CE #1

Karen, a slightly overweight 13-year-old girl, is referred for therapy by her teacher. Parents, Brad and Nina, attend the first session with Karen. Nina shares that her daughter has complained about going to school since they moved to town a month ago. Brad adds that she used to be excited to hang out with the family and now she just wants to be alone in her room. He adds, “You can fix her, right?” Karen glares at her father and says, “Fix me? You’re the ones who needs help”.  How should the therapist clinically manage the ethical responsibilities in this case?

A. Address clients’ expectations for treatment; Discuss risks and benefits of being in therapy; Set fees prior to the first session. 
B. Address clients’ expectations for treatment; Inform clients of the limits of confidentiality; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment. 
C. Manage the fee; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment; Provide referrals if family decides not to continue therapy
D. Address clients’ expectations for treatment; Manage the fee; Obtain a signed release from each of them prior to speaking with Karen’s teacher.

During an initial assessment interview, a therapist observes that her new client is suspicious of the agency and the therapist.  The therapist provides informed consent, including the limits of confidentiality.  After receiving informed consent, the client tells the therapist that he wants to share certain information but is concerned it could get his friends in trouble.  What is the most appropriate response to address the client’s concern in this case?

A. Encourage the client to talk about these things and reassure him that the therapist is not required to report on the behaviors of his friend.
B. Acknowledge it could be hard to feel safe in this situation and encourage him to only share information when he feels he is ready. 
C. Confirm the client understands when a therapist must break confidentiality and show him where the files are locked to ensure his privacy. 
D. Recognize the client is not ready to talk about the situation and shift the focus to a less threatening subject.

A 17-year-old is referred by her doctor to a mental health agency for counseling.  The client learned several weeks ago that she’s pregnant.  She reports she is in a relationship with the person who got her pregnant, but they are not getting along, she does not want him to know, and does not think she wants to have the baby.  She is conflicted about what to do and tells the therapist she would like support as she decides what to do.  The therapist has personal beliefs against abortion and feels strongly the client should not have an abortion.  How should the therapist address the conflict presented in this case?

A. Seek consultation and refer the client to prenatal services. 
B. Share the therapist’s personal beliefs and process how it effects the client and therapist’s relationship.
C. Encourage the client to include her boyfriend in making a decision. 
D. Seek immediate consultation to discuss the matter and determine if a referral would be appropriate. 

Kayla, age 15, is brought in for therapy by her Aunt Lynda who was given legal custody following the death of Kayla’s mother three years ago. Lynda reports that Kayla is “running with the wrong crowd”, has been skipping school and is lying to her about where she goes at night. Lynda states, “She told me that she was at her friend's house, but I went over there and nobody was home.  I just can’t trust her anymore.” Kayla rolls her eyes and responds “Don’t pretend like you care. I’m not afraid of you anymore.” What legal obligations does the therapist have in the case described in this vignette?Score: 1 of 1 

A. File a child abuse report; Request documentation to verify custody; Obtain a release to speak to school counselor. 
B. Obtain signed informed consent to treat a minor; File a child abuse report; Set fee prior to the onset of therapy.
C. Obtain signed informed consent to treat a minor; Set fee prior to treatment;Assess for child abuse.
D. Set fee before the onset of therapy; Explore expectations of therapy; Assess for child abuse. 

A lesbian couple, Michelle, a 44-year-old Black woman, and Kara, a 38-year-old white woman, are referred by a friend to couples therapy. The couple reports that they fight all of the time and can’t agree how to parent. They have two adopted children, Josh, 6 and Logan, 4. They report that Josh has been disruptive in class, won’t stay seated and is aggressive with other children.  Kara starts crying when she says, “I don’t know what to do to help him. I am so worried about him. I can’t sleep without taking something”. Michelle complains angrily, “Well, she pops pills whenever she’s stressed and she worries about everything. If she actually disciplined him, we wouldn’t have this problem. He listens to me. Now, he’s completely out of control like you with that sleep drug”. Kara whimpers back, “He listens to you because he’s afraid of what you’ll do. ”What interventions would a Bowenian therapist use in the beginning phase of treatment with Michelle and Kara?



A.  Identify the role of substance abuse as intrusive in their partnership and assist the couple in understanding the role of parenting in their families of origin. 
B. Reduce the emotional reactivity of Michelle and Kara's opposing responses to parenting and Interpret the multigenerational parenting styles of Michelle and Kara's families of origin. 
C. Analyze the triangulation of substance abuse in Kara & Michelle’s relationship and develop a family history to identify Michelle and Kara's learned parenting styles.
D. Develop a family history to identify Michelle and Kara's learned parenting styles and analyze substance abuse as Kara's avoidance of relationship responsibility.

Helen, a 61-year-old woman referred by her medical doctor, is having difficulties adjusting to a below-the-knee amputation due to complications from diabetes. A note from her doctor indicates that Helen has elevated blood sugars and inconsistently follows her eating plan and medication regimen. Initially, Helen is very animated, speaking rapidly and using expansive gestures. She becomes irritable when asked how she is feeling but admits that she has no appetite and isn’t sleeping well at night. Upon further discussion of her medical condition, Helen becomes tearful and states, “I can’t keep track of this disease. It’s just too much! I’m afraid I am going to get depressed again.” What clinical issues require further assessment in the case provided in the vignette?



A. Helen’s social isolation; Suicide potential for Helen; Helen’s preoccupation with physical challenges and limitations.
B.  Helen’s psychiatric history; Suicide potential for Helen; Helen’s mental status. 
C. Helen’s substance use; Socioeconomic stressors affecting Helen; Helen’s mental status.
D. Helen’s understanding of her medical issues; Socioeconomic stressors affecting Helen; Helen’s mental status.