other people, including the principal, vice principal, and several teachers I had when I went to school there years ago is just plain embarrassing,” she states, emphasizing her words. You talk about your plan for today’s session. The client arrives for the next session informing you that he has received 2 weeks of detention at school for fighting. He again insists that it isn't his fault. Though you note that he is beginning to exhibit some motivation to figure out how to not get in trouble, especially due to detentions. During this session you continue to work on goals to help him have better behavior at school and at home.
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Domain: Core Counseling Attributes

In a counseling relationship, _____________ is the attitude of complete acceptance and love, whether for yourself or for someone else

Domain: Counseling Skills and Interventions

When asking the client about his homework from the past week, he states that he noticed that he calls people names during fights, which tends to make the fights worse. He recently called his younger brother an 'idiot'. From a Solutions-Focused Brief Therapy perspective, what would you say to help the client reduce name calling?

Domain: Core Counseling Attributes

What therapeutic metaphor would you use to describe why the client needs to reduce fighting?

Domain: Counseling Skills and Interventions

Which of the following statements about abuse is false?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Case 3

Part One

Age: 25
Sex: Female
Gender: Female
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: Community clinic
Type of Counseling: Individual
Presenting Problem: Uncontrolled eating
Diagnosis: Binge-Eating Disorder

Presenting Problem: Client is a 25 year-old Caucasian female who has been referred to you by her primary care physician after the client gained 35 pounds in less than one year. Client describes that for the last nine months, she has been eating large amounts of food after work. The client works as a software developer at a start up advertising company. Since work has started to get more stressful, the client has noticed her eating getting more and more unhealthy. She expresses concern that a lot of the time she isn’t even hungry when she starts eating, but she can’t get herself to stop. She tends to eat quickly during these periods of time, and feels guilty afterward. She states that she gets so uncomfortably full that she does not feel like doing anything for the rest of the night. She hopes that you can help her feel better about herself.

Mental Status Exam: The client is oriented to person, place, and time. She shows up early to her appointment and is tearful during session. Thought content is normal, absent of hallucinations and flight of ideas. The client’s speech is normal. The client demonstrates guarded body language. She denies suicidal and homicidal ideation.

Relationship History: At the age of 19, the client was one of the first in her group of friends to get engaged. The boy she dated all through high school finally asked her to marry him the summer after their graduation. She was elated at the thought of spending the rest of her life with him. They liked the same kinds of movies, restaurants, and enjoyed walking in parks together. She ended up calling off the engagement, however, after four years because she felt like it wasn’t going anywhere. Despite having an engagement ring, she felt as though there was a lack of serious commitment. She broke it off in a public place and encouraged her ex to not reach out to her. She hasn’t heard from him since, but still thinks about him from time to time and wonders what her life would be like had they stayed together.

Health History: The client has always been generally healthy. She went to the doctor two weeks ago with complaints of shortness of breath. The client also asked for her thyroid to be checked because she noticed significant weight gain in the past year. All of the tests the doctor ran were normal, aside from an elevated HgA1C, meaning that the client could potentially be at risk for type two diabetes. The client is not on medications and does not have a surgical history. She hopes that you can help her get her eating under control before she develops a chronic condition.
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Domain: Intake, Assessment, and Diagnosis

You decide to begin by administering a Mental Status Exam. Thought blocking, fusion, and loosening of associations are all part of which MSE Domain?

Domain: Counseling Skills and Interventions

You say to the client, “You know yourself best, and I wouldn’t want to make assumptions about how you’re feeling, however it seems like you are carrying some strongly negative self perceptions.” What is the primary purpose of this statement?

Domain: Professional Practice and Ethics

As you work with the client, if over time you need to modify the client's diagnosis, what would be the best course of action?

Domain: Treatment Planning

From a Cognitive Behavioral Therapy perspective, which of the following would you say to build a therapeutic alliance with this client?

Domain: Counseling Skills and Interventions

You are finishing up a session with a different client who is an adult client from West Africa. You remember reading something about how West Africans tend to include their family and spiritual leaders in decisions about health. Which of the below statements would be most beneficial in this situation?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Two

Second session, two weeks after the original intake session

The client comes to session eager to discuss some coping skills the client can put in place to help her eating habits. You start by helping the client list some of the thoughts she has about herself. After looking over the list, she realizes that most of them have to do with feelings of inadequacy. She discusses the ways she has compared herself to her coworkers. She states, “My manager says I'm doing well, but I feel like she just doesn't want to hurt my feelings”. You help the client identify evidence that supports the idea that she is competent to do her job and fit in with her coworkers. She brings up a recent time in which her coworkers decided to go to the midnight showing of a new movie that just came out. She heard some of her coworkers discussing the plans, and was convinced no one would ask her to go. At the end of the night, one of her team members was organizing rides, and put your client on a list for one of the cars. She shares that she was surprised that it wasn’t even a question of whether she would go or not, but she was already included in the plans. On the other hand, she notes a time when her manager wrote her up for making too many mistakes in one day, however she was successful in completing the improvement plan that was set up with her. The plan involved setting up more concrete goals for herself, asking for help, and taking two online trainings, which she completed faster than the allocated time. She discusses her professional accomplishments and unique skills she brings to the team. You reinforce the client’s positivity with statements that promote self-esteem.
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Domain: Counseling Skills and Interventions

The client's statement in Part Two is an example of which Thinking Error?

Domain: Intake, Assessment, and Diagnosis

What statement would reflect the use of cognitive reframing in addressing the client's feelings of inadequacy?

Domain: Core Counseling Attributes

You ask your client about her spirituality. Your client becomes tearful, stating that she does not want to discuss spirituality at this time. Which is the best course of action?

Domain: Professional Practice and Ethics

As part of your practice, you agree to begin supervising a recent graduate. Which of the following does not describe proper ethics of supervision?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Three

Fifth session, six weeks after the original intake session

The client reports that she only had four episodes of unhealthy eating this week, as opposed to up to seven per week as in previous months. You praise the client for her mindfulness and for the improvement. You ask the client what led up to the four times this week in which she demonstrated disordered eating. She states that she is unsure what happened, which makes her feel embarrassment and shame. You walk the client through her evening step by step to help her understand what was happening before, during and after her binge-eating. You normalize the experience for the client and bring her attention back to the progress she reported in the beginning. After discussing her progress, she states that she is now aware of her train of thought leading up to the binge eating. She identifies extended periods of time in which her social media usage caused negative self talk to arise. She talks about one of the social media accounts she follows that is all about how to weigh and measure carbs and protein correctly that made her realize that she is not as engaged with her diet as she used to be. The thoughts that she identifies in session are “I’m ugly”, “I’m unlovable”, and “I’m permanently damaged.” You help her identify times in her life when these thoughts have come up, and make a list of more reality-based, non-biased self-talk that she can remember if the thoughts were to arise again. You help her identify other ways she can spend her time aside from engaging with social media.
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Domain: Intake, Assessment, and Diagnosis

Based on the Transtheoretical Model, and on the information revealed in Part 3, in which stage would you place this client?

Domain: Counseling Skills and Interventions

Which of the following would be the best choice for a brief assessment into potential comorbid diagnoses?

Domain: Intake, Assessment, and Diagnosis

You devise a plan with the client to in which she agrees to spend 30 minutes mopping her floors and cleaning her bathroom immediately following any episode of unhealthy eating. This is an example of _____

Domain: Counseling Skills and Interventions

Your 'step by step' intervention from the fifth session after intake is an example of which of the following CBT techniques?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Case 4

Part One

Age: 14
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: Community clinic
Type of Counseling: Individual
Presenting Problem: Heightened anxiety at home and school
Diagnosis: Obsessive-Compulsive Disorder

Presenting Problem: You are a clinical counselor at a community mental health clinic. Your client is a 14-year old Caucasian male who comes to you to get help so his school day runs more smoothly. Over the past six months, the client has received numerous detentions for being late to class. He states that the issue is that when he goes to his locker to get the books he needs for the next class, he often walks away, but feels like he forgot something in his locker, so he goes back to his locker and opens it only to find that he has everything he needs. He states that he feels better after checking, but there have been times where he opens his locker five times during a class change and reports to class late.

Mental Status Exam: The client comes to session well groomed and makes good eye contact. Mood and affect are appropriate. The client is visibly anxious as evidenced by shallow breathing and tenseness. The client has a bandana that is very special to him. He wipes his brow with his bandana three times when he comes into your office.

Living Situation: The client lives with his mom in a small apartment. Mom reports that the client spends about an hour and a half each night in the shower. Mom has found the client still showering well after the hot water has run out. The client states that he has a very specific showering ritual that he must perform, and if one of the steps is out of order he has to start over. Sometimes he loses track in the middle and has to get out and start all over again. He states that he knows that if he does not complete the ritual then “something bad will happen.”

Academic History: The client has always been a good student. He has perfect handwriting and always has his supplies organized. Teachers often say that he is very responsible and a pleasure to have in class. The detention monitor, who is also the client’s English teacher, was surprised to see him in detention over the last few months, and upon learning of his situation, recommended that he see the school counselor who referred the client to your agency. The client has good grades and has not missed a homework assignment all year.

Family History: The client has three younger half siblings who live with dad full time. The client’s parents got divorced when he was 9 years old, and the client found himself caught in the middle of an intense custody battle. He had to go to numerous court hearings and met with social workers and lawyers on a regular basis. Although his parents encouraged him to always tell the truth, he found himself intimidated by all of the conversations and appointments. He recalls that many of them ended abruptly, leaving him unsure if he said something he shouldn’t have said. He says that TV was an escape for him during that time and he would often imagine himself in the cartoon worlds depicted on the screen. He also says that he developed a love for school during this time of his life because school was the one place where it didn’t feel like people were fighting over him.
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Domain: Intake, Assessment, and Diagnosis

From an Solutions-Focused Brief Therapy perspective, what would you focus on to help this client?

Domain: Professional Practice and Ethics

As you begin working with the client, you also check in with your supervisor for continued professional development. The process that insures that a supervisee's rights are protected from start to finish refers to which of the following?

Domain: Counseling Skills and Interventions

From an Acceptance and Commitment perspective, what would you say to build therapeutic alliance with this client?

Domain: Intake, Assessment, and Diagnosis

Which of the following symptoms most affirms this client's diagnosis?

Domain: Treatment Planning

Below are steps to creating a treatment plan for this client. Which step would come first?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Two

Second session, two weeks after the initial intake

The client wipes his brow three times as he comes into your office. He states that he has felt nervous about coming to counseling because your office is located in such a big building saying, “I know it's going to collapse one of these days.” You ask the client if he has ever seen a building collapse and if it tends to happen often. He says that earthquakes and tsunamis are the cause for the collapsed buildings in the most recent videos he has watched. You point out that you are in an area where it would be impossible for a tsunami to reach, and he states that there is still enough water in the ocean to cover the entire continent. He discusses his interest in construction that he’s had over the years, and impresses you with his vocabulary about the techniques architects use that help strengthen buildings. “I know what you were getting at, though,” he says, “We both know that I’ve never actually seen a building collapse with my own eyes. It just seems like it could happen, though, you know?” The client says that his mom has limited the amount of movies client is allowed to watch since he would talk about how the plots could play out in daily life. He says his mom is being overprotective, but he has been able to sleep better since reducing the amount of movies about natural disasters he watches. The client makes a list of intrusive thoughts and images, including buildings collapsing and forgetting class materials. You help the client gather evidence about buildings and encourage the client to ask himself “What’s the evidence?” when these thoughts and images come up. You help the client brainstorm what he can do instead of opening his locker multiple times. The client states that he can start looking at the books that he is carrying instead of opening his locker again since it takes so long to put in the combination. You encourage him to experiment with this throughout the week. The client wipes his brow three times as he leaves your office.
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Domain: Counseling Skills and Interventions

The guided imagery technique that you used in Part Two is an example of which technique?

Domain: Counseling Skills and Interventions

The client's statement from Part 2 is an example of which Thinking Error?

Domain: Intake, Assessment, and Diagnosis

From an Object Relations perspective, how would you explore the client’s behavior of wiping his brow?

Domain: Core Counseling Attributes

There are two primary sources of information gleaned in a counseling session: Content and Process. Process mostly focuses on:

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part Three

Third session, three weeks after the initial intake

The client wipes his brow three times when he comes into your office. He states that he has been experiencing less intrusive images, however he still has to wipe his brow “just in case.” The client states that it has helped to check what materials he has in his hands rather than going back to his locker, however he still usually opens it twice during class changes, but hasn’t been late to class this week. You praise the client for his progress in lowering the amount of times he has opened his locker. You teach him the concept of “one and done”. You encourage him to make observations about that this week and report back next time. He tells you about a recent conversation he had with his school counselor, who has noticed progress, including fewer detentions. He said that she quizzed him on some of the coping skills he is developing. “I just told her that I can think about things in a different way now. I mean, it’s not perfect all the time, but that’s okay. Hey, that sounds like something you’d say!”, he says with a laugh. He says that the school counselor would like to talk to you, and that she would be sending you a form that his mom filled out to allow you to speak. You ask the client if there’s anything he wouldn’t like you to mention to the school counselor, and he says he has nothing to hide and he trusts you. He gets up to leave, thanks you for helping him, and says he is excited for your appointment next week. The client wipes his brow three times as he leaves your office.
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Domain: Counseling Skills and Interventions

What insights from the homework would you hope to elicit from your client?

Domain: Counseling Skills and Interventions

You have been working with a group of high school students for the past year. This week the group discussed how one of the members was a victim of cyber bullying, and how the group members stuck up for the bullied person by posting on social media about her good attributes. One of the members stated, “I can’t let her be treated like that. I have had the privilege to see her as if she were a sister.” You take in this shift in the group and realize that it has moved into the ___________ stage.

Domain: Counseling Skills and Interventions

Regarding what the client shares about his locker progress in Part 3, which of the following best describes a therapeutic response based on Cognitive Therapy?

Domain: Core Counseling Attributes

Which of the following skills is least associated with the others?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Case 5

Part 1

Age: 66
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Married
Counseling Setting: Agency
Type of Counseling: Individual
Presenting Problem: Memory Loss
Diagnosis: Major Neurocognitive Disorder due to probable Alzheimer's disease

Presenting Problem: You are a counselor at a mental health agency and your client has been referred to you by his primary care physician due to some concerns with memory loss. The client, a 66 year-old Caucasian male, attends the session with his wife who expresses more concern than her husband. She states that lately her husband has been showing a gradual decline in his ability to carry out day to day tasks. He recently left the stove on for an hour after heating up some water to make tea. The client states that he has noticed that it takes him about a week to finish a crossword puzzle that used to take about an hour, and this increase in time has been steadily increasing over the past year. “I just can’t think of the words,” he states. The client’s wife says that the client has stopped doing crossword puzzles out of frustration and he has no longer been interested in reading, which has always been one of his favorite pastimes.

Mental Status Exam: The client comes to session well groomed with good hygiene. The client is oriented to person, place, and time. The client does not report a history of hallucinations or delusions. At the end of the session, the client is unable to recall three words that were mentioned to the client at the beginning of the session. The client grows frustrated in session when he cannot recall some details that his wife mentions. At numerous times, the client stares out the window while his wife talks to you.

Family History: The client is a father to six adult children and eighteen grandchildren. His oldest grandchild is about to graduate high school, and his youngest grandchild was just born at a hospital not far from your office. He recalls going to the hospital for each of their births, except the birth of Isaac, his grandson who was two years ago. Your client tells you the story about how his daughter was on a flight from Los Angeles to Des Moines when, all of a sudden, her water broke and she went into active labor while on the airplane. Luckily there was a gynecologist and a paramedic on board who safely delivered the baby. Your client shares that he doesn’t know what the “place of birth” says on his grandson’s birth certificate, but it should say “somewhere over the Rocky Mountains.” He regularly spends time with his grandchildren, and states that the family is planning to get together for his upcoming birthday.

Living Situation: The client lives with his wife. They have six grown children, who are all married with children. The client is retired and is dependent on his wife for transportation since losing his license 3 months ago due to transient memory loss.

Health History: The client’s doctor has ruled out cerebrovascular diseases via neuro-imaging and has made a preliminary diagnosis of Major Neurocognitive Disorder due to probable Alzheimer's disease. The client is otherwise in good health. The only factor that stands out in client’s health history is that the client’s father and grandfather were both diagnosed with Alzheimer’s disease before they died.
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Domain: Professional Practice and Ethics

You will be having some sessions with just the client and some with both together. What is the preferred necessary documentation at the onset of therapy?

Domain: Professional Practice and Ethics

During the intake, how would you establish a therapeutic relationship with the couple?

Domain: Intake, Assessment, and Diagnosis

Based on the information in Part 1, what is the most pertinent criteria that distinguishes this as a Major Neurocognitive Disorder as opposed to a Mild Neurocognitive Disorder?

Domain: Professional Practice and Ethics

During the intake session, the client's wife asks if she can talk with you alone. How would you best respond to this request?

Domain: Counseling Skills and Interventions

How would you interpret the client's frustration regarding his inability to recall some of the details that his wife is sharing?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part 2

First session, two weeks after the initial intake session

The client comes to the session alone, stating that his wife is waiting for him in the waiting room. He reports frustration over not being allowed to drive after he got lost about 3 months ago when he was trying to go buy lottery tickets from the same store where he always buys them. He has a good relationship with the store owner Frank, and the two are known to spend up to an hour chatting about neighborhood happenings. Your client states that he felt frustrated because the store is just around the corner from his house, and it’s a “well worn path that I’ve been taking for years.” When the silver alert came out across the news, Frank even closed the store to help the client’s family locate him. Your client says that he felt embarrassed that so many people put their lives on hold because he took a wrong turn and refused to work the GPS one of his sons got him for Christmas. “I just got turned around. They don’t have to take my independence away for something like that! My life is worthless if I can't drive”, he says. You gather information by making a timeline with the client about his life. He discusses his time overseas when he worked as a foreman for a mining company, as well as his current hobbies. You notice that he has trouble remembering his grandchildren’s names. He says that one of the most important changes he has made is that he has started to walk more. “Not because I want to get healthy or anything, but it’s the only way I can go out if they won’t let me drive!” he exclaims. You provide patience and understanding to the client by allowing him to take the time he needs to discuss his life. You provide unconditional positive regard.
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Domain: Treatment Planning

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

Domain: Intake, Assessment, and Diagnosis

From a Cognitive Therapy perspective, how would you respond to the client's statement in Part 2?

Domain: Treatment Planning

Which of the following assessments would be most effective for a brief monitoring of the client's cognitive status?

Domain: Core Counseling Attributes

Which of the following statements best reflects unconditional positive regard for this client?

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to move forward.

Part 3

Second session, four weeks after the initial intake session

The client was supposed to come to counseling the week before, but he “no showed” because he forgot he had made the appointment. His wife again brings him to his session and attends this session. The client discusses his feelings toward his wife, ranging from frustration to compassion. He discusses how his mother and grandmother coped with his father and grandfather having Alzheimer’s. His mother took on daycare responsibilities for the client’s children, nieces, and nephews, but once his dad’s disease progressed and he had to quit his job, he didn’t handle being around so many children very well, so the daycare operations had to be suspended, leaving all of the family members to scramble to find daycare for their children. He remembers his father getting violent during some bouts of frustration. “We’ve already talked about that, though, and I will not follow in his footsteps. I may be forgetful, but I’m not going to hurt anyone in this process,” the client says as he squeezes his wife’s hand. She looks out the window pensively. He tells you he doesn’t know much about his grandfather’s Alzheimer’s disease because that side of the family wasn’t as close as it is now. “My grandfather was always quite cold toward us kids,” he recalls. The client expresses that he knew that Alzheimer’s was his fate, but now that it has been gradually setting in, he feels increasing amounts of fear and embarrassment. You help the client define areas of his life in which he feels these emotions. You give the couple a homework assignment to begin scheduling weekly pleasant outings.
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Domain: Treatment Planning

During the session, the wife begins disclosing her increasing struggle with eating, including episodes of binge eating that she connects to the increased life stress of caring for her husband. What is the best course of clinical action?

Domain: Intake, Assessment, and Diagnosis

From a Psychodynamic psychotherapy perspective, the client's comment that he, “Just got turned around” the last time he went for a drive and got lost is an example of which defense mechanism?

Domain: Counseling Skills and Interventions

You have been working with a different client for over two years. She tells you that she will be moving to a state where you don’t currently hold a license, but would like to continue seeing you. What would be your best course of action?

Domain: Counseling Skills and Interventions

The homework assignment in Part 3 is an example of ______

REVIEW SCREEN

At the end of Parts 1, 2 and 3 you will encounter a Review Screen that will allow you to review the questions from that Part. Once you start the next Part, you will no longer be able to review or change answers from prior Parts.
Select answer A to conclude your exam.