Question 1

Which of the following inventories can be used to gauge progress during the therapeutic process or to determine whether further therapy is necessary?

Accepted Answer

Any of the above inventories can be used to assess for progress during therapy. However, it always helps to use the same measurements in the middle and at the end of therapy than were used at the beginning. This way, the measurement is identical and can be gauged against amount of time and energy expended. Also, while the BDI and BAI are for the client to fill out, note that the YMRS is usually more accurate when completed by a professional.

Question 2

Bullet Bob wants therapy to be a quick fix. He is in quite the hurry. After six weeks, Bob is getting anxious. He doesn't see any improvement and so he asks you as his therapist if you see any improvement. One of the best ways to handle this question is to:

Accepted Answer

When a client is especially anxious about the progress of therapy, it can say different things, but primarily, it indicates that the client is not happy with how things are progressing. It could be that Bob has trouble with patience, particularly when it comes to getting what he wants. Bob could benefit from some patience training, since therapy is almost never a quick-fix process.

Question 3

One misconception about solution-focused brief therapy is that problems get solved right way. Instead, as the name implies, there is a focus on finding the solution. Oftentimes, in the middle of therapy, that could mean:

Accepted Answer

SFBT focuses particularly on what the client needs and how the client defines what the problem is. After all, from the SFBT standpoint, without the problem, there is no reason to attempt finding a solution. If the problem changes throughout, as human nature allows, SFBT by nature asks to reassess on a regular basis to be sure that the appropriate behaviors are being targeted.

Question 4

There could be a large difference between when the clinician feels the work is done and when the client feels the work is done. The clinician may be able to see other issues at play. If the clinician sees other issues at play:

Accepted Answer

As is known, therapy is not necessarily a quick fix and those problems that come in are not always those that need adjustment. It is common for alternate problems to be addressed and in these cases, it is necessary to alert clients to the presence of additional work to be done. When the therapist is the only one who sees this, however, he is obligated to share this with the client so that he follows the protocol of best care. Without it, the therapist is in danger of not completing care properly. The one thing he can't do is force the client to remain in therapy.

Question 5

Talkative Tyler is a terribly tormented teenager. However, as much as things are bothering him, he is ritually refusing his requirement to release his ranting and raving. When something like this happens, the therapist must be able to:

Accepted Answer

It sounds simple: providing the best level of care possible. However, paying attention and providing empathy to a teenager who is providing the silent treatment can be more difficult than it appears. Terminating makes things more difficult in the face of complications and there is not necessarily a guarantee of keeping personal feelings out of therapy, hard as therapists may try.

Question 6

As you are coming to the end of your therapeutic relationship with Daisy Debts, you realize that she has not paid you for your last six sessions. Since this is the last time you will see Daisy, it would be best to:

Accepted Answer

If she were to leave owing a good deal of money, she may believe that she can perpetrate this behavior on others. A better idea would be to confront her about the behavior to make sure that nothing stands in the way of her payments before proceeding with any actions against her, since the therapeutic relationship is almost always the primary concern.

Question 7

At the end of your time together, Maria is remarkably thankful for the work that you have done with her family, but especially with her children. As a sign of her appreciation, she has baked you a very special cake that has cultural significance to her. How do you handle such a gift?

Accepted Answer

When gifts are important culturally and they do not imply any particular power struggle or imbalance of power in a relationship, it is especially important to consider how one would be viewed in light of being culturally sensitive and appreciative. Declining the gift could be seen as offensive and work to undercut the entirety of the relationship that took so long to build. The same could be said for any other choices that involve exchanging the gift.

Question 8

As your treatment with Frisky Frank continues, he begins to share with you how he has been engaging in unprotected sex with his girlfriend. Frank is seventeen, almost eighteen. You know that his parents do not approve of his girlfriend. What is your place as a therapist?

Accepted Answer

As therapists, we do not give advice. Not to mention that our primary job is to protect the client's confidentiality as a matter of safety. By sharing with anyone, we violate that confidentiality. Terminating therapy when Frank needs your presence the most is probably not something to set up for any expectation of future relationships. Stay the course by providing Frank with a safe environment in which to explore his options.

Question 9

You are an intern who works for free at a non-profit agency and you have just received an offer for full-time employment with your local county health department. In order to ensure that your clients at the non-profit continue receiving the best care, you decide to:

Accepted Answer

Transitions are difficult, but we need to be prepared for them to come at any time. This includes telling clients when we need to move on. Keeping both jobs is impractical and declining the offer that pays would only work if you were independently wealthy, which, for purposes of this question, we have assumed you are not. Avoiding a transition is one of the worst things we can do. Instead, work to make it smooth and efficient in the best way possible that is client-centered.

Question 10

You are working with Brett, a sixteen year old who recently transferred to the local public high school where you are a therapist. Brett comes from a wealthy Connecticut suburb, where private school was the norm. After six months of working with him on an Adjustment Disorder, you should:

Accepted Answer

(A) would be unethical, particularly if the criteria for the specifier did not present itself at the beginning of treatment to be monitored. You should likely bring in the family for their perspective long before the six month mark. And if he has been working on adjustment issues, friends are most likely already part of the equation. If Brett still needs therapeutic work, there could be a diagnosis that is more appropriate.

Question 11

You are working with Jeanine, whose husband, Peter, refuses to come to therapy. Your main concern revolves around whether or not this marriage will work. Peter still refuses to come in, even after eight weeks of therapy. How do you continue treatment?

Accepted Answer

Giving advice is not really the way to continue or terminate treatment. Neither is demanding that one person participate whether or not the other is participating. Instead, you can work to focus the power of individual change, encouraging Jeanine to make changes at home, even without Peter coming in to therapy. The odds are that Jeanine will soon see a difference in her reception at home.

Question 12

You have seen a client for fifteen sessions, the maximum on his insurance policy for the year. You've made great progress, but he's still interested in pursuing some of the areas that you've uncovered. When he doesn't have the money for your fee, how do you proceed?

Accepted Answer

While wrapping things up might be a good option, since you wouldn't rush it, you could always attempt to work out a sliding scale. Options C and D don't seem too practical, one due to his insurance plan and the other due to his wanting to keep his friends just that, friends.

Question 13

An urgent matter has come up for one of your clients and she needs to have a surgical procedure done in the next few days that will result in her being home-bound for the next several weeks. You are at an impasse with therapy, where she is not responding and resistant to certain challenges so far. You might recommend:

Accepted Answer

Any of these might be reasonable steps. You may consider picking up when she is well again, considering that she may not focus too well while she isn't feeling up to doing therapy. A referral could work out as well, but perhaps only if the impasse is personal in nature, which can sometimes be worked out.

Question 14

One of your clients, who is court-mandated, has just reached the conclusion of his twenty sessions with you. He has gotten to know you over the last several weeks and lets you know that he appreciates the time you've spent together. He's thought it over and he'd like to end at the mandatory twenty sessions. You feel that he has quite a bit of potential left to explore a lot of his residual issues. What makes for a good option?

Accepted Answer

When you think a client is capable of more positive change, this is usually always a good time to mention it before they walk away and close the book on therapy for good. Without a certain nod to the progress that they have made, some clients do not possess the insight to know more is possible. This is one place you could use your expertise to encourage clients to explore.

Question 15

When writing treatment plans, it is often important to establish when the goal will be considered achieved or when the symptom will be considered stabilized. For example, symptoms will be considered stabilized when client reports zero auditory hallucinations for a period of xx." Of the following options, which may be best suited for a stabilization goal?

Accepted Answer

One month seems to be the most appropriate for measuring decrease in hallucinations. The others seem to be a bit too long. Waiting for an entire six weeks without hallucination or delusion could be a long time coming. Instead, measurable could also be paired with the word reasonable when considering satisfactory progress.

Question 16

About six weeks into therapy with a family, you are tempted to ask "How is this for you?" fully expecting the answer you've always heard. Instead, you change your mind and instead choose to ask the parental unit, "What are you learning about your son?" In this way, you have effectively:

Accepted Answer

This question allows the family unit to assess itself, with you free to observe any changes that might be taking place that you might otherwise miss in the midst of providing therapy. While you haven't quite empowered the teen fully, you're giving him the sense that he will be empowered soon, if there is something to learn about him. Clearly, both parties can benefit from the question.

Question 17

You live in a small, rural town in northeastern Michigan, where you are one of two practicing therapists in town. You are in the market for a new car and realize that the only dealership in town is owned by a former client. Do you buy your car locally or not?

Accepted Answer

Power, duration and termination tests are: Power: How much power does one person possess over the other and is there a perceived balance or imbalance? Duration: How long has the relationship been formed versus how long has it been separated/terminated? Termination: Would this result in termination if the therapeutic relationship were still being pursued? All of these are important questions.

Question 18

What is one essential question to ask in order to gauge whether or not behavior might be considered an ethical violation or cause for termination?

Accepted Answer

Can you see a risk coming from the behavior in which you are engaging? If you can foresee a risk, then it is likely an ethical violation. While asking who would find out sounds more underhanded than unethical, it still leads to what might be classified as improper behavior. Consider minimizing risk, instead.

Question 19

Your informed consent document never included a section that defined what you would not be able to do for clients. A client is approaching you and is asking you to serve as a couples therapist for her and her husband, while continuing individual therapy with her only. Your response would be:

Accepted Answer

While you may be able to see her in couples work, you may want to point out that because you have so far only seen her, it could be difficult to separate her own personal material from that which is "the couple's" material. In fact, given what is discussed, it may throw into conflict the therapist's obligation of confidentiality and could put the individual therapy at risk.

Question 20

Nate has been coming in to see you for about eighteen weeks. At the end of eighteen weeks, he finds that he isn't benefitting from therapy. When he shares this with you, you examine what has kept him coming back for eighteen weeks if there is no progress. One common reason might be:

Accepted Answer

Many clients are unsure of how to address the therapist's lack of efficacy and others even fear retaliation on the part of the therapist. But really, when a client does not feel that therapy is moving like it needs to, you may need to address this on his behalf. It may be more difficult, but in the end, is well worth his understanding that the process is different for all who have done it.

Quiz 3: Ongoing