1.
C The use of candor mean the social worker will
use openness and sincerity to build a trusting relationship with the
teenager. The teenager oppose a social worker who is authoritative and secretive. The first thing
the social worker should do is start where the client is by letting the client
know you are there to listen and offer support. Teenagers usually need to know
that they are valued, accepted and cared for in order for them to trust you.
The social worker should not tiptoe
around the issues but be open about what is going on and invite the teenager to
ask questions and share their feelings. A,B,D are steps you may take later in
treatment.
2.
C.Psychoanalysis theory first founded by Sigmund Freud. It is
a psychodynamic approach which views human behavior as being motivated largerly by unconscious
processes. Psychoanalysis proposes early development problems such as child
maltreatment will have a profound effect on adult functioning such as
parenting, social and occupational functioning.
3.
B.
Cognitive Behavioral Therapy. is used with individuals who can understand that
can incorporate learning theory and cognitive psychology. A client with pervasive developmental
disorder refers to a group of developmental conditions that involve delayed or
impaired communication and social skills,behaviors and cognitive skills
(learning)
4.
D.
According to psychoanalytic theory the superego emerges when the child is five
years of age which also the time when the child is able to postpone
gratification of the id’s instincts. During the phallic stage, a child between
the ages of 3-5, is faced with the primary task of the resolution of the
Oedipal Conflict, which is marked by a desire for the opposite-sex parent as
arrival. A successful outcome results from identification with the same sex
parent.
5.
A.According
to the NASW Code of Ethics, there are 6 core values; service, social justice,
dignity and worth of the person, importance of human relationships, integrity
and competence.
6.
D.This
type of ethical dilemma may be especially acute for social workers in
healthcare settings who are privy to medical and genetic information that may
affect the welfare of others. Social
workers should always provide psycho-education about safe sex, explore client’s
perception of HIV and clarify and possible biases in relations to the disease
first.
7.
B.
Beck (1988) comments on the difficulty of predicting violent behavior,
especially for client who are likely to be impulsive, such as those with certain mental disorders. Until now,
whevenever violence appears to be impulsive for whatever reason, courts are
reluctant to find the defendant negligent” for not warning a potential
victim(Beck, 1988,p.381) NASW code of ethics encourages social workers to
disclose confidential information to prevent serious,foreseeable and imminent
harm to a client or other identifiable person”(1999,1.07c) The limits on duty
to protect have been codified in the state stautes that explicitly make
reference of the Tarasoff Duty.
8.
A. Social worker is experiencing an ethical
dilemma because she was hired to provide therapy to students not to do crisis
intervention. The social worker’s most
appropriate action is to explain competing values with the teacher.
9.
D.
Bipolar I is characterized in the DSM as a person experiencing or or more manic or mixed episodes. Often,
but not always,there is a history of major depressive episodes. A manic episode
of at least one week with symptoms of grandiosity,decrease need for
sleep,pressure to keep talking,flight of ideas,distractability,increase goal
directed activity, increased pleasureable activities;shopping sprees,sexual
indiscretions,foolish investments)
10.
D The
current school setting is not addressing the child’s needs. A comprehensive
evaluations would assess client’s social, cognitive and psychological needs;
which would be in the best in interest of the client.
11.
A.
Anxiolytic are used to treat anxiety. It is characterized as a sedative
12.
C.
Whenever client’s are experiencing stressors or losses Social Workers ought to
address them in the session and provide resources to families without support
in order to stabilize the family.
13.
A. Social worker is experiencing a value
conflict regarding self determination
and morals. Personal values can cause
biases and stereotypes and can have negative impact on the therapeutic
relationship. It is in the best interest
of the clients that the social worker seek supervision to address
countrertranference issues and if value conflict continues to impact the
therapy case should be tranfered to another social worker.
14.
C. It
appears that the social worker did not discuss morality with the client.
Stealing is an unacceptable crime that applies to everyone in society which
should be discussed at the beginning of treatment.
15.
B.
Schizoid is characterized in the DSM as a
pervasive pattern of detachment from social relationships and a
restricted range of emotional expression in interpersonal settings. People with
this disorder do not want or enjoy close relations; they prefer to be loners.
16.
D.The
diagnostic criteria for Histrionic Personality Disorder is a pervasive pattern
of excessive emotionality and attention-seeking behaviors such as;constant
demands for approval,inappropriate exaggeration of emotions,discomfort when not
in the center of attention, inappropriate sexual seductiveness and consistent
use of physical appearance.
17.
. A.
It is important to start where the client is. B,C,D are steps that may be taken
later in treatment.
18.
. D.
D is too vague and it does not explain the reasons why cultural diversity is
beneficial to clients.
19.
A. Impulse Control disorder is the failure to
resist an impulse,drive temptation to perform an act that is harmful to the
person or others. Trichotillomania is te
recurrent failure to resist impulses to pull out one’s own hair. Intermittent
Explosive Disorder,kleptomania,pathological gambling and pyromania are also
classified as impulse control disorder.
20.
C. Pain
is the focus of the clinical presentation and it cannot be fully accounted for
by a general medical condition. Psychological
factors are judged to have an important role in the onset, severity,
exacerbation or maintenance of pain.
21. A
Beck and his colleagues have conducted several studies to identify the factors
that are most associated with suicidal behavior. Not surprisingly, perhaps,
they have found that feelings of pessimism and a sense of failure are the best
predictors. In other words, the research has found that the cognitive
characteristics associated with hopelessness are most highly correlated with
suicide attempts. Consequently, a goal in the treatment of suicidal patients is
to increase hopefulness.
22.B
The prognosis in schizophrenia varies with the type of reaction, the particular
patient, and the nature of the patient's home situation. Note that the question
is asking about the type of reaction that does not have a poor
prognosis. The prognosis for schizophrenia is better when the onset is acute
(sudden) rather than insidious. Earlier onset (e.g., in adolescence), lack of
emotional responsivity, and the presence of obsessive-compulsive symptoms are
all associated with a poor prognosis.
23. A
Recurrent or persistent depersonalization is an essential feature of
depersonalization disorder. Even if you are unfamiliar with this disorder, its
name ("depersonalization") suggests its symptoms. The DSM defines
depersonalization as an "alteration in the perception or experience of the
self so that one feels detached from, and as if one is an outside observer of
one's mental processes or body (e.g., feeling like one is in a dream)."
Thus, depersonalization can be described as feelings of disorientation and lack
of ego functions. Alternative "b" is incorrect because, although
anxiety might be a result of depersonalization, it is not the best description of
it. Response "c" is incorrect because uncontrollable thoughts are
characteristic of obsessive-compulsive disorder, not depersonalization.
Alternative "d" is wrong because extreme fear and avoidance are
characteristic of phobias, not depersonalization.
24. A The
use of the plastic bags in this manner is associated with "autoerotic
asphyxia," which refers to asphyxia caused by intentionally strangling
oneself while masturbating; this behavior, which may or may not be suicidal in
intent, is based on the person's belief that reduced oxygen flow to the brain
can enhance orgasm. A variety of physical aids may be used, including a plastic
bag, hanging platform, or a basin of water. Teens abusing inhalants
("b") may use paper (rather than plastic) bags: e.g., Glue sniffers
may distribute the glue on the inside surface of a paper bag; the solvents
commonly found in glue then disperse into the air inside the bag, and are
inhaled or "huffed" by the abuser. Although the boys' behavior may be
considered deviant ("d"), the term autoerotic asphyxia specifically
describes the likely intent of their behavior.
25. A
Family therapy is frequently an important adjunct to other treatments for
patients with substance use disorders. This is true, first, because the
addiction of one family member can have profound effects on other family
members, and second, because addressing family problems greatly increases the
probability that the substance addicted patient will be able to maintain his
sobriety. Enlisting the support of family members is particularly important
when the patient lives with his family and has a dual disorder, as in this
case. Family members need to be educated about how to provide support, what to
expect in terms of functioning and relapse potential, how to avoid "enabling"
behavior, and the patient's medication regimen and potential medication
side-effects. The patient would have been given a referral to a 12-step group
("b") from the residential facility staff. And although maximizing
the patient's occupational functioning will be an important treatment goal, the
priority at this time is to stabilize him after his discharge, and intervening
with his family is a more relevant and effective way of doing this.
26. D Feeding
disorder of infancy or early childhood (a.k.a. failure to thrive) involves a
persistent failure to eat adequately, along with a significant failure to gain
weight or significant loss of weight. According to the DSM, parental
psychopathology, child abuse and neglect, and problems in the parent-child
relationship are frequently associated with failure to thrive, and should be an
assessment focus. For instance, infants with feeding disorders are often highly
irritable and difficult to console during feeding, and, in some cases,
parent-child interaction problems may contribute to or exacerbate the child's
feeding problems (e.g., the parents may have inadequate knowledge about how to
respond to the baby's needs and may respond to his or her food refusal as if it
were an act of aggression or rejection).
27. C
An IQ of 30 is associated with severe mental retardation; by adulthood, many
(though not all) individuals with severe mental retardation are able to develop
the skills listed in answer "c." The skills in answer "a"
are associated with mild mental retardation (IQ 50-55 to about 70); the skills
in answers "b" and "d" are associated with moderate mental
retardation (IQ 35-40 to 50-55).
28. D
Schizotypal personality disorder is characterized by social and interpersonal
deficits and cognitive or perceptual distortions and eccentricities.
Individuals with schizotypal personality disorder usually have few friends and
are uncomfortable around most people. They may say they want closer
relationships, but they generally prefer to stay alone. Choice "a"
better describes schizoid personality disorder; response "b" sounds
more like paranoid personality disorder; and alternative "c" is
symptomatic of avoidant personality disorder.
29. C
In the somatoform disorders (e.g., somatization disorder, conversion disorder),
there are clear and existing physical symptoms that are suggestive of a somatic
disorder but there is no detectable organic or neurophysiological dysfunction
that can fully explain the symptoms; there is a strong presumption that the
physical symptoms are linked to psychological factors.
30. B
Behavioral assessment is used as both a diagnostic and evaluative tool to guide
decisions related to interventions and to assess their effectiveness.
Behavioral assessments focus on samples of behaviors rather than signs of
underlying phenomena. The other responses accurately describe the
characteristics of behavioral assessments.
31.
|
D
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Only “d” is true. Encopresis is
characterized repeated passing of feces into inappropriate places. The
symptom is usually involuntary, but can be intentional (which rules out “a”);
there is at least one soiling event per month for three or more months (which
rules out “c”); and the child’s chronological or mental age must be at least
4 years. In addition, the disorder cannot be due to a general medical
condition or the use of laxatives or other substances. Option “b” is not
required for a diagnosis of encopresis. In earlier versions of the DSM,
encopresis and enuresis were both coded as either “primary” or “secondary.”
DSM-IV-TR no longer includes this distinction for diagnostic purposes, but
does discuss it when describing the expected course of an elimination
disorder: Encopresis (or enuresis) is “primary” if the person has never
established fecal (or urinary) continence (the ability to control
elimination); and “secondary” if the disorder develops after a period of
established fecal (or urinary) continence.
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32. D
Although you would want to obtain information about the client's social
situation, ruling out a medical disorder would be more important for
determining an accurate diagnosis and treatment plan. Depending on whether a
medical condition is confirmed or ruled out by the medical professional, other
forms of assessment, such as a referral for psychological testing, could be appropriate.
33. A
While all of these indicators could tell you something about a client's level
of motivation, the most telling factor would be his reason for coming to
therapy. A client who seeks therapy voluntarily ordinarily is more motivated
than one who comes in involuntarily (e.g., at the insistence of a family
member, because he is referred by the courts).
34.
|
B
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You needed to choose the answer
that does not describe a purpose of role-playing. Some role-playing involves
having a client rehearse a behavior that will be useful in an anticipated
situation because it will enable her to achieve a goal or fulfill an
expectation (“a”): The client practices the behavior and receives feedback
from you. When used in this way – i.e., in behavioral rehearsal –
role-playing increases the client’s sense of self-efficacy. Similarly,
modeling through role-play is effective for helping a client learn
vicariously new behavior and reducing her anxieties about performing the
behavior. When you model a behavior, you ask the client to play the role of
the other person involved in the situation, which helps her anticipate that
other person’s behavior. Other role-playing involves having the client
re-experience something from her past by imagining that she is someone else, such
as her mother or father. This form of role-playing increases the client’s
self-awareness and understanding of others (“c” and “d”). By contrast,
role-playing is not used to understand the cause of a client’s social role
ambiguity: “Role ambiguity” occurs when the client has a lack of clarity
about the role expectations associated with one of her social roles and can
result in insecurity and interpersonal conflict.
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35. B. A
classic description of an Histrionic Personality. The need for being the center
of attention and the sexually seductive behaviors are big clues
36. C
Baumrind (1972) identified three types of parenting styles: Authoritarian,
authoritative, and permissive. Authoritative parents combine rational control
with warmth, receptivity, and the encouragement of independence and produce
children who are independent, self-assertive, self-confident, self-controlled,
and content. Authoritarian parents, who impose absolute standards of conduct,
stress obedience, and use force to obtain compliance, are likely to produce
children like those described in response "a." Permissive parents,
who provide their children with few controls or demands and display moderate
levels of warmth, are most likely to produce children like those described in
response "b." No parenting style in particular has been associated
with the set of traits in alternative "d."
37.
|
D
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When working with an involuntary
client who has been mandated to seek therapy, a social worker should open the
first meeting by telling the client the factual information she has about why
he has been referred to her and required to seek professional help. After
sharing this information, the social worker should invite the client to tell
his side of the story. If the client alleges any contradictions in the two
versions of events, the social worker should tell him that she will seek
clarification. A social worker should be aware that a client who has been
forced to seek professional help may have negative feelings about therapy
(“a”), but the question doesn’t describe this client’s feelings. Moreover,
“d” describes the most appropriate way to open the first interview with an
involuntary client. If the client ends up expressing negative feelings,
however, then the social worker should address them directly, using her
interview skills to help the client express his feelings. Ru d set a negative
tone to open the interview this way. Finally, identifying a goal that the
client is motivated to le out “b”: The social worker will inform the client
of the consequences of not cooperating, but it woul work on (“c”) is one
effective strategy for engaging an involuntary client, but this strategy is
more appropriate later on.
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38.
|
D
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|
You needed to consider all of the
information in the stem. While “a” might be a good thing to do at some point,
it doesn’t address the client’s immediate concern. Option “b” seems
unnecessary because the source of the client’s confusion is already apparent.
If the client is interested, this issue could be examined more closely later
but emphasizing it now doesn’t address the client’s primary need in a direct
enough way. In addition, the client’s concerns about having premarital sex
seem to be related directly to his religious faith and training, so there is
no good reason to suspect molestation. “Reassure” is OK, but the rest of
answer “c” sounds judgmental. Option “d,” on the other hand, relates well to
the information we have. The question tells us that most of the client’s
confusion stems from his sense of conflict between his religious training and
strong faith on the one hand and what he sees his peers doing on the other.
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39.
|
B
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Solution-focused therapists
de-emphasize the causes of problems and emphasize helping clients become
“unstuck” and focus on solutions. Stating goals in positive concrete
(behavioral) terms helps the client recognize when he is accomplishing his
goals and is a good predictor of outcome in solution-focused therapy.
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40. D
Erikson identified eight stages of psychosocial development: Oral-sensory,
muscular-anal, locomotor-genital, latency, adolescence, early adulthood, middle
adulthood, and maturity. Each stage involves a different psychosocial conflict.
The anal stage of development occurs during the second year of life. The task
of the anal stage is to achieve muscular control, which leads to the
development of a sense of self-control (autonomy). Failure to gain self-control
causes shame and doubt. Alternative "a" is characteristic of
adolescence; choice "b" is characteristic of the latency stage; and
response "c" is characteristic of the oral-sensory stage.
41. C The
item draws attention to the Social Worker's responsibility to both parents and
also points to issues of "best interest of the child." The outside
expert who knows nothing about either parent and who is responsible to the
court is the cleanest and best way.
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42. C
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You have no option
in this case as it clearly describes physical abuse. You are required to
report. Your best bet is to involve the client in this process and hope you
can keep her engaged in treatment. You are legally
and ethically mandated to report child and abuse and neglect
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43.
|
A
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Retirement produces the loss of a
familiar and often valued social role. For any person, especially one who has
been working for most of her life, retiring can lead to feelings of
depression and social-role functioning problems. The client’s race may also
play a role in this case: African-American individuals tend to be
group-centered and work-and education-oriented and to have strong kinship
bonds (McCollum, 1997). The V-code religious or spiritual problem (“c”) is
tempting, since the woman says that her church work has less meaning than it
did before; her symptoms, however, involve more than just this, and “a” is a
more encompassing choice. Regarding “d,” although depression is possible,
malnutrition is improbable because the woman is eating at least one hot meal
each day at the senior citizen center.
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44. A The
answer is goal-setting; the hallmark of task-centered therapy. This is an
information question.
45 . C The social worker is required to respond to
the subpoena, but is not required to release records since the subpoena was
issued by the attorney and not a judge. Releasing the entire record of the
therapy sessions to the attorney (answer “A”) and releasing only those records
that make direct reference to the wife’s relationship with the son, not her
treatment issues (answer “B”) are both not correct because the subpoena was
issued by the attorney, not a judge. The social worker does not have to respond
to the subpoena because the client’s records are confidential (answer “D”) is
not correct because the social worker does have to respond to subpoenas but can
object to releasing confidential information on the basis of privilege.
46. C
The child appears to be exhibiting stranger anxiety, which typically develops
at 8 months of age and appears to reflect maturation of the infant's perceptual
skills such that he or she is able to distinguish between familiar individuals
and strangers. In terms of test-taking strategy, given the child's age and lack
of information about any other behaviors that might suggest pathology, the most
parsimonious explanation for the child's behavior is stranger anxiety.
47. C The cultural
context presented in this item suggests that answer “c” is correct. When
working with clients from an Hispanic culture, a social worker should be aware
that family welfare is emphasized over individual welfare. Responding to the
client’s disclosure by asking “how much money?” might convey to the client that
the social worker does not approve of his sending his money to his family or
that the social worker’s approval is conditional, depending on the amount of
money he is planning to send.
48. C
The symptom described in the question is listed in DSM as a symptom for both
substance dependence and substance abuse. Specifically, the existence of
physiological or psychological problems caused or exacerbated by use is
characteristic of substance dependence. (A diagnosis of substance dependence
also requires the presence of other symptoms, such as inability to control
substance use, withdrawal symptoms, and/or marked tolerance). By contrast,
social or interpersonal problems caused or exacerbated by use are
characteristic of substance abuse.
49.
|
B
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Supportive therapy (e.g.,
reassurance, advice-giving, mobilizing strengths and resources) is useful
when objective stressors and losses dominate a client’s life. Supportive
treatment may include encouraging and helping the woman to make provisions
for her children (“d”); however, there is no information given in the
question to suggest that this issue must be addressed first (e.g., we don’t
know anything about this woman’s medical prognosis). Referral to a support
group (“a”) would not be the social worker’s first intervention since this
woman appears to be in crisis; it might be appropriate later on, however.
Though the social worker might be able to recommend books about cancer (or
more likely, books about coping with cancer), the social worker would be
practicing beyond the scope of his or her license by giving the woman medical
information about cancer (“c”).
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50. A” - Preaffiliation
(approach-avoidance), Power and Control, Intimacy, Differentiation, and
Separation. The other answer options (answers “B”, “C”, and “D”) do not
describe the “Boston Model” of group work.
51. C
Aversion therapy (usually olfactory aversion) can be an effective form of
treatment for individuals with pedophilia. In this case, however, you are
treating an incestuous family system, not an individual with pedophilia.
Treatments for incest and other forms of parental maltreatment reflect the view
that most child abuse perpetrators are amenable to rehabilitation; their
primary goal is to strengthen and maintain the family system whenever possible
by providing a broad range of relevant services. Treatments for the perpetrator
usually include individual therapy (i.e., for issues of low self-esteem,
feelings of inadequacy or powerlessness, low tolerance for frustration or
stress, poor impulse control, unmet dependency needs, and childhood history of
maltreatment); marital therapy (i.e., to resolve marital conflicts, improve
communication between the parents, explore dependency needs, increase the
parents' ability to gratify each other's needs, help the parents recognize
their respective roles in the maltreatment, and encourage greater reliance on
outside support systems); and/or group therapy.
52. C
When you suspect that a woman is in denial about domestic abuse (but is not in
immediate danger), it is recommended that you focus initially on building a
trusting relationship with her. You should allow her to move past the denial at
her own pace and avoid attempting to break through it using techniques such as
direct confrontation. Forcing her to acknowledge her situation may duplicate
the abuse she has experienced. In addition, she may believe that her very
survival depends on continuing to conceal the abuse, perhaps even from herself.
53.
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C
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The question says the client can
afford to pay but is refusing to do so and that the social worker has tried
to address the client’s reasons for nonpayment. Under these circumstances, a
social worker is ethically allowed to terminate treatment if the client does
not pose a danger to self or others and he has discussed with the client the
potential consequences of nonpayment and termination of treatment. The social
worker also should document his impressions about this situation in the
client’s record.
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54. B
Kubler-Ross's stages, in order, are: Denial, anger, bargaining, depression, and
acceptance. The statement in "b" best reflects denial, the usual
initial response to learning of one's impending death. Alternative
"a" is more characteristic of the second stage (anger). Responses
"c" and "d" best reflect the fourth stage (depression).
55.
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A
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Generally, in the context of an
EAP, information about an employee/client’s condition or treatment should not
be disclosed without the employee/client’s consent. And confidentiality can
also be breached under the same conditions that it can be breached in other
contexts (e.g., danger to self, mandated reports). And, as “a” says, when the
employee/client comes to therapy as the result of a referral by her
supervisor, the supervisor can be given certain limited information: He or
she can be told if the employee/client kept the appointment, whether the
employee/client needs treatment, and whether the employee/client accepted
treatment. The supervisor should not be given any other confidential
information unless the social worker has permission from the employee/client.
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56. D
Neuroleptic (antipsychotic) drugs are used primarily to treat schizophrenia and
other psychotic disorders. Although neuroleptics are sometimes used for acute
aggression, they are not the treatment-of-choice for chronic forms, both
because of their ineffectiveness for this problem and the potential for harmful
side-effects. On the other hand, a neuroleptic is often useful during the acute
phase of mania when the individual is experiencing transient psychotic
symptoms. Tourette's disorder is another disorder that responds favorably to
neuroleptics.
57. C There are lots of clues for Bipolar Disorder,
and it is clearly a manic episode. He is feeling great, but what about the
people around him sees him differently, “irrational”.
58. D
The processes of accommodation and assimilation are critical to Piaget's theory
of cognitive development. These processes enable the child to progress from one
stage to the next. Assimilation involves fitting a new situation or object into
one's existing cognitive structure or schema, and is therefore the correct
answer. Accommodation ("c") occurs when the child modifies his or her
existing schema to fit a new situation or object. Equilibration ("a")
refers to the establishment of a state of equilibrium through a combination of
accommodation and assimilation. To Piaget, people adapt to their environment
through cognitive growth, and such "adaptation" ("b")
involves both assimilation and accommodation.
59. B
Hiring a professional interpreter (with permission from the client) would be
the most effective (and timely) way of facilitating communication with a deaf
client. While the client may have a friend or a family member who can help you
to communicate with her, there is no indication that the client would want a
significant other to be present in her therapy sessions.
60. C
Answer "c" would be the appropriate action with any client.
Some gay/lesbian clients present with concerns that relate in a direct way to
their sexual orientation; more often, however, gay/lesbian clients seek
professional help for reasons that have nothing to do with their sexual
orientation or that are related to it only indirectly. Before formulating
treatment goals and a treatment plan, however, you would need to fully
understand the clients' problem -- this understanding encompasses not only the
way the clients define the problem as they enter treatment, but also any other
issues you uncover during a comprehensive assessment that may affect the
problem, but that the client are not aware of.
61. D
While it is important to respect and honor other cultures' customs and values,
there is a therapeutic issue that needs to be addressed in this case. Response
"d" incorporates being aware of cultural differences, as well as
addressing the relevant clinical issue. You are inviting the family to talk
about their perceptions of time, which would encourage a dialogue, provide you
with important information, and, ideally, offer a way of correcting the problem.
While the awareness mentioned in "a" is an important prerequisite,
answer "a" does not indicate how you would handle this situation.
Although there is some truth to the statement in "b," you do not have
enough information to conclude that this is true for this family; in addition,
"b" does not indicate how you would address the present situation
with the clients. "C" would be premature: If, after talking to the
clients about this issue, you determined that their needs would be better
served by a social worker from their own culture, you could make this referral
at that time.
62. A The
information presented in this question suggests that you need to interpret this
situation within a cultural context. Only answer "a" describes what
may be a typical reaction for an Asian individual. A traditional Asian
individual may have difficulty discussing family matters with an
"outsider" (such as a social worker), especially matters concerning
his parents and other elders. In addition, a traditional Asian individual is likely
to emphasize interdependence and responsibility to the family (rather than
independence and autonomy) and respect for his elders (rather than egalitarian
values).
63. B
Clinical issues that commonly arise when working with elderly clients include finding
meaning in life, developmental issues (e.g., Erikson's integrity vs. despair
stage), coping with changes and loss, unfinished business (coming to terms with
the past and finding meaning in the present, anticipatory loss of one's own
life), and intergenerational issues (e.g., conflict within the family). In this
case, the man is complaining of feeling depressed, isolated, and useless,
suggesting that it would be most useful to help him develop or reestablish a
sense of fulfillment or purpose in his life.
64. D
Although you want a child to feel free to express herself in play therapy, it
is also important to provide structure and set limits so that, for example, the
child does not get hurt. Alternative "c" probably would be
countertherapeutic because the goal of play therapy is to help a child express
her feelings -- the unruliness may be an expression of feelings.
65. C
As its name implies, strategic family therapy involves the use of
"strategies." Of the responses given, alternative "c" is
the best example of the techniques used by a strategic family therapist. The
therapist is assigning the couple a task that will help them face their own
conflicts. The other choices are not characteristic of strategic family
therapy.
66. B An important issue here is whether or not the content of a
dream is enough to constitute a reasonable suspicion of child abuse. You need
to also consider a social worker’s ethical obligation to maintain his or her
client’s confidentiality and provide effective therapy. Option “b” is the best
of the four answers: The social worker needs to create a safe atmosphere where
Jeremy can feel comfortable exploring the meaning of his dream. Because we have
no clear indication that the social worker should suspect actual abuse at this
time (see below), “a” does not address the client’s needs. Rule out “c”: The
client is taking a risk and confessing a dream that is disturbing. Incestual
dreams, similar to homoerotic and sadomasochistic dreams, are not uncommon,
though few people are open to discussing them. Having seen Jeremy for six
months, the social worker would have an idea of whether he has a propensity to
be abusive; the social worker would want to be aware of the possibility that
abuse is taking place, but a dream alone does not raise a reasonable suspicion
of abuse. Although a client-centered approach is appropriate, as “d” suggests,
it would not serve a useful purpose for the social worker to review the limits
of confidentiality right now. Doing so would most likely shut the client down
and hold him back from revealing any more information.
67 D you cannot testify legally and
ethically. Choice a is incorrect. Choice B is Technically correct, but not as
good as choice D. Choice C is incorrect.
68. A
The goal of "prescribing the symptom," a paradoxical technique, is to
help family members change their dysfunctional rules. Choice "a"
describes the purpose of prescribing the symptom, which involves asking the
family to continue or even exaggerate what it is doing in order to undermine
the family's resistance to changing that behavior. Alternative "b" is
a better description of the technique known as "relabeling." Response
"c" is simply another way of stating alternative "b" and,
therefore, is a better description of the technique known as relabeling.
Alternative "d" is the goal of Bowenian family therapy, which does
not typically use prescribing the symptom as a therapeutic technique.
69. B. This
is the best answer offered. Play therapy would enable the social worker to
explore the problem and what might underlie it, including potential child
abuse, in a relatively relaxed and non threatening setting using materials that
are famililar to the the boy. A,C,D involves direct questioning or confronting
the boy or his mother about sexual abuse would be less appropriate for several
reasons. First, the social worker has a relatively small amount of information
(only one indicator) to support a suspicion of child abuse in this case.
Second, even if the social worker had good reason to suspect child abuse, the
assessment approaches listed in these answers are not recommended ; e.g open
ended questions tend to be more effective than close-ended questions when
assessing child maltreatment problems. Third a therapist must prepare a child
(e.g., develop rapport with him) before raising the topic of child abuse with
him.
70 D”- Neglect. While neglect is not
often thought of as abuse, neglect is the most commonly reported type of elder
abuse. Verbal abuse (answer “A”), emotional abuse (answer “B”), and physical
abuse (answer “C") are incorrect answers. While verbal, emotional, and
physical abuse are all possible forms of elder abuse, neglect is the type of
elder abuse that is most commonly reported.
71 D”
- Solution-Focused. The “miracle question” often serves as a catalyst for the
client to construct a more concrete vision of a preferred future for himself.
Psychoanalytic (answer “A”), Humanistic (answer “B”), and Task-Oriented (answer
“C”) are all incorrect answers because the technique described in this scenario
is not strongly associated with these other therapies.
72. C
To answer this question, you must recognize that the client has multiple
problems; therefore the first step, before recommending any form of treatment,
is to partialize, or set priorities, with the client. Alternative "c"
(but not "a") indicates that the social worker would encourage the
client to participate in determining which problem they will deal with first.
73.
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B
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The Education for All Handicapped
Children Act of 1975 (P.L. 94-142), which is now codified as the Individuals
With Disabilities Education Act (IDEA) of 1990 (P.L. 101-474), requires that
each identified child with a disability be evaluated and provided with an
educational plan to meet his or her unique needs. This plan must be developed
before the child is placed in any educational program. The overriding purpose
of the law was to guarantee that all school children with special needs would
receive an appropriate free public education, and a key feature of the
Individualized Educational Plans (IEPs) required by this law is that a
student’s plan must provide him or her with the “least restrictive
environment” at school. Parents, teachers, and school counselors are members
of a child’s Individualized Educational Plan (IEP) team, and parents and
teachers can appeal decisions regarding the best classroom placement for the
child; the final decision on this matter, however, is made by the local
school committee.
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74.
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A
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It sounds as though this client
might be having panic attacks. Before concluding this, however, it is
necessary to rule out a medical illness underlying the symptoms. Symptoms of
hyperthyroidism include excitability, nervousness, confusion, higher
metabolism, body temperature, and heart rate, increased appetite with weight
loss, fatigue, and insomnia. Untreated diabetes mellitus (“c”) is associated
with apathy, confusion, and mental dullness, increased appetite with weight
loss, polyuria, polydipsia, and increased vulnerability to infection.
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75. D
This question is about narrative therapy, a post-modern approach in which the
therapist collaborates with clients to construct a new "story" about
their experience; the new story is presumed to offer greater opportunities for
growth and solutions than the versions the clients are currently locked into.
Narrative therapists believe that objective reality cannot be known (i.e., all
"knowing" requires interpretation) and that the meaning people
attribute to events in their lives determines their behavior. Narrative therapists
help clients to identify "unstoried" parts of their experience
("unique outcomes") and then to develop new meanings around these
outcomes. The initial step is to separate clients from the problem: This
entails "externalizing" (objectifying) the problem and then
"mapping" its influence in the clients' lives and relationships. Each
client's description of the problem and its effects is considered
"privileged"; i.e., while family members may have common definitions
of problems, each client is presumed to experience a problem and its effects in
a unique way. Answers "a," "b," and "c" are more
straightforward, information-gathering questions, which might be asked in any
standard assessment situation. Answer "d," on the other hand, implies
that each family member's unique experience of the problem is important.
76. C Option “c” is the best answer to this question: American
Indians tend to be more comfortable with an indirect gaze both when listening
and when speaking to other people, including their therapists. Option “d” is
the second best answer: Asian individuals do tend to avoid direct eye contact
when listening and speaking to certain individuals, including high-status
people or those in positions of authority; this preference may carry over into the
treatment setting. Among Caucasians (“a”), it is considered respectful to use
direct eye contact when both listening and speaking. And, although
African-American individuals (“b”) tend to avoid direct eye contact when
listening, they usually prefer to make eye contact when speaking (D. Sue et
al., “Counseling the Culturally Different,” John Wiley & Sons, New York, p.
79, 1999).
77. A
Ellis's RET assumes that irrational ways of thinking underlie dysfunctional
behaviors. Alternative "b" (dysfunctional behaviors are the result of
incongruence between self and experience) is the underlying premise of Rogers's
client-centered therapy. Alternative "c" is not the best response
given because, although RET views irrational thoughts as determiners of dysfunctional
behaviors, the notion of "automatic thoughts" is more characteristic
of Beck's theory of and treatment for depression. Response "d"
(dysfunctional behaviors are the result of a lack of "awareness") is
the underlying premise of Perls's gestalt therapy.
78. A
Minuchin's structural approach to family therapy regards dysfunctional families
as being either "enmeshed" or "disengaged." In an enmeshed
family, boundaries between family members and subsystems are too diffuse so
that family members are overly dependent and close; in a disengaged family,
boundaries are overly rigid so that family members are too isolated from one
another. Minuchin's structural family therapy can be characterized as
"manipulative, unyielding, and crisis provoking" (Goldenberg &
Goldenberg, 1985). It uses a number of techniques to restructure a family's
transactional patterns including marking boundaries, escalating stress,
utilizing symptoms, and manipulating mood. When using the latter technique, the
therapist might imitate, in an exaggerated way, the family's style in order to
point out their dysfunctional patterns. One criticism of Minuchin's approach is
that it does not emphasize fostering insight and understanding; therefore,
alternative "b" is incorrect. The genogram ("c") was developed
by Bowen and is used primarily by family systems (Bowenian) therapists in order
to clarify a family's multigenerational relationship systems. The therapeutic
double-bind ("d") was an outgrowth of research on the pathological
double-bind conducted by Don Jackson and his colleagues, and is used primarily
by communications family therapists.
79. D
Yalom views conflict in group therapy as a natural phenomenon and considers it
to be a useful therapeutic tool if handled correctly. According to Yalom, the
therapeutic use of conflict in group therapy involves two stages: Experience
(affective expression) and understanding of that experience.
80. B Choice
"b" is the best answer by process of elimination. With any client who
has been raped, you should emphasize listening and providing emotional support,
but this intervention is not listed among the alternative answers. Certain
medical and legal procedures also should be carried out after a rape (e.g.,
medical care, gathering of evidence for possible prosecution). While these
procedures should not be emphasized at the expense of providing the client with
emotional support, it is appropriate to help this woman explore her resources,
including the importance of seeking medical attention (e.g., she may have
sustained injuries or been exposed to a sexually-transmitted disease). Rape is
not a mandated report, unless the victim is a minor. Therefore, you could not
call the police ("a") without permission from your client. Moreover,
she has said that, at this point, she does not want to press charges.
"C" is not appropriate, since you should not probe for details about
the rape; you should allow the client to reveal these at her own pace. Last,
even if the woman wanted you to speak with her husband, contacting him
("d") would not be your first intervention. Moreover, it is not your
role to remind clients or their family members about their "community
responsibility."
81.
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C
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The only appropriate answer is “c”
since the social worker no longer owns this apartment. Answers “a” and “b”
reflect dual relationships that might end up harming or exploiting the
client, and “d” suggests that the social worker would recommend a living
situation that does not meet a basic need this client might have — he is
described as “low-income,” suggesting that it would be important for him to
have access to public transportation.
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82. B
The answer is having the parents work through the disagreement in an
appropriate manner. What created the anger is not nearly as important as
learning to resolve conflicts in appropriate ways. The tendency of these
parents to vent their anger has gotten them into trouble in the first place.
Insisting that the parent stop arguing does not help him or her to learn
appropriate ways of resolving differences.
83. B Process Recording is a system for recording social worker-client
interactions over the course of treatment. Contrary to “a,” it does not require
verbatim documentation of worker-client interactions. Instead, the case record
begins with “face-sheet” factual information about the client and relevant
social, physical, and economic data. A description of the presenting problem
follows, including all data the worker has collected about the client’s
problem. The record then contains the worker’s description of therapy
objectives, obstacles to achieving the objectives, means to reaching them, and,
when relevant, a contract signed by the worker and client. Next, the record
contains entries for each contact the client makes with the worker and agency,
including not only face-to-face contacts, but also telephone contacts and
contacts with family members. These entries include the date and time of the
contact and a summary of the information obtained, including any subjective
impressions derived by the social worker.
84. C
In Transactional Analysis (TA), "scripts" are the life plans that
people live by; they result primarily from early messages and injunctions the
child gets from his or her parents. "Games" are recurring transaction
83. B Process recordin s between people that have a
concealed motive. An initial process in TA is the identification of a client's
life scripts and the "games he or she plays" that maintain those
scripts.
85. B
According to Murray Bowen, a high degree of fusion (emotional "stuck
togetherness") is the source of family dysfunction. The goal of Bowen's
form of family therapy, therefore, is to help family members become less fused,
or more differentiated (individuated). In contrast to many other family
therapists, Bowen's form of therapy typically does not involve seeing all of
the family members. Instead, Bowen often worked with the most differentiated
family member on the assumption that, when that member changed in a positive
way, his or her change would motivate other family members to move toward
greater differentiation. Alternative "a" is the opposite of the
correct answer; as noted, followers of Bowen would likely work first with the most
differentiated family member. Alternative "c" is incorrect because,
in contrast to many other family therapists, Bowen typically worked with the
two most significant adult family members, usually the parents, or the parent
who was the most differentiated, even when the "identified patient"
was a child. Alternative "d" is not a technique used by Bowen.
86. A
In order to make a recommendation based on current and complete information,
you should have the child retested to see if special education is appropriate.
If you determine that it is, additional follow-up actions might be required
given the nature of the situation. Therefore, alternative "a" is the
best response of those given. Alternative "b" is incorrect because
the student's welfare is of greatest importance in this situation, and
referring the teacher for therapy would not provide a rapid solution to the
problem. Response "c" is incorrect because previous test results may
not be an accurate indication of the child's current needs. Alternative
"d" assumes that the principal and teacher are acting
inappropriately; however it is possible that their objections are well-founded
(i.e., the student may not need to be placed in a special education class).
87. B
This question should have been fairly simple. The names of the defense
mechanisms act as a clue to their manifestations. Choice "b" is an
example of projection, not displacement. Displacement involves shifting an
undesirable impulse to a more acceptable and less threatening object. Reaction
formation involves warding off an undesirable impulse by overemphasizing its
opposite. Sublimation involves altering unacceptable impulses by channeling
them into acceptable, even admirable, behaviors. Regression is what it sounds
like -- a return to an earlier stage of development.
88. D The
various cognitive therapies emphasize the importance of cognitive processes as determinants
of behavior. They assume that behavior and emotions result largely from one's
appraisal of a situation, and that, because one's appraisal is influenced by
beliefs, assumptions, images, and self-talk, these cognitions should be the
targets of therapy. Compared to other forms of therapy, cognitive therapy more
directly challenges the client's faulty assumptions, beliefs, and thoughts.
Delusions are false beliefs that cannot be corrected by reasoning and that are
not consistent with the client's intelligence or cultural background.
Cognitive-restructuring techniques can sometimes be effective for delusions;
cognitive-retraining techniques, however, should be used only after the
therapeutic alliance is strong enough for you to question and challenge the
client's faulty beliefs.
89 “C” - Alan likely has Encopresis.
Encopresis is a pattern of expelling feces into places deemed inappropriate and
would therefore not apply in this situation. To make a diagnosis of Enuresis,
which is a specific Elimination Disorder, a child must have reached the
chronological or developmental age of five. Inappropriate urination must occur
at least twice a week for three months or the frequency of inappropriate
urination must cause significant distress and interfere with the child’s school
or social life. Finally, the behavior cannot be caused exclusively by a medical
condition or as a side effect of medication. The other three answer options
(answers “A,” “B,” and “D”) are all true statements regarding Alan’s situation,
and the question asks which answer option is NOT a true statement. Because
stressful life factors could also affect bed wetting, the social worker should
continue to assess the situation in considering other factors.
90. C
Research suggests that only one in ten cases of spouse abuse is reported and
that, in therapy, few couples "present themselves to the therapist with
abuse as the presenting problem" (Mack, 1989). Because directly
confronting couples about abuse may elicit denial, a more indirect approach is
preferred. As noted by Mack, this approach "is not accusatory and does not
immediately focus on abuse, but provides an opening for the therapist should
the data gathered point in the direction of abuse" (p. 199). Alternative
"d" would be the next step after abuse has been revealed. The first
goal in treatment in cases of spouse abuse is to the stop the abuse, and a
"no-violence contract" has been found helpful for achieving this
goal. Alternative "a" is incorrect because the issue of abuse must be
identified and dealt with early in treatment to ensure that it is stopped as
soon as possible. Thus, waiting for the husband or wife to bring up the issue
of abuse would not be considered appropriate in conjoint therapy or any other
type of therapy. Alternative "b" is incorrect because, although some
conjoint therapists do see husbands and wives individually, especially during
the initial sessions of therapy, conjoint therapy usually involves seeing both
parties (not just the wife). In addition, while most experts do recommend
individual, rather than conjoint, therapy in cases of spouse abuse, so far in
this situation, you have yet to confirm the existence of spouse abuse.
91. B
In this situation, the child's behavior is increasing following the parents'
intervention; in other words, the child is being reinforced. Reinforcement, by
definition, increases a behavior. This is positive reinforcement, not (as in
choice "c") negative reinforcement. Negative reinforcement involves
the removal of a stimulus; here, a stimulus is being applied.
92. D Reinforcement
involves applying or removing a stimulus in order to increase a behavior, while
punishment involves applying or removing a stimulus in order to decrease a
behavior. Alternative "a" is incorrect because both reinforcement and
punishment involve stimuli and responses. Although reinforcement and punishment
are often associated with, respectively, pleasant and unpleasant stimuli, from
a strict behavioral point of view, the distinction in alternative "b"
is incorrect. As noted above, reinforcement and punishment can both involve
either the application or removal of a stimulus, so the distinction in response
"c" is also incorrect.
93. C
This child had problems with attachment related to her home situation
(neglect of all sorts), and it is clear from her behavior that she is
disinhibited (the excessive familiarity with strangers).
94. C
During the termination phase of therapy some clients (even those for whom
treatment has been successful) experience the loss of support from the
therapeutic relationship as uncomfortable. This may produce a regression or a
reappearance of the presenting symptoms ("flight into illness"). In
psychodynamic terms, this would be viewed as a defense mechanism. Freud
believed that anxiety serves to alert the ego to danger, including danger
arising from a conflict between the id's impulses and the demands of reality or
the superego and danger arising from an actual threat in the environment. When
the ego cannot ward off danger using rational, realistic means, it may use one
its defense mechanisms. The defense mechanisms function to defend against
unacceptable unconscious impulses or drives (i.e., to keep them from reaching
awareness).
95.
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B
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Partners of rape victims often have
conflicted feelings. Being in a group with others facing a similar situation
would help this client feel normal and reduce his sense of isolation. The
wife may have too many individual issues to be available for couples therapy,
so “d” is a poorer choice. Answer “a” is appropriate, but “b” responds more
directly to the client’s expressed needs. In the context of this question,
which asks for the best approach to treatment, “c” is a poor choice because
it doesn’t describe what kind of treatment you would offer this man.
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.
96. B The client has lost functioning in his hand and the
physician has been unable to find a biological cause. Conversion disorder
involves a symptom or deficit that affects voluntary motor or sensory function,
cannot be fully explained by a general medical condition, the effects of a
substance, or another mental disorder, and is not produced voluntarily or
controlled by the patient. Instead, the symptom or deficit is presumed to be
related to psychological factors – in this case, probably the fact that the man
killed people when he fired a gun with this hand. Rule out “a” and “d” because
we have no evidence that the client is intentionally producing or faking his
symptom: In factitious disorder, the patient intentionally produces or
simulates physical or psychological symptoms out of an intrapsychic need to
adopt the “sick” (patient) role; and in malingering, the patient deliberately
fakes or exaggerates a symptom in order to avoid a responsibility or obtain an
external reward. And although PTSD (“c”) is often associated with having been
in combat, this client has no signs of PTSD (e.g., no anxiety, no
re-experiencing of events from the war).
97. D
Rogerian therapists tend to de-emphasize both diagnosis and assessment. They
usually reject diagnosis on the ground that it places the therapist in a
superior, authoritarian role that can impede the development of autonomy and
self-actualization in the client.
98.
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B
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The parents want help placing their
son in a psychiatric hospital, apparently because he is gay. Option “b” is
the best answer because it directly addresses the parents’ presenting
concern. The social worker would want to educate them about the purposes and
appropriate uses of psychiatric hospitalization, discuss homosexuality with
them, and explore and allow them to vent their feelings. Option “a” omits any
mention of the parents’ feelings, which seem to need the social worker’s
attention. The referral in option “d” is premature, given the parents’
current strong feelings; in addition, “d” fails to address their desire to
hospitalize the boy. Option “c” is clearly incorrect, because there is no
good reason to believe that this boy is simply passing through an
“experimental phase.”
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99.
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A
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This question required clinical
reasoning. The client (who is depressed but not a danger to himself) has been
seeing the social worker for five months without progress and has refused
repeatedly to see a psychiatrist for a medication evaluation, even though
doing so might help him. It’s possible that he is not ready to change or that
this social worker is not the right therapist for him. Therefore, discussing
termination and referral is consistent with a social worker’s ethical
obligation to discontinue treatment when it’s clear that a client is not
benefitting from his or her services. Because the social worker also has an
obligation to respect a client’s right to and need for self-determination,
the social worker cannot force this man to see a psychiatrist; however, this
does not mean that the social worker should simply continue to treat the
client as before (“d”), since he doesn’t appear to be benefitting from the
social worker’s services. And, we can rule out inpatient treatment (“b”)
because the question says that the man does not pose any danger to himself at
this time.
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100. C
Knowing that cognitive therapists emphasize the identification and replacement
of dysfunctional cognitions would have helped you select the correct answer to
this question. Alternatives "a" and "b" are more
characteristic of Bandura's approach, which incorporates cognitive techniques
but is not a typical example of cognitive therapy. Bandura's treatment goal is
to increase a client's self-efficacy beliefs, which is not a technique
characteristic of cognitive therapy. Response "d" is also not
characteristic of the cognitive approach.
101. B
Minuchin's structural family therapy is based on systems theory and views a
family member's symptom as a factor that helps maintain the family's
homeostasis. A primary goal of therapy is to disrupt the family's homeostasis
in order to help the family change their dysfunctional patterns. Alternative
"a" is incorrect because Minuchin and his followers typically join
with the family by imitating its manner, affective style, and communication patterns.
Minuchin and his followers do just the opposite of alternative "c";
i.e., they encourage confrontation in order to disrupt the family's current
homeostasis. Response "d" is a characteristic of Murray Bowen's
approach to family therapy, not Minuchin's.
102. B A social worker must consider relevant cultural/religious
differences when evaluating whether her clients’ behavior constitutes child
abuse or neglect. Due to the severity of this boy’s medical condition, however,
his parents’ unwillingness to follow the doctor’s urgent treatment
recommendation would be considered a form child endangerment, or neglect of his
medical needs.
103. B
In gestalt therapy, the primary goals are increased awareness and integration
of all aspects of the personality. That is, a primary goal of gestalt therapy
is to integrate all aspects of the self; i.e., all aspects of the mind and
body. Alternative "a" is incorrect because, in gestalt therapy, the
focus is on the present. In fact, Perls argued that nothing exists but the
"now." Response "c" is the goal of Reality Therapy.
Alternative "d" is not a goal of gestalt therapy. In fact,
internalization of the external is viewed as a potential source of pathology by
gestalt therapists.
104. D
Minuchin distinguishes between two types of disturbed boundaries: Enmeshed and
disengaged. In disengaged families, there is a lack of emotional involvement.
Family members not only avoid expressions of love and concern toward one
another but also avoid conflicts and the expression of anger. When family
members are enmeshed, they are overly involved with one another, so alternative
"a" would be characteristic of an enmeshed family. Disengagement
entails a lack of involvement, so response "b" would be
characteristic of a disengaged family. Alternative "c" is incorrect
because one benefit of enmeshment is that family members may receive a great
deal of attention and concern.
105. C
In his book, "The Theory and Practice of Group Therapy," Yalom (1985)
identifies the types of people who are and are not likely to benefit from group
therapy. He argues that heterogeneous outpatient groups are inappropriate for
sociopaths (although they may benefit from homogeneous groups in inpatient and
other controlled settings). According to Yalom, a person suffering from anhedonia
or a workaholic is a good candidate for group therapy. He also believes that
disorders related to social interactions are amenable to group therapy.
106. D
Both legally and ethically, you must take reasonable steps to prevent a
threatened suicide by a client. To determine what these "reasonable
steps" should be, you should evaluate the degree of risk posed by the
client and determine the client's ability and willingness to comply with your
recommendations. Mobilizing the support system is a reasonable step with a
client expressing suicidal ideation. For example, you might suggest that the
client temporarily stay with friends or relatives, arrange to see the client
more often, and have the client touch base with you over the phone at regular
intervals. In addition to providing support, family members or friends can also
be a source of logistical help, by keeping an eye on the client and/or removing
all weapons from the client's home. (Though not mentioned in the answers, this
intervention should also entail developing a no-suicide contract in which the
client promises not to kill himself or herself for a specified period of time
and promises to contact you or a suicide hotline whenever he or she feels an
impulse to commit suicide.) Calling the parents ("c") is just one way
of mobilizing a client's support system, so "d" is a better answer.
If this client has unresolved anger, "b" might be an appropriate
long-term treatment goal, but it is not a first intervention with a suicidal
client.
107. C Negative
reinforcement occurs when the removal of a stimulus following a response increases
the occurrence of that response. In the situation in choice "c,"
restrictions are removed following a behavior in order to increase the
behavior. Alternatives "a" and "d" are examples of negative
punishment; i.e., something is being taken away following a behavior apparently
in order to decrease the behavior. Response "b" is an example
of positive reinforcement
108.
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B
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The first thing to do is assess why
the boy is interested in this information. Answers “a” and “d” would violate
the boy’s confidentiality, unless he had given the social worker permission
to discuss this matter with his biological family or foster parents. It might
be perfectly appropriate for the social worker to help the boy attain the
information he wants (“c”), but first the social worker should discuss the
boy’s interest with him as a means of increasing the boy’s self-awareness and
the social worker’s understanding of him and his needs.
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109.
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B
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The focus of the court’s inquiry in
this case is on the assessment of problematic alcohol use (not antisocial
conduct, which is mentioned in “c”); also, individuals are at higher risk for
alcohol abuse/dependence when they have a family history of this problem. A
genogram can be used to identify behavioral patterns in a client’s immediate
family, including whether or not other family members have or have had
substance use disorders. Although constructing the genogram would require the
client to remember aspects of his childhood, assessing long-term memory (“a”)
is not a purpose of this assessment tool — e.g., a client’s “inability” to
remember information about his family could be due to resistance, rather than
memory deficits. Similarly, while the social worker is likely to assess the
effects of alcohol use on this client’s interpersonal functioning (“d”), a
genogram is not used for this purpose.
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110. A
According to Freud, the defense mechanism "projection" involves
attributing one's own unacceptable impulses to another person. Answer
"b" is generally correct, but it is a layperson's description of what
is happening. Rule out "c" because the man's desire is conscious
(expressed), rather than unconscious. According to Freud, Oedipal feelings
("d") refer to a young boy's erotic interest in his mother and
resulting feelings of rivalry toward his father.
111. A
In group therapy, resistances can take several forms and occur most often in
the early-middle stage of therapy when members try to establish their preferred
position in the group. By definition, resistances are covert efforts to
undermine change; thus, they are best handled by being brought out into the
open. Discussions should focus on the here-and-now and deal with what the
resistances imply. Alternative "b" is wrong because, while the
developmental process of the group might be of interest to some members, this
approach would do little, if anything, to deal with resistances. The strategy
in alternative "c" would probably engender resistances in greater number
and intensity. Response "d" is incorrect because capitulation to
resistances amounts to reinforcement of them and is likely to increase their
occurrence.
112. A A
social worker is ethically required to take reasonable steps to prevent the
suicide of a client, and only answer "a" describes an appropriate way
of doing so in this case. These "reasonable steps" are determined by
the level of risk posed by the client. In this case, the client is depressed
and has a detailed suicide plan, suggesting a high level of risk. If you
believe that a client is a high risk to himself and he refuses less aggressive
means of protective intervention (e.g., voluntary hospitalization), you need to
take more aggressive protective steps, such as initiating involuntary hospitalization.
Answers "b" and "c" might be appropriate interventions for
a client who is at less risk for harming himself.
113. B is the best answer, hopefully, you have
already discussed options and your response with Martha should you be in a
similar situation. Choice A is incorrect. Choice C is partially correct. You
cannot legally even acknowledge that you know Martha to Mrs. Jones, much less
give her any information. Choice D is incorrect .
114.
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B
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The social worker’s “next” step is
to complete the biopsychosocial assessment of this client. The question
describes two components of a comprehensive biopsychosocial assessment –
“psycho” and “social.” Answer “b” describes the third component – “bio.”
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115. C.
You have to know your medications, Depakote is one of the major ones.
116.
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B
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In general, treatments that target
the individual (e.g., pharmacotherapy, individual therapy) are insufficient
in treating conduct disordered children, and most approaches emphasize parent
training and other techniques that target the family, the school, and the
community. Parent training is often combined with operant techniques at home
and at school.
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117. B
In this case, the social worker’s client is the
child, and the purpose of the home visit was likely to collect information to
facilitate his work with the child. The social worker has apparently discovered
some disturbing information that probably affects the child, as well. However,
given the mother’s obvious reluctance to talk about the problem, the best action
would be to continue helping her child. Doing so would allow the social worker
to build a relationship with the mother and, after a while, she might come to
trust the social worker. Although the action in “a” might protect the mother
and child, it is not appropriate because it states that the social worker would
call the shelter, and would do so despite the mother’s reluctance to bring the
abuse out into the open at this time. (A good answer would have been that the
social worker should give the mother information about shelters, but we’re not
offered that choice.) Option “d” is not best choice because the woman may feel
threatened or alienated if the social worker confronts her. If the social
believed that there was imminent danger, then he could be more active in
encouraging the woman to acknowledge the abuse, but otherwise, a therapist
should usually avoid confronting a battered woman with the “reality” of her
situation because she may feel that this replicates the abuse by her husband.
And, because the question clearly indicates that the mother is reluctant to
admit she is being abused at this time, “c” could also alienate her, so that
the social worker might never be able to help the family.
118. B
Option “b” is “most” likely to be true. First, as “b”
says, these clients may not view the man’s alcohol use as a problem, even if
the social worker does. Substance abuse is one of the most significant problems
faced by American Indians, and experts (e.g., Sue & Sue, 1999; Manson,
Tatum & Dinges, 1982) have attempted to explain this in a number of
different ways. Many of these explanations reflect a view of alcohol use that
probably differs from the one this social worker has – e.g., among American
Indians, refusing a drink offered by someone else is viewed as an act of
personal autonomy that disrupts group harmony; drinking alcohol is a social
event; and drinking alcohol is an accepted practice and is encouraged among
family members. In addition, alcohol use may allow American Indian individuals
to release feelings that are otherwise kept under control (e.g., frustration,
boredom). Second, Sue and Sue (1999) say that when working with American Indian
clients, therapists often need to address the clients’ basic needs first, such
as problems stemming from poverty (e.g., inadequate food, shelter, child care,
or employment). This is recommended, in part, because many traditional American
Indians are more oriented to the present than the future. Clients who are
oriented to the present tend to prefer interventions that work in the here and
now.
119. D
This is the best answer offered. There is no information given about where the
father is living and the question does not indicate that you have had an
opportunity to observe or evaluate him yourself. Before advising the children
about whether or not their father needs to be placed in an independent living
facility or recommending any other services, you would need more information
about his level of daily functioning. Because the children are your clients,
not the father, you do not have permission to do an in-home assessment at this
time; you could, however, suggest to the children that this would be the best
way for you to gain an understanding of their situation and determine the best
way to help them. You might then be able to attain permission to evaluate the
father. Giving the children literature on independent living facilities
("a") suggests that you agree with their decision and, given what we
know about the father, such a decision would seem to be premature. There is no
information given that would lead you to conclude that the father needs a
guardian ("b").
120.C Therapy groups may be either “closed” or “open.” Closed
groups begin and end with the same members and usually have a preset
termination date. Open groups permit members to join and leave the group at
different times. Some authors also identify open groups as those without a set
number of sessions or a preset termination date.
121. C
This is pretty straightforward. The boy's welfare is your first concern, and
you'd want to make sure that he is not at risk for suicide. Suicide threats and
ideation should always be taken seriously. Before notifying his parents,
however, you'd want to determine how serious his thoughts about suicide are.
122. C
This is essentially a "common sense" question. Obviously you can't
force a client to continue seeing you, but you should discuss your reservations
about his termination. If you believe it would not be good for the client to
quit at this time, you should discuss this with him. If he still wants to
leave, then you'd want to assure him that he can come back and/or give him
appropriate referrals.
123. A
Respite services would provide temporary care for the children, thereby
allowing the woman to pursue other activities to improve her situation
(including, for example, vocational training or a support group). Note that
there is no information given to suggest that the woman needs to attend a
parenting class.
124. D The incorrect answers are not bad interventions, but the
social worker’s priority is to prevent the girl from having any more contact
with this man, and “d” would be the most direct and effective way of attempting
to do this. When a social worker believes that a child is being persistently
pursued by an adult over the Internet, he should encourage the child and her
parents to report the situation to the police or the FBI (the FBI has a task
force that investigates cases of child abuse over the Internet). If this girl
said that she didn’t want the social worker to tell her parents about her
“friendship” with this man, the social worker would be justified in breaking
her confidentiality because doing so appears necessary to protect her. The
social worker should tell the girl that he needs to discuss this situation with
her parents; and with the parents he should discuss the option of notifying the
police. He should also talk with the parents about how to monitor the girl’s
use of the Internet more closely and how to better control the content she can
access when she’s online..
125. A
The problem-solving model emphasizes deficiencies in the client's
problem-solving skills; specifically, a lack of motivation, capacity, and/or
opportunity to solve a problem. Alternative "b" is incorrect because any
social worker might modify a client's environment; this goal it is not
specifically associated with the problem-solving model. Alternative
"c," an emphasis on modifying the person-in-situation system, is
associated primarily with the psychosocial model. Alternative "d"
sounds more like the functional model, which emphasizes the individual's
potential for growth.
126. A
Of the available responses, only alternative "a" suggests a way of
providing the client with an adjunct to psychotherapy that might improve her
depression (presumably the psychiatrist would conduct a medication evaluation).
In other words, the client may progress if the social worker modifies the
treatment plan. Nevertheless, this question is difficult because, probably, the
social worker should have recognized before now that the client might profit
from taking medication. However, the other two likely alternatives
("c" and "d") are even more clearly components of the
initial phase of helping with a depressed client (i.e., they would have enabled
the social worker to determine a diagnosis). Answer "b" is incorrect
because it suggests that the lack of progress is just the client's fault. In
this context, it is better for the social worker to attempt to provide the
client with additional and possibly more effective modes of treatment.
127. D The
process illustrated in the question is homeostasis, which describes the
tendency for a system to react in a way that will re-establish the "status
quo" in the event of change. Family therapists predict that families will
make systematic efforts to restore equilibrium when their balance is disturbed
or threatened. Therefore, when a "sick" family member gets better,
another family member may develop symptoms to restore balance in the system.
Complementarity ("a") is said to exist when the tendency of one
person in a relationship enhances the tendency of the other person; e.g., when
a wife's dominance increases her husband's submissiveness. Wholeness
("b") is also a property of systems. It states that every part of a
system is so related to the other parts that change in one part will
automatically cause change in the other parts and in the whole system. In this
situation, change in one part of the system (the alcoholic) has led to change
in one family member. not the entire system. Equifinality ("c"),
which is also a general systems concept, predicts that dissimilar causes can
produce the same results.
128. C
With few variations, crisis intervention is a well-defined form of treatment in
which a therapist applies the same principles, regardless of his or her
theoretical orientation. The therapist is directive and does not allow the
client to select from a variety of treatment alternatives.
129. B
The most pressing issue described in this question is the women's recently
emerging difficulties with performing activities of daily living. Homemaker
services are designed to help individuals remain in their own homes; they
assist with daily living chores (preparing meals, cleaning, etc.) and provide
transportation and some nursing services. The referrals in "a" and
"d" may be given, as well, to broaden the women's support network
but, from a "safety" standpoint, the resource "b" is more
important.
130. D
Only the intervention in "d" would enable the social worker to
evaluate and begin to address the man's immediate needs and emotional state in
a timely manner.
131. A
The stem does not specify the nature of the client's question. In general,
however, the best approach would be to have the client bring the issue up in
front of the group. In the first stage of group therapy, the members tend to
look to the group leader to answer their questions and to interact with one
another in only limited ways. Encouraging the member to bring his question up
during a group meeting would facilitate the development of group cohesion and
functional behavioral norms.
132. D
Unlike classical (i.e., Freudian) psychoanalysis, in which past experience is
emphasized, ego psychology focuses on current problems. The other available
responses are characteristics of classical psychoanalysis. Specifically: 1.
Freud emphasized transference in therapy, while the ego analysts relied less on
transference and more on offering the client opportunities for reparenting and
building more adaptive defenses. 2. Freudian personality theory (which is the
basis for classical psychoanalysis) focuses on the role of the id (sexual
impulses) in the formation of personality, while ego psychology focuses on the
impact of the ego. 3. While Freud conceptualized maladaptive behavior as due to
intrapsychic forces, the ego analysts considered that maladaptive behavior
results when the ego loses its autonomy from the id or from reality. When this
occurs, behavior is no longer under the individual's conscious control.
133.A Children generally begin
to understand the concept of death between the ages of 7 and 9 years, and the
concrete operational stage (Piaget) occurs between the ages of 7 and 12 years.
The preoperational stage (“d”) occurs between 2 and 7 years; Freud’s phallic
stage (“c”) occurs from 3 to 6 years and the genital stage (“b”) begins after
puberty.
134. D
In most situations, a therapist will want to get an informed consent before
providing professional services. The need for an informed consent is not waived
when a treatment is court-ordered (e.g., when it is a condition of probation or
parole). Alternative "a" is incorrect because, in some emergency
situations, it is not feasible or necessary to get an informed consent (e.g.,
when a client is having a psychotic episode and must be hospitalized
immediately for his or her own protection). Alternative "b" is
incorrect because competence to understand information about a procedure and
its possible consequences is a condition for a truly informed consent. When an
individual is not competent, his or her assent (rather than consent) should be
obtained. Response "c" is incorrect because a client can, of course,
waive his or her right to informed consent (but should be warned of the
consequences of doing so).
135. A
The incorrect answers are too limited. According to
Barker (“The Social Work Dictionary,” 5th Ed., 2003), permanency planning is,
“... a systematic effort to provide long-term continuity in dependent
children’s care as an alternative to temporary foster care placements.” Efforts
associated with permanency planning include facilitating adoptions (“d”),
establishing clear guidelines for remaining in foster care, and helping
biological families become capable of meeting their children’s needs (“c”).
Workers attempt to prevent out-of-home placement whenever possible and to
restore families if a child has been removed from his or her parents’ home.
They also apply guidelines designed to improve out-of-home placements (“b”),
such as placing a child in the least restrictive, most family-like, setting
available and as close to his or her parents’ home as possible. The placement
setting should also be consistent with the child’s best interests and should
meet any special needs the child has..
136. B
The best answer offered is "b." A social worker should consider
cultural/religious differences when assessing whether or not a parent's
behavior constitutes child maltreatment. Due to the severity of the boy's
medical condition, however, his parents' unwillingness to follow the doctor's
urgent recommendation would be considered a form child endangerment or neglect
of his medical needs. Answers "a" and "c" might be good
choices if this were not a medical emergency.
137. B
A social worker is legally and ethically required to make a report of known or
suspected child abuse to the appropriate authorities. The action in alternative
"b" is consistent with state laws and the provisions of the Ethics
Code. Choice "a" is incorrect because a social worker must make a
report even if the abuse occurred in the past and it seems unlikely that it
will occur again. This makes sense, since the victim of the abuse is likely to
need of physical and/or psychological help. Alternatives "c" and
"d" are incorrect because reporting the incident to the child's
parents would be an unauthorized breach of confidentiality and not in
accordance with state laws.
138. D
When answering questions related to confidentiality or privilege, the best
answer is usually the most conservative answer. A social worker's first
response to a subpoena duces tecum should be to seek legal advice to determine
what his or her responsibilities are. Usually, the most appropriate action will
be to assert the privilege not to release information about a client and then
to release the information only when the client has authorized such release or
when the court has ordered the release.
139. C
The Ethics Code requires social workers to cooperate with other professionals
but also mandates that they provide others with confidential information only
when the client's consent has been obtained. Before releasing confidential
information, the social worker should obtain a signed consent from the girl's
parents. Alternatives "a" and "b" are incorrect because
providing information to the counselor without the parents' consent would be a
violation of confidentiality. Although releasing only relevant information is a
good and ethical practice, no information should be given without first
obtaining the appropriate consent. Alternative "d" is incorrect because,
although a social worker has an obligation to ensure that information is not
misinterpreted by others, he also should cooperate with other professionals by
supplying them with needed information after an appropriate consent is
obtained.
140. C
Social workers must recognize the boundaries of their competence in order to
make sure their clients receive the best possible treatments. The action in
alternative "c" is most consistent with the requirements of the
Ethics Code. Response "a" is incorrect because it would not be in the
best interests of the client to use an alternative treatment simply because
Karen is not experienced in providing a more appropriate treatment. Choice
"b" is incorrect because merely reading the literature on the
treatment would not give Karen sufficient expertise to provide the client with
that treatment. Alternative "d" is incorrect because, if a social
worker knows that another treatment would be most effective and the treatment
is outside the scope of her competence, an appropriate referral would be the
best course of action.
141. B
Although the specific details of child abuse reporting laws vary from state to
state, the situation in answer "b" would always be reportable because
one of the parties is under the age of 14 and the other is not: Sexual activity
with a male or female under the age of 14, whether or not the activity is
consensual, is considered a form of child abuse. Non-coercive sexual activity
involving two minors under the age of 14 (answer "a"), on the other
hand, is not reportable in most states.
142. C
This is fairly simple. Since this is an ethics question, you can eliminate
responses "a" and "b" because they deal more with a
clinical issue. Alternative "c" is a better answer than response
"d" because it more clearly takes the welfare of the client into
consideration. It is also the more conservative answer, and a good strategy for
ethics questions is to pick the more conservative course of action. Alternative
"d" comes too close to being client abandonment.
143. A Answers “b” and “c”
are possible, but “a” is correct because it is consistent with Piaget’s theory
of cognitive development, which is alluded to in the question. A preoperational
child’s thought is limited by centration, which is the tendency to focus on just
one aspect of a situation or object. Therefore, this child may understand that
his parents are gone, but miss the fact that they will be back in a few days.
144. C Of
the choices given, "c" is the best answer. The incorrect answers
would reveal the nature of your professional relationship with this person and,
thereby, violate her confidentiality.
145. D
From an ethical standpoint, the correct answer is "d." Social workers
are encouraged to provide appropriate professional services in public
emergencies to the greatest extent possible and to place service to others
above their own self-interests. In addition, the NASW Code of Ethics states,
"social workers should not engage in solicitation of testimonial
endorsements from current clients or from other people who, because of their
particular circumstances, are vulnerable to undue influence."
146. A
This item goes to the worker/client relationship. We never consider a client or
a relationship hopeless (goes against Social Work values), and we refer when it
is in the client's best interest, not for worker comfort.
147.C Hospice care is for people at the end stage of terminal
illness, when curative treatments are no longer available and death is near. It
provides psychological, social, and medical care, and emphasizes the quality,
rather than quantity, of life. Patients are provided with holistic treatments
for pain control, including physical, psychological, and spiritual pain. Option
“d” is incorrect because people accepted into hospice care must have a family
member or friend who is willing to be designated as a primary caregiver.
Hospice care emphasizes the involvement of loved ones in the care of the
patient, and supports caregivers by providing respite and convalescent care.
Answer “a” describes home health aide services. Home health aides are health
care workers who provide homemaker services and personal care to people who are
disabled or recovering after discharge from a health care facility.
148.
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C
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We don’t seem to have enough
information to choose an answer: For example, does “Jack” live at the
juvenile detention facility? Does the client still live at the facility? What
does the client mean by the words “get him.” The answers to these questions,
if we had them, would help us to determine whether “Jack” is in imminent
danger of being physically harmed by the client. Whether this is a “Tarasoff”
situation or not, however, it would be appropriate, as well as important, for
the social worker to inform the client about the limits to confidentiality and
a social worker’s related legal obligations
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.
149. B All four answers
are side-effects of the antipsychotic drug Prolixin (Fluphenazine). Seizures,
however, though they are rare, are the most dangerous side-effect associated
with this medication. Physicians advise patients taking Prolixin to stop taking
the drug and seek medical attention immediately if they experience a seizure.
Other rare side effects of Prolixin include low white blood cell count, tardive
dyskinesia, racing heartbeat/palpitations, tremors, dizziness, weakness, sexual
problems, restlessness, skin rash, and reduced urinary output. More common side
effects of Prolixin include lethargy/sleepiness, low blood pressure, dry mouth,
blurred vision, constipation, weight gain, difficulty urinating, and stiffness.
In general, Prolixin is less sedating than many other antipsychotics but has
more movement side-effects. (Additional information: A rare, but very serious
side-effect of all the antipsychotic drugs that you should be aware of is
“neuroleptic malignant syndrome.” This condition includes a rapid onset of
motor, mental, and autonomic symptoms, such as muscle rigidity, tachycardia,
hyperthermia, and altered consciousness. To prevent a potentially fatal
outcome, the drug must be stopped as soon as symptoms of NMS develop.)
150. D, Which
one of these you would do depends on the situation. Know the limits of your
training and experience and when you are not certain seek consultation.
Choice A is incorrect, refer and
consult when in doubt of your competence. Maintain your competency by keeping
abreast of developments in diagnosis and treatment. Choice B is incorrect, terminate treatment carefully
and for the right reasons. Find an appropriate referral. "Under managed
care plans, therapists may be accused of abandonment if they terminate when
doing so could result in harm to the client." Choice C is incorrect,
practice well within the scope of your competency and expertise.
151. B
This item deals with the issues of aging. You need to know how depression masks
itself with different age groups.
152. B The best approach is to refer him to another
therapist or program that specializes in smoking cessation while he continues
his anger management work with you.
153.
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B
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The ego may resort to one of its
defense mechanisms when it is unable to ward off danger through using
rational, realistic means. Displacement involves the transfer of an
instinctual drive from its original target (the boss, in this case) to a less
threatening target (the wife) so that the drive can be expressed more safely.
Projection involves attributing one’s own unacceptable instinctual needs and
drives to someone else; sublimation is a type of displacement in which an
unacceptable impulse is diverted into a socially acceptable, even admirable
activity; and reaction formation involves avoiding an anxiety-evoking
instinct by expressing its opposite.
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154.
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D
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The only reasonable assumption that
we can make, based on the information in the question, is that the boy’s lack
of interest in learning more about his family’s background is related to his
developmental stage. Adolescents are striving to disengage from their
families, to attain greater independence, and to develop an identity of their
own. On a day-to-day basis, peers play a more dominant role in their lives
than family.
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155.
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A
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Body dysmorphic disorder involves
preoccupation with an imagined defect in appearance or excessive
preoccupation with an existing minor abnormality in appearance.
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156.
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C
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This situation reflects a dual
relationship, and the NASW Code of Ethics prohibits social workers from
engaging in a dual relationship with a client or former client when there is
a risk of exploitation or potential harm to the client. So, the underlying
issue here is whether this situation (essentially, an existing dual
relationship) poses a risk of exploitation or harm to this client. As the
test-taker, you have few details about the situation – you don’t know how big
this church is; how much contact individual church members have with each
other (before now, however, the social worker didn’t know that he and the
client both attend this church, which implies that they’ve never run into
each other at church); or whether there is even another church in the
community for the social worker to attend (“a”). In other words, this
situation is too ambiguous to be a clear example of an unethical (harmful)
dual relationship, but it could pose problems in the future. All of this
reasoning indicates that the social worker’s “best” action at this time is
seek consultation (or supervision) to help him decide how to handle this
situation. The Code of Ethics says that if a dual or multiple relationship is
unavoidable, a social worker should take steps to protect the client and is
responsible for setting clear, appropriate, and culturally sensitive
boundaries. Therefore, it would be a good idea for this social worker to
discuss with the consultant, among other things, the best way to handle any
future encounters with the client at church.
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157.
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D
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The question suggests that the
client’s religious faith is important to him (he’s been an active member of
his church for many years), but his faith has been challenged by this
experience. Given this, the “best” intervention would be to provide the client
with a way of finding out that religious support is available to him
elsewhere. The referral in “d” offers the client an alternative place to find
the religious support he has lost at his church. Some churches (e.g.,
Fellowship United Methodist Church) are accepting of homosexuals. Moreover,
social workers working with gay clients should be aware of and use community
resources to enhance their clients’ support network. Option “a” doesn’t
address the client’s presenting problem (i.e., he feels alienated at his
church, and this is making him question his faith). Another reason why “a” is
poor is that it implies that the social worker would focus on questioning the
client’s decision-making process, or on the idea that his decision to come
out at church was a bad one; whether or not the client’s decision was
appropriate, such an intervention would blame the client for what happened at
his church after he came out. Option “b” is OK (particularly because it
mentions validating the client’s feelings), but the correct answer is better
because it offers the client a specific place where he can go to find the
support he has lost. And exploring the client’s diminished faith (“c”) is not
bad, but the social worker already knows why the client’s faith has been challenged;
the correct answer recommends a way of addressing this problem in a direct
and immediate way.
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158.
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B
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Mediation is a method of conflict
resolution in which a compromise between the opposing parties is sought. The
goal of the mediator is to get the two parties to agree on a resolution of
the conflict; thus, he or she would encourage the parties to be more flexible
about their goals. The mediator uses various tactics and encourages the
parties to speak freely in order to facilitate voluntary agreement between
the parties. The mediator can make recommendations or suggestions, but he or
she has no formal power and cannot impose a solution or decision (which rules
out answer “c”). If the parties can’t come to an agreement, then the
mediator’s work is finished. When an impasse is reached and a more formal
evaluation or recommendation is needed (e.g., when a court is seeking an
evaluation or recommendation), this role must be filled by someone other than
the mediator. Contrary to choice “a,” the mediator should remain neutral. And
choice “d” sounds more like the goal of a therapist than a mediator..
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159..
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C
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Regardless of a client’s cultural
background or the possibility that she is having acculturation problems, the
first step when assessing a suspected substance use disorder is taking a
complete alcohol/drug use history. This information is needed before the
social worker can determine appropriate treatment recommendations, including
the appropriate level of care (“d”). Moreover, taking this history could help
the social worker determine whether this client’s pattern of drug use is
related in some way to acculturation problems (“b”).
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160.
D Depending on the nature of the
violation, you cannot only lose your license, but there can be grounds for
legal/criminal action as well. Choice A is not the best response,
Sanctions may include the suspension or revocation of your license to practice.
Choice B, C are incorrect.
161.
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B
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The question emphasizes only the
client’s desire to prepare a will. Thus, the social worker should refer the
client to an attorney for assistance in writing her will. It would be
tempting to explore how the woman is coping with the news that she is
terminally ill, but this is not the reason why she was referred to the social
worker.
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162.
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C
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Only “c” describes a goal of TA.
The goals of TA are to help the client make new decisions about her life that
reflect the following: an integration of the three ego states – adult,
parent, and child (which both rules out “a” and shows that “c” is correct);
an “I’m OK/You’re OK” life position; and flexible, autonomous (“scriptless”)
behavior (which rules out “b”). Answer “d” is wrong for two reasons: First,
the adoption of a “success identity” is a goal of Glasser’s reality therapy.
Second, TA therapists attempt to help clients stop playing “games” – they
don’t help them learn more “more adaptive” games. “Games” are repeated
ulterior transactions (i.e., transactions involving two ego states in the
initiator and/or responder and a disguised message) that appear to provide
strokes and promote intimacy, but, in fact, allow people to avoid getting
close and advance their life scripts.
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163.
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D
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It was important to note this
client’s age – 18. In addition, the question provides no information about
what arrangements the social worker has made with the client and her parents
regarding sharing confidential information (we don’t know whether the social
worker has a release from the client allowing her speak with the parents).
Therefore, “d” is correct. What may have misled you in this case, however, is
that the client’s parents are paying for her therapy. Parents or others
paying for an adult client’s treatment do sometimes assume that they have a
right to be given confidential information about the client, but this is not
true. A social worker should make information available to the people paying
for a client’s therapy only at the client’s request or when the client has
consented to have the information released at the request of another person,
and only when disclosing the information is in the client’s best interests.
At the beginning of therapy, a social worker should clarify with all involved
persons (in this case, the client and her parents) the conditions surrounding
the release of confidential information.
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164. A This question may be confusing because it contains a double
negative. You can change a double negative to a positive – for this question,
that means you are looking for something suggesting that this client is a good
candidate for group therapy. Contraindications for group therapy include: Low
motivation to change (“b”); certain symptoms, diagnoses, or characteristics –
e.g., severe depression (“c”) and withdrawal, paranoia, acute psychosis, brain
damage, sociopathy, a high level of denial, high somatization, low self-esteem
(“d”), low psychological sophistication, and low IQ; incompatibility with group
norms for acceptable behavior (e.g., significant deviancy from the other group
members); inability to tolerate the group setting; unfavorable expectations
about group treatment; and acute crisis. By contrast, “a” would indicate that
this client may be a good candidate for group therapy: Groups are often able to
confront resistance more quickly and effectively than a single therapist.
165.A According to psychoanalytic theory, a patient
with an obsessive-compulsive neurosis is likely to strongly rely on which of
the following sets of defenses?
166.
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C
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A social learning approach draws
concepts and techniques from behavioral therapy. With families, therapists
using a social learning approach assume that family members have failed to
learn basic relationship, communication, and conflict-resolution skills;
consequently, treatment focuses on teaching these skills. The behavioral
technique “time-out” is often taught to parents as an alternative to physical
discipline. Time-out involves removing a child from an environment that is
reinforcing an unwanted behavior for specific period of time, with the goal
of reducing or eliminating that behavior.
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167.
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A
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This question is difficult because
when using play techniques, therapists generally do not direct a child’s play
behaviors or statements; instead, they allow the child to “lead the way”
(V.M. Axline, “Play Therapy,” Ballantine Books, New York, p. 119, 1947).
However, of the answers offered, “a” is the best one. The action in “a” would
allow the social worker to check out the validity of her belief, and also
provide the boy with a therapeutic opportunity to express his feelings
verbally. Answer “b” is too directive for play therapy. It is also a
roundabout and probably ineffective way of finding out what the boy is
feeling. It seems to assume that he will play out another angry scene and
that, if he does, this will somehow give the social worker more insight than
the first game did. In other words, this action fails to capitalize directly
on an opportunity that is already present, the chance to encourage the boy to
talk about his first game. An interpretation at this point (“c”) would
probably be less beneficial than providing the boy with an opportunity to
verbalize his own feelings. The social worker could help the boy label his
emotions after he has expressed them, if he needed help with this, but she
first should provide him with an opportunity to express himself. Rule out “d”
because it’s better for the social worker to give the boy a chance to
identify and verbalize his feelings on his own, rather than presuming that
she knows what he feels. He may clam up or just agree with the social worker,
no matter what he truly feels, if she puts words in his mouth.
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168.
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B
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The best answer offered is “b”
because the NASW Code of Ethics requires social workers to consult and
“cooperate with other professionals in order to serve their patients or clients
effectively and appropriately.” Moreover, a social worker is not qualified to
decide whether a client should or should not take a medication. Instead, an
appropriate role for a social worker to take in this situation is to (with
the client’s permission) discuss the client’s needs and concerns with the
doctor, including his psychosocial needs. Answer “c” is true but it
inappropriately dismisses the client’s concerns, which seem legitimate –
i.e., it would be irresponsible to assume that a client who has past problems
with alcohol use and a family history of drug abuse will have no problem
taking this pain medication only as prescribed. Finally, behavioral and
cognitive-behavioral interventions (“d”) have been found effective for
treating many forms of chronic pain, but, again, it would unethical and
illegal for a social worker to dismiss or override a physician’s
recommendations regarding medication for a client.
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169..
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C
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Psychoanalytic theory suggests that
the paranoid individual “projects” his or her own threatening or unacceptable
impulses onto others. Freud suggested that reaction formation (“a”) underlies
obsessive-compulsive personality traits. He viewed certain
obsessive-compulsive personality traits as obedience in defense against
unacceptable rageful impulses. Freudian personality theory proposes that
introjection (“b”), as well as regression, underlies depression. For example,
the person internalizes anger he or she feels toward someone else. And Freud
believed that displacement (“d”) underlies obsessions.
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170.
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A
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This question doesn’t specify why
the attorney is requesting the records, nor does it indicate whom the
attorney represents. An ethical social worker, however, would not simply
release a client’s records based on just a request from an attorney (“b”),
without having prior permission from the client to do so. Instead, a social
worker would take steps to protect the client’s confidentiality to the
greatest extent permitted by law. So, while this question is vague, we can
assume that the test-writers are assessing whether you know about this
obligation. With this in mind, your first reaction in this situation should
be to assert the privilege on your client’s behalf and refuse the attorney’s
request for now. You might ultimately advise the client to sign a release of
information for the records (once you have more information about the purpose
of the request), but simply having him or her sign a release now (“c”) would
not be a good first step: Instead, you will need to discuss the attorney’s
request with the client and, if relevant, with the client’s attorney; in
these discussions, you will want to go over the possible consequences of
releasing the records to the attorney. If the client did end up signing a
release, you could then provide the records. On the other hand, if the client
refused to sign the release after you discussed the matter with him or her,
you would need to continue asserting the privilege. The issue could then end
up in court: If the court decided that the privilege should be waived in this
case, it would issue an order requiring you to release the client’s records;
you would then have to comply with the order or else risk a charge of court
contempt. “D” is incorrect because you would violate the client’s confidentiality
if you had any additional discussion with this attorney about the client or
the request for his or her records before speaking with your client and
getting a signed release form.
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ALL THE BEST & GOD BLESS !!!
