Part VII Direct and Indirect Practice questions (30)

1 A social worker is meeting for the first time with a female client, age 31, who was just raped. The social worker’s MOST appropriate intervention is to:
A		have the client call the police from his office to report the rape
B		allow the client to choose what she would like to do in this session, in order to restore her sense of control
C		encourage the client to talk about the rape
D		establish a specific plan with the client, covering the next two days
2. Micro” social work practice generally emphasizes which of the following?
A		education, mediation, negotiation, and facilitation of communication
B		resolving the psychosocial problems of small groups, individuals, and families
C		problem solving and developmental activities in the social environment
D		planning, administration, evaluation, and community organizing

3. A child isolates herself and is unwilling to join the group’s activities. A social worker’s BEST intervention is to:
A		ask the child to join in activities
B		have the other group members include the child
C		give the child more time
D		actively incorporate the child into group activities

4. Alice, age 35, has been making good progress in therapy lately and suggests that she and the social worker celebrate this by having the next session outdoors. Alice offers to bring a picnic lunch. The social worker’s BEST response is to:
A		use the material as an opening for a discussion of boundaries, power struggles, and the limits of therapeutic relationships
B		agree in order to reinforce the alliance and validate Alice’s feelings of success
C		suggest that this behavior would cause Alice conflicts later in treatment or after treatment ends
D		explain how transference and countertransference work in therapy

5. A social worker using a brief therapy model would rely on all of the following principles or assumptions, EXCEPT:
A		the client’s problem is not a sign of pathology
B		she should be an active participant in finding solutions with the client
C		she should create a self-fulling prophecy by conveying to the client that change is possible
D		the client lacks resources for change and she will provide him with skills and knowledge to bring about change

6. The client is a female, age 25, whose primary complaint at the start of treatment was persistent anxiety. The social worker has been working with the client for three months on the goal of reducing her anxiety, using cognitive-behavioral interventions. During a session, the social worker discovers that the client has been using amphetamines for about six months. The social worker should FIRST:
A		confront the client about her low motivation to change
B		tell the client that continued sessions with him will be contingent on her ceasing all use of amphetamines
C		have the client hospitalized for detoxification
D		shift temporarily to insight-oriented work so that the client can develop insight into why she uses drugs that make her feel anxious

7. A 75-year-old woman who has come in alone for treatment is displaying signs of depression. The social worker can BEST proceed with assessing this client by:
A		asking about her support system
B		referring her to a physician or neurologist
C		helping her express her feelings of depression and identifying what underlies them
D		encouraging her to talk about her past

8. When a client in psychoanalysis begins to be aware of repressed material, which of the following is MOST likely to occur?
A		the therapist will initiate termination
B		the client will have insight
C		the client will use defense mechanisms to manage the anxiety aroused by the material
D		the client’s transference will be resolved

9. A client presents with concerns about his inability to sustain meaningful relationships and expresses an eagerness to learn how to communicate better with others. During his first three sessions the client shares stories about his failed relationships, offering lots of details and vague ideas about what might have gone wrong. When the social worker tries to redirect the client so that they can explore how he might improve his communication skills, he resists and tells more stories about his past. What would be the BEST way for the social worker to redirect this client’s energy toward efforts at therapeutic change?
A		set clear short-term goals and a time-frame for treatment
B		confront him
C		empathize as he describes his relationship failures
D		directly tell him it is time to move beyond story-telling

10. A 7-year-old boy has been placed in foster care as the result of severe neglect by his natural parents. The boy is anxious and shy and has a lot of trouble speaking to people he doesn’t know. The social worker learns that the boy’s foster parents make fun of him when he’s nervous and punish him when he refuses to talk to them or their friends and family. What should the social worker do?
A		arrange more training for the boy’s foster parents
B		provide mental health services to the boy
C		talk over this problem with the boy’s foster parents
D		find a different placement for the boy

11. A young child referred to a social worker is unkempt, malnourished, and withdrawn. It would be MOST important for the social worker to refer to:
A		the school counselor
B		a neurologist
C		a pediatrician
D		a child protective services agency

12. A patient in hospice care tells a social worker that he has signed papers saying he doesn’t want life support procedures to be used should he require them near the end of his life. The social worker discovers that the patient’s parents don’t think he’s competent to make this decision because he has a history of depression and other mental illness. They want his doctors to use life support procedures. The social worker’s BEST response is to:
A		request a competency hearing
B		meet with the patient and his parents to explore this situation
C		tell the parents they need to respect their son’s decision because he has a right to self-determination
D		get permission to speak to mental health providers who have treated the patient in the past

13. A man has been taking care of his mother, age 72, since she had a stroke a year ago. She is now showing signs of dementia, and her medical needs have increased to a point where her son can no longer meet them. The mother’s physician has recommended a complete care nursing facility for her. The son is upset about the idea of leaving his mother in the care of strangers, and says that he wants to continue caring for her at home. The physician has referred the son to a clinical social worker. The social worker’s BEST action is to:
A		arrange a family meeting, including the mother, to discuss the decision
B		encourage the son to be more realistic about his ability to care for his mother and to reconsider the physician’s recommendation
C		recommend to the son that he tour the nursing care facility
D		urge the son to discuss the issue further with his mother’s physician

14. A client becomes upset and defensive when her social worker refers her to a psychiatrist for a medication evaluation. She says “Whatever you may think, I know I’m not some insane person who needs medication. I just came here to talk.” The social worker’s BEST response is to:
A		explain that social workers can’t prescribe medication, so this referral is necessary
B		acknowledge the client’s feelings and hold off on this referral
C		explain the uses of medication and how medication can help the client benefit more from the work they do in therapy
D		explore why the client is resistant to accepting an intervention that will help her

15. Two adult gay men are patients at a residential drug treatment facility. One of the men has HIV disease. A social worker employed at the facility discovers that the men had sex with each other the night before. The social worker’s BEST action at this time is to:
A		discuss the dangers of unsafe sex with the HIV negative man
B		encourage the HIV negative man to get an HIV test
C		inform the man with HIV disease about relevant HIV laws
D		meet with each man to reinforce the facility’s rules prohibiting sexual contact

16. The client is a 60-year-old woman who complains of depression. She reports feeling sad and lonely and having difficultly sleeping at night. Her husband died seven weeks ago. After performing a thorough assessment, the social worker determines that the woman would benefit from joining a bereavement support group. The social worker’s FIRST step in providing this referral is to:
A		give the client the information necessary to contact the resource
B		discuss with the client how the referral relates to her needs, concerns, and objectives
C		persuade the client that joining the group will improve her mood
D		contact the group leader to notify him or her about the referral

17  A social worker sees a client for an initial session; the client was diagnosed by her last therapist as having borderline personality disorder. Just as the social worker tells the client that time is up for the day, the client asks the social worker to explain what it means to be “a borderline personality.” The social worker’s BEST response is to:
A		give the client literature on borderline personality disorder
B		schedule a session for the next day so that he can explain the disorder to her
C		tell the client that he will explain the disorder to her in the next session
D		tell the client she should not ask questions just as the session is ending

18. A client whom a social worker has been treating for about a month suddenly stops showing up for his appointments. Soon thereafter, the client calls the social worker, requesting an immediate appointment. The social worker’s BEST response is to:
A		ask the client why he stopped coming in
B		schedule the appointment
C		ask the client whether he thinks he will be able to commit to treatment this time around
D		find out why the client needs to see her immediately

19.  As a part of her duties at an agency, a social worker visits elderly people who live alone. The social worker visits a 75-year-old man who lives in small apartment in a nice community populated mostly by young people. The man says he has few friends but receives visitors several times a month. His children live about an hour away. Other than appearing lonely, the man seems healthy and happy. He thanks the social worker for coming but says that he’s not interested in any services. The social worker’s BEST action is to:
A		get the man’s phone number so that she can check up on him
B		leave the man literature about services he can access if he ever needs assistance
C		urge the man to allow her to contact his children so that they will visit more often and reduce his loneliness
D		explain to the man that he appears to need services because he is frequently alone, and tell him that a caseworker will come by soon

20.  You have been leading a weekly psychotherapy group for two months. Near the end of a group meeting, one of the members says that she won’t be coming to any more meetings. She says she’s decided to quit the group early because “it’s not helping.” Your BEST response is to:
A		ask the other group members how they feel about this and encourage them to urge the client to stay in the group
B		arrange to meet privately with this member to determine whether she has thoroughly considered her decision
C		allow the client to terminate because the group is not helping her
D		arrange to meet privately with this member to find out what underlies her decision to terminate

21.  Two sisters in their late 70’s share an apartment. Neither one has ever married or had children. They mostly keep to themselves and don’t have much support in their community. The sisters have recently started having some difficultly completing daily living tasks, such as shopping, cleaning, and cooking. The social worker’s MOST appropriate intervention is to:
A		recommend homemaker services
B		refer them to community-based activities for seniors
C		locate family members
D		recommend placement in a nursing home

22.  When do you share insight with a client?
A		at termination, to consolidate treatment gains
B		when you understand and can interpret his behavior
C		when the client asks you to do so
D		when you determine that the client is ready

23. A difference between the brief dynamic therapies and crisis intervention is that only crisis intervention:
A		addresses underlying personality issues
B		views the client’s symptoms as pathological
C		seeks to return the person to the prior level of functioning
D		focuses on specific symptoms

24. A social worker is working in the initial stage of therapy with an adolescent client. To establish rapport with this client, the social worker is LEAST likely to:
A		firmly encourage him to self-disclose if he is silent
B		show personal warmth and relate to him as an ally
C		elicit his negative feelings
D		inform him that she needs to inform his parents about dangerous behaviors

25. The single mother of a 15-year-old boy eagerly agrees to participate in her son’s therapy for depression and alcohol use. After two sessions, she begins dropping her son off and not returning until the session is over. In the fourth session, the boy tells the social worker that his mother never asks him what goes on during therapy. He is upset by this. To BEST handle this situation, the social worker should:
A		consider what role the mother’s indifference plays in the boy’s depression and substance use
B		talk with the mother about the inconsistency between her current actions and her verbalized commitment to be a part of her son’s treatment
C		encourage the boy to tell his mother how much her indifference has upset him
D		incorporate resolution of this parent-child problem in the treatment plan for the boy

26A client with depression, postpartum onset, saw a clinical social worker for several sessions and was showing improvement. The client suddenly stopped coming to treatment. The MOST appropriate interpretation of this situation is that:.
A		the client has recovered
B		the social worker did not establish rapport with the client
C		the client is resistant
D		the depression has worsened and the client needs a medical evaluation

27. A social worker meets with a client who has been referred to therapy by his physician who reports that the client drinks heavily and is endangering his health. The client says that he just drinks alcohol to unwind after work. He adds that he’s held down the same job for two years and that an alcoholic wouldn’t be able to do that. He’s annoyed that his doctor thinks he needs to see a therapist, but she was so insistent that he decided to give it a chance. The social worker would use “motivational interviewing” with this client to:
A		help him recognize for himself the need for change
B		address his negative feelings about coming to therapy
C		confront his denial about his drinking patterns and the effects of drinking on his health
D		encourage him to self-disclose

28.  The main purpose of reflection is to:
A		Build understanding
B		Confront
C		give support
D		interpret

29. A social worker’s new clients are a young couple who married a year ago and have decided to divorce. They want the social worker to help them part on good terms. They say they no longer feel “the same love” they felt when they were dating, are on “different wave-lengths,” and have been arguing about mundane household issues. They are disappointed with married life. The social worker should:
A		explain that divorce does not seem necessary
B		focus on clarifying the problem by doing a genogram to establish whether either of them has a familial pattern of divorce and/or marital conflict
C		work on their stated goal by helping them communicate their individual needs and then refer them to a divorce mediator
D		educate them about the myths and realities of marriage and provide training in communication skills

30.  A client arrives for a session with his social worker feeling angry. He soon becomes agitated and begins yelling and pacing the room. The social worker’s LEAST appropriate response to this is:
A		to ask the client to sit down and tell her what has upset him
B		to tell the client to take a seat and try to calm down
C		to offer supportive feedback in an effort to reduce the client’s agitation
D		to tell the client that she is going to leave him alone briefly to give him a chance to regain control

ANSWERS

1.       The intervention in “d” would be appropriate in any crisis situation, regardless of the precipitant. An important principle of crisis intervention is that the therapist should participate actively and be directive in developing activities that will help the client resolve or manage the crisis (which rules out “b”). It is especially beneficial for rape or abuse victims to have a specific plan for the days following the rape or abuse, so that they can move from victimization to empowerment. Treatments for trauma include providing opportunities for catharsis and gradual exposure to the trauma in the imagination; these can reduce the client’s distress and prevent the development of delayed and chronic PTSD symptoms. However, beginning the treatment by having this client describe the rape (“c”) is not appropriate: Because the rape just happened, her thinking, feelings, and/or behavior are probably quite chaotic and, therefore, the social worker should focus on providing crisis intervention. Last, the decision to file a report with the police (or not) must be left to the client (“a”). Moreover, we don’t have any information indicating that this client has not already reported the rape to the police.

2.       B. Most “micro” practice occurs on a case by case basis or in a clinical setting. Micro social workers use their skills to help resolve the psychosocial problems of individuals, families, and small groups. Response “a” describes “mezzo practice,” which usually takes place with small groups and families, and emphasizes mediation, negotiation, providing education, facilitating communication, and other strategies for bringing people together. Distractors “c” and “d” both describe elements of “macro practice,” which emphasizes problem solving and developmental activities in the social environment. Macro social workers use their skills to improve and change society in general; activities include planning, administration, evaluation, and community organizing.

3. D

Answer “c” is incorrect since it ignores the problem. Among the other three answers, choice “d” is best because it is both general and inclusive — actively involving the girl in the group could entail using one or more of several different strategies, including having the other members make an effort to include her; talking to her about her feelings toward the group; explicitly inviting her to participate; designing activities that would encourage her involvement, etc.

5. D

Answer “d” is not consistent with a brief therapy model, which adopts a strengths perspective. This perspective assumes that the social worker and client both have resources that can be used to bring about change. The client has knowledge, abilities, resiliency, coping skills, and problem-solving skills, but is unable to use them effectively at this time simply because he is temporarily overwhelmed or stuck (“a”). In treatment, the social worker helps the client access these resources so that he can become unstuck and find solutions (working with what the client brings is referred to as “utilization”). Other assumptions of the brief therapy model include the following: The relationship is collaborative and avoids hierarchy; the social worker’s role is to be an active and engaged participant (“b”); the goal is to empower the client; therapy focuses on establishing measurable goals with the client that reflect small steps toward an end and are meaningful to the client; and measures are used before, during, and at the conclusion of treatment to document progress. In addition, answer “c” describes “expectancy,” which is a key element of a brief therapist’s stance.

8 C

Psychoanalytic theory proposes that when an individual becomes aware of previously unconscious material, anxiety will be aroused and the individual will attempt to reduce the anxiety by using defense mechanisms. We can rule out “a” because the question does not describe the final stage of psychoanalysis. Similarly, “b” and “d” are poor because awareness does not automatically lead to insight or the resolution of transference — working through still has to take place.

9.A

Answer “a” describes the most direct and appropriate way of addressing this problem: Setting clear goals and a specific time-frame for therapy is an effective way of mobilizing a client’s energy for therapeutic change.

10. D

The boy would probably benefit from beginning therapy of some kind (“b”), if he’s not already receiving treatment, but the more urgent issue here is the quality of his foster care placement. In order to receive Title IV-B funding for foster care (funding for child welfare services), states must provide certain protections to all children in foster care, including ensuring that the child’s placement is consistent with his best interests and special needs. This boy’s foster care placement is clearly not consistent with his best interests or special needs, and, therefore, the social worker should seek an alternative placement for him. Other required procedures and protections for children in foster care include the following: The provision of a detailed written case plan that describes the placement, the services provided to the child, and a plan for attaining permanence for the child; a case review every six months; the parents and child must be allowed to participate in the development and approval of the case plan; and the placement must be in the least restrictive environment, in the most family-like setting available, and in close proximity to the child’s biological parents.

11. D

The signs described in the question suggest a strong possibility that this child is neglected. Therefore, the question taps into your risk-assessment skills and understanding of your legal responsibilities. The child’s medical and other needs will be identified and addressed by the CPS unit once the social worker has made a report.

13. C

Based on the son’s reported misgivings, having him tour the facility would be best. After becoming familiar with the surroundings where he will leave his mother, he may come to view the staff as something other than “strangers” and feel more comfortable leaving his mom in their care. He may also conclude that the facility is better equipped to meet his mother’s needs than he is. Having a family meeting (“a”) is not as immediately helpful; in addition, the question suggests that the mother may not be capable of participating in a meaningful way in this decision. Option “b” is overly confrontive and dismisses the man’s genuine (and expectable) concerns about placing his mom in a nursing facility. Option “d” doesn’t seem useful since it is unlikely that having another conversation with the doctor would put to rest the man’s concerns and feelings.

14. C

The intervention in “c” is a direct way of addressing the client’s apparent misconceptions about medication and responding to her concerns about what taking medication implies. This intervention also communicates to the client that the social worker has her goals and best interests in mind when making this referral. Answer “a” is a truism that does nothing to allay the client’s concerns or increase her understanding about why this referral may help her. Rule out “b” because we can assume that this social worker has made this referral because he or she believes that the client would benefit from taking medication; while the social worker can’t force the client to see the psychiatrist, before “holding off” on this referral, the social worker should provide the client with information that will help her make a more informed decision about taking medication. Answer “d” is not as useful as “c” because the client’s response to the referral implies that she has misconceptions or fears about taking medication. The social worker should be able to infer this and, therefore, should begin by attempting to address these beliefs and feelings directly.

16. B

Before providing a referral to a client, a social worker should elicit the client’s feelings about the referral (e.g., anxiety, abandonment) and determine the client’s readiness for it. If a client is not ready to use a resource, she is unlikely to follow through on the social worker’s recommendation. A particularly effective way of motivating a client to use a resource is to relate it to the needs and concerns she has expressed and to her goals. While “c” seems to mention this approach, it suggests that the social worker would offer the client a guarantee that the group will help her. Offering clients such guarantees is not appropriate. Similarly, because all agencies have their own policies, procedures, and eligibility criteria, a social worker should never guarantee a client that she is eligible for a service unless he or she has the authority to make eligibility decisions. Note, too, that a social worker should usually explain both the advantages and limitations of a recommended resource or service when providing a referral (although if the client is confused, afraid, or very dysfunctional, the social worker should avoid focusing too much on the limitations, because doing so might create another barrier to the client’s use of the resource or service). Answer “a” is appropriate, but for the reasons cited above, providing the client with information about how to contact the group leader is not the social worker’s first step. Answer “d” is not the social worker’s first step and is also problematic because social workers usually encourage their clients to take as much responsibility as they can for making arrangements to receive a service they want. On the other hand, if a client is afraid, overwhelmed, or might have difficulty making the arrangements for some other reason, then a social worker will usually help the client make the linkage, especially if the referral is an important one. For example, the social worker may contact the other provider to notify him or her that the client will be calling (as “d” suggests) or may go with the client to an agency or find family members or friends who can accompany the client.

18. D

The client has asked to see the social worker immediately, so the social worker would want some brief information about why the client’s present need is so urgent, especially because he terminated prematurely before. Later, if the social worker sees the client, openly discussing his prior resistance or lack of motivation and his current thoughts and feelings about therapy would be useful for re-engaging him and reducing the barriers to successful treatment this time around.

19. B

The man is basically fine, perhaps lonely but otherwise “healthy and happy.” Thus, the social worker should respect his right to decline services at this time (his right to self-determination). The best way to do this would be to leave reference material for the man in case he changes his mind or needs services later on.

20. D

Option “d” is the best answer offered. Usually, more than one factor underlies a client’s decision to terminate therapy prematurely and, to know the best way to address this client’s decision, you need to find out more about what underlies it. It best to do this in a private meeting with the client. Usually, premature termination from group therapy is detrimental for both the client who leaves and for the group. Therefore, as “a” seems to say, you will probably want to process this event with the entire group – whether or not the client ends up leaving, her statement may have been disruptive or upsetting and some members may not want her to leave. However, the second part of answer “a” – encourage them to urge the client to stay – would put undue pressure on the client, particularly since you don’t know yet what really underlies her decision to leave. For example, maybe something happened in a group session that upset the client and you overlooked it. Option “c” is clearly not the best way to respond because, even though the client said that the group isn’t helping her, you should realize that this statement could be a sign of resistance or that some other barrier is preventing her from wanting to stay in the group even though she hasn’t achieved all of her goals.

21. A

The pressing issue described in this question is the sisters’ recently emerging difficulties with performing activities of daily living. Homemaker services are designed to help individuals remain in their own homes for as long as possible; they assist with daily living chores (preparing meals, cleaning, etc.) and provide transportation and some nursing services. The referral in “b” may be given, as well, to broaden the sisters’ social support network, but from a safety standpoint, the resource “a” is more important.

22. D

Most clinical social workers seek to increase their clients’ insight, or self-understanding and awareness of their feelings, motivations, and problems. One important way of facilitating insight is to offer clients relevant and timely interpretations of their statements, behaviors, etc. It is the social worker’s responsibility to determine when a client is ready to receive an interpretation and accept and assimilate the insight it provides. For instance, even if a social worker has a relevant interpretation to share, he or she does not suggest it to the client if the related material is still far removed from the client’s awareness; when interpretations are offered too early in the helping process, clients usually reject them (and the insights they are intended to yield) as meaningless, irrelevant, and/or inaccurate.

23. C

Crisis intervention seeks to bring the person back to pretrauma levels. There’s no attempt at addressing underlying personality issues or even behavioral symptoms; the effort is directed just at getting the person up and running at the previous level, whether that level is disordered in some way or not. Brief dynamic therapies emphasize specific symptoms and these symptoms are viewed as pathological; therefore, the emphasis is on altering the normal (prior) level of functioning rather than returning the person to it.

24. A

Adolescents are attempting to become more independent and to develop a coherent personal identity; and many are involuntary clients who are in therapy because they have been brought in by their parents or referred by school officials, probation officers, or juvenile court judges. For these reasons, adolescent clients often have negative feelings about therapy and expect the therapist to try to control or punish them. An adolescent would probably see the intervention in “a” as an effort to control him and become more resistant as a result. To build an effective therapeutic relationship with an adolescent, a social worker usually needs to neutralize his negative feelings – i.e., start where he is by using empathic responding to elicit his negative feelings (“c”); respond in ways that are opposite to his expectations; and relate as an accepting and understanding ally (“b”). While informing a client of the limits to confidentiality (“d”) is not usually associated with developing rapport, “a” is a better answer to this question because it describes something that is likely to interfere with the development of rapport; by contrast, honestly informing a client about the limits to confidentiality is less likely to block rapport and is something the social worker is required to do.

25.B

This situation offers the social worker an opportunity to deal therapeutically with a problem the boy and his mother have. Remember, the boy is upset about his mother’s lack of interest. Option “a” is fine in and of itself, but it fails to capitalize in a direct or immediate way on this opportunity. Doing option “c” now would probably be premature. It would be better so early in treatment for the social worker to model assertiveness for the boy, as the action in “b” would do. Answer “d” may be appropriate, but it fails to indicate that the social worker will talk to the mother directly about her behavior. Although the social worker may well talk to the mother when doing what “d” says, “b” is a better choice because it states directly that the social worker will take advantage of this opportunity to manage the situation in a therapeutic way.

26. D

This is a difficult question because we have very little information to work with. We choose “d,” however, because it is the most responsible interpretation of a situation like this one. Though the other answers are possibly true, they don’t address the possibility that the woman may require additional intervention to re-start or sustain her recovery. Because it is also possible that her symptoms have worsened, it is wisest, from a “client welfare” standpoint, to go with this possibility and consider that she may need to be seen by a physician for an evaluation.

27. A

The goal of “motivational interviewing” is to help a client, himself, recognize and do something about his problem; the approach is particularly useful for clients who are ambivalent about changing or reluctant to change. MI uses a client-centered approach to build the client’s commitment and readiness to change. Underlying MI is the assumption that ambivalence is the main obstacle to change; as such, MI facilitates behavior change by helping the client explore and resolve his ambivalence about change. The therapist creates a safe and positive atmosphere that encourages change and employs strategies that are persuasive and supportive rather than coercive and confrontational (which rules out “c”). Additionally, MI assumes that interventions are most effective when they are matched to the client’s level of readiness to change.

28. A

The best choice is “a.” Reflection of feeling is used to clarify and show a client what his or her here-and-now feelings are. This encourages the client to continue expressing himself or herself and helps the client understand his or her feelings. Because it also conveys that the social worker has understood the client’s feelings, reflection is a useful tool for building rapport and trust.

30. B

Answer “b” is the “least” appropriate intervention because telling the client to “calm down” dismisses his strong feelings and may seem confrontational to him. The intervention in “a” is better because the directive to sit down is followed by a supportive statement of concern. Generally, the first thing you want to do with an angry client who seems to be losing control is attempt to help him regain control. When the client’s loss of control is mild to moderate, this can often be achieved by giving the client supportive feedback to reduce his fears and hostility (“c”) and by setting firm limits that provide some structure; the latter are effective for reducing the client’s anxiety and letting him know what you need from him in order to help (“a”). And if you feel threatened by the client’s loss of control, it is appropriate to leave the room briefly to give the client a chance to regain control (“d”). If none of your interventions are effective or if the client’s loss of control is severe, then you should consider calling others for assistance, such as appropriate emergency personnel, who can medicate or restrain the client and/or transport him to a hospital.

4.A  To preserve appropriate therapeutic boundaries in this case, the social worker shouldn’t agree to have this picnic. You needed to determine the best answer from among choices “a,” “c,” and “d.” Answer “a” is the best choice because it takes the social worker somewhere clinically, without locking him or her into a particular framework (“d”). Option “c” may be true, but the social worker is just giving a warning here, which does not promote any learning or growth for the client.

6.B Of the choices offered, “b” is the best. The client’s purpose for seeking therapy was to reduce her anxiety, however, any therapeutic intervention to achieve this goal will be ineffective so long as the client is taking amphetamines. Merely confronting the client (“a”) is unlikely to produce any beneficial effects: With patients who abuse or are addicted to drugs, nondirective, supportive approaches are associated with better outcomes than more directive, confrontive styles. While answer “c” can be important when initially addressing drug abuse, we don’t have enough information to conclude that this client needs to be hospitalized. Answer “d” is a poor choice since the client’s thinking is likely to be distorted by the drugs she is using. Moreover, “d” says nothing about attempting to curtail or end the client’s drug use at this time.

7. B…This question is fairly difficult because the incorrect answers could also be useful interventions in this case. To choose the correct answer, you needed to recognize that before formulating the problem or planning treatment, the social worker must determine an accurate diagnosis for this woman. This requires confirming or ruling out any effects of a medical condition on the client’s mood and cognitive functioning. In particular, in an elderly person, dementia can resemble depression, so it would probably be important for this woman to undergo neurological testing. (Additional tip: In the context of a question like this one, words such as “best” or “first” can often be interpreted to mean “most important.” Therefore, while the incorrect answers for this question may be appropriate interventions, they are not the best answer, because they don’t reflect the social worker’s “most important” intervention in this situation.)

12. B The best response in this situation is to meet with the patient and his parents. It’s not clear from the question whether the patient is competent or not to make this decision (which rules out “c”), but either way, his decision has upset his parents. Additionally, if the parents’ concerns are well-founded, then this meeting would offer a venue where the social worker could explain that a court needs to determine the issue of competency. Or, if the parents’ concerns are unfounded, then this meeting could be used to help the patient and his parents resolve their dispute and, perhaps, increase the parents’ ability to support their son during his illness. The meeting could also help uncover other reasons for the parents’ unwillingness to accept their son’s decision. Answer “d” could help the social worker determine whether the parents’ concerns are valid; before seeking this information, however, the social worker should meet with the patient and his parents because they are in the midst of painful dispute, probably need support, and should be involved in determining the best way to proceed.

15.A This question is one with a “best” answer, rather than an ideal one. In a situation like this one, it is important to encourage a patient to practice safe sex and to provide him with information and possibly referrals (e.g., a medical professional) so that he can learn how to do so as well as possible. Thus, answer “a” is the best choice we are offered — it educates the patient as suggested above, thereby addressing his risky sexual behavior, while also protecting the confidentiality of his HIV+ sexual partner. Of course, it would be even better to review the dangers of unprotected sex with both of these men independently, but we are not given that choice. Answer “b” is tempting, however suddenly advising the HIV negative patient to have an HIV test might end up breaching the confidentiality of his sexual partner: He might infer from this suggestion that the social worker knows he just had sexual contact with an HIV+ person and, thereby, learn of the other patient’s serostatus. As “c” suggests, a therapist does have a responsibility to inform HIV+ patients of their duty to tell their sexual (and needle-sharing) partners about their serostatus; therefore, this discussion will need to take place in the near future. Right now, however, a higher priority is the HIV negative patient’s protection from additional risky behavior. Finally, merely reviewing facility rules with these men (“d”) would not deal directly enough with the health issues arising from their having (possibly) unprotected sex.

17.C Answer “c” would usually be the right thing to do with any client in this situation, regardless of her diagnosis. Nevertheless, your familiarity with borderline personality disorders might have helped you choose “c” if you weren’t sure what should be done: Many authorities say that therapists need to set firm, clear, and consistent limits with a patient who has BPD so that the patient doesn’t become dependent or manipulate them. The social worker might also do some form of the action described in “d,” but “d” doesn’t tell the client when the social worker will answer her question. (Additional information: Lawrence Shulman has coined the phrase “doorknob communication” to describe any client’s disclosure of apparently significant information just as a session is about to end. Such behavior is thought by some to reflect an unconscious effort to prolong the interview or set up the therapist for an accusation of indifference [Barker, 2003]. Schulman alternatively suggests that such communication may reflect information that’s important to the client but that the client has been uncomfortable addressing earlier in the session [e.g., perhaps the client wants to inform you about the concern but doesn’t want to discuss it], or that the communication reflects important information that the client did raise earlier in the session, but that you overlooked.)

                                              

29. C The principle of self-determination dictates that a decision on marital status is ultimately up to the clients. Therefore, even though it appears this couple is experiencing fairly normal difficulties and adjustments during the first year of their marriage, the social worker cannot explicitly tell the couple not to divorce (“a”). The approach in “d” would best serve the couple because it immediately normalizes their marital problems: It offers them an alternative perspective, as well as behavioral options that will allow them to either work on their marriage or divorce more amicably. With this information, the couple can make a more informed choice about whether divorce is their best course of action. So, even though “a” might be true, it would be more beneficial therapeutically (as well as more ethical) for the social worker to intervene in a way that allows the couple to come to this conclusion themselves. Similarly, before undertaking the action in “c,” the social worker should educate the couple about the myths and realities of marriage, so that they can make a better informed decision about the fate of their marriage. The genogram in answer “b” might be appropriate later, if the couple agrees to work on their marriage.