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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 7 of 33

121.

Use the following case study to answer this question. 

Aside from group membership, what would be the best intervention for this client? 

  • Individual psychotherapy

  • Hypnosis 

  • Medication 

  • Inpatient treatment 

Correct answer: Individual psychotherapy

Even in cases where clients are involved in group modalities, individual treatment can benefit in many ways. In this case, the client clearly has a need to process his own issues with more time than the group modality allows. He might also benefit from learning skills to manage his symptoms and other items that would take time that a group process might not allow. 

Hypnosis may or may not be indicated, but it would happen in an individual context. Medication, similarly, may be called for in cases more severe than this patient seems to be experiencing; however, like inpatient treatment, the client's own desires play a large part in determining adjunctive care. 

122.

Use the following case study to answer this question.

Is family therapy indicated for clients with dissociative identity disorder? 

  • Yes, to increase communication skills and work together better 

  • No, as these clients do not respond well to non-individual therapy

  • Yes, if the family has a history of abuse 

  • No, as these clients can only be treated with CBT

Correct answer: Yes, to increase communication skills and work together better 

When it is an option, family therapy can be indicated for clients with dissociative identity disorder. This assumes that there is a close enough relationship within the family for such therapeutic interventions to be meaningful. The focus of such therapy would be on helping the client manage their symptoms and help the family understand the client better through increased communication.

Clients with dissociative identity disorder can respond well to family therapy, and though the history of abuse would likely be a therapeutic focus of such therapy, it is not a qualification for family therapy. Clients with dissociative identity disorder do not have to be treated with cognitive behavioral therapy (CBT) alone.

123.

Use the following passage to answer this question.

Which of the following would be the most congruent statement for the therapist to make with this client?

  • "I understand how you would be very upset about what's happening to you."

  • "Can you see how it's important not to panic?"

  • "You're going to be fine. All of this will work itself out."

  • "Tell me about your children."

Correct answer: "I understand how you would be very upset about what's happening to you."

Congruence in counseling means that you are meeting the client where they are in the context of the therapeutic situation, rather than approaching with a pat agenda. It means that the client understands that the therapist is trustworthy, interested in their situation, and invested in helping them on a very basic, human level. By immediately validating the client's emotions (if not their degree or intensity), the therapist has an opportunity both to hear more from the client about what's bothering them and to establish a real connection that will foster a solid therapeutic partnership.

The other responses try to talk the client out of their feelings, fail to meet the client in their current distress, or engage the client in a tangential distraction that does not address the acute distress of the client.

124.

Use the following case study to answer this question.

Would it be unusual for a person with frotteurism to be arrested?

  • No, as the fetishistic behavior is illegal

  • Yes, as the fetishistic behavior is harmless

  • No, as persons with paraphilias generally have a high level of legal involvement 

  • Yes, as the client is not engaged in illegal behavior

Correct answer: No, as the fetishistic behavior is illegal 

One key consideration with most paraphilias, and especially in the case of frotteuristic disorder, is that the client is definitionally engaged in the violation of the rights of another by engaging in non-consentual touching. In this case, it is not unusual for this client to have been arrested due to his illegal behavior. 

125.

Use the following case study to answer this question.

Would you expect this client to be in danger due to his diagnosis? 

  • No, as he is not experiencing delusions and knows his symptoms aren't real

  • Yes, as his relational life seems to be highly volatile 

  • No, unless he also suffers from hallucinations 

  • Yes, as clients with trauma-related disorders are often suicidal 

Correct answer: No, as he is not experiencing delusions and knows his symptoms aren't real

One key to differentiating depersonalization/derealization disorder from psychotic disorders is that the client knows that what they are experiencing isn't "real"; that is, the client knows they are having a feeling about reality rather than actually experiencing an alternate reality. Delusions are fixed beliefs in the false that are unshakable.

The client's relational life appears relatively normal, and he does not suffer from hallucinations. Those with trauma-related disorders do become suicidal, but in this case the client has shown no evidence of suicidal intent. 

126.

Use the following case study to answer this question.

What additional intervention might be appropriate to add for this client after the second session? 

  • Relaxation techniques 

  • Hypnosis 

  • Mindfulness 

  • Exploration of past trauma 

Correct answer: Relaxation techniques 

As part of an overall counseling strategy for persons with seasonal affective disorder, relaxation techniques are indicated as an adjunct to other interventions that highlight control over affective factors, such as coping skills and cognitive identification and differentiation.

Hypnosis, mindfulness, and exploration of past trauma are valuable tools, but not as congruent with the existing treatment plan as relaxation techniques. 

127.

Use the following case study to answer this question.

Which of the following is likely to be this client's biggest barrier to treatment progress?

  • His lack of desire for treatment 

  • His relationship with his girlfriend 

  • His economic circumstances 

  • His symptom profile 

Correct answer: His lack of desire for treatment 

There are many barriers that can affect a client's progress in treatment. In this case, it seems that, so far, the client does not wish to be treated, having only come to the first session at the request of his girlfriend and seeming hostile to the idea of needing help in the second session. Without some grasp of his need for help, the client will not make much therapeutic progress.

The client's relationship could be seen as a strength. There is nothing in the client's economic circumstances that would preclude treatment, and his symptom profile is significant but would be expected to mitigate with treatment.

128.

Use the following case study to answer this question.

Would it be necessary to address the client's culture in this case?

  • Yes, it is important to address culture in every case 

  • Yes, as the client is Hispanic

  • No, as culture is not implicated in this diagnosis 

  • No, unless the client suggests it 

Correct answer: Yes, it is important to address culture in every case 

Aside from questions involving cultural sensitivity that should be part of every treatment, a cultural assessment of some kind is necessary in almost every case. This cultural formulation can take various forms, but the most important aspect is that it finds issues of cultural importance that may affect treatment. This is true for every client, whether or not they are part of an identified underrepresented group. It should not be left to the client to bring cultural issues to the forefront, though some may. 

129.

Use the following case study to answer the following question.

What should you take into account when dealing with this client in terms of your awareness of self? 

  • The client is sensitive to feedback and was reluctant to seek out therapy 

  • The client is masking her substance use by minimizing it

  • The client is likely experiencing substantial transference issues 

  • The client is malingering for an unknown reason 

Correct answer: The client is sensitive to feedback and was reluctant to seek out therapy 

Persons with avoidant personality disorder tend to be very reluctant to seek out therapy, and their fear of rejection and negative evaluation calls for a special sensitivity and awareness of self on the part of the counselor. What might seem like a normal comment might be evaluated by this individual in a very negative light. 

There is no indication the client is overusing substances or that they are malingering. The client may or may not have transference issues, which, if present, would further indicate a need for the counselor to carefully monitor their responses to the client. 

130.

Use the following case study to answer this question.

What would we expect to see if this patient had Conduct Disorder?

  • Criminal and aggressive behavior 

  • Argumentative and spiteful behavior 

  • Delusional and isolative behavior 

  • Labile moods and substance use 

Correct answer: Criminal and aggressive behavior 

What differentiates Conduct Disorder from Oppositional Defiant Disorder are aggressive and criminal behaviors, such as setting fires, vandalism, or assault. If this client had struck their teacher or acted vindictively in a criminal way toward that teacher, then a Conduct Disorder diagnosis would be entertained. In this case, there is argumentative behavior but no overt acts of violence directed at persons or property.

Argumentative and spiteful behavior would fall into the diagnostic arena of Oppositional Defiant Disorder. Delusional and isolative behavior may point to a thought disorder. Labile moods and substance use could indicate many different kinds of disorder, but would not necessarily indicate Conduct Disorder. 

131.

Use the following case study to answer this question.

What is unique about a non-judgmental stance with this client? 

  • It can help deepen the therapeutic bond without confronting the delusion 

  • It can reduce the effects of the delusion by improving a human relationship 

  • It can provide a way to gently confront the delusion early in treatment 

  • It can help increase the client's overall self-esteem 

Correct answer: It can help deepen the therapeutic bond without confronting the delusion 

It is especially difficult in the case of clients experiencing long-term stable delusions to establish and increase the therapeutic bond without becoming involved in the delusional matrix. A non-judgmental stance helps provide a listening, neutral posture that allows for the full expression of feelings without agreeing to the substance of the delusions themselves.

Improving human relationships and the client's self-esteem are important, but a non-judgmental stance is important with delusional clients in particular ways. Confrontation of the delusions is not the goal of providing a non-judgmental stance. 

132.

Use the following case study to answer this question.

What will be the most important factor affecting this client's success in the community upon release? 

  • Coordination about medication adherence 

  • Planning for therapy in outpatient settings 

  • Reconnection with family members 

  • Establishment of job search strategies 

Correct answer: Coordination about medication adherence 

Given that the client has schizoaffective disorder, it is especially important that their way of securing and maintaining their medications is coordinated with the community mental health center or other receiving body. This is not the only issue affecting the client, but without medication to manage his most florid symptoms, progress in the other areas mentioned will be unlikely. 

133.

Use the following case study to answer this question.

What would be your response if this client were to mention suicide?

  • Clarify roles and responsibilities

  • Ignore it, as the client does not mean it

  • Notify law enforcement immediately 

  • Stop the session immediately and refer to an inpatient facility 

Correct answer: Clarify roles and responsibilities 

Any mention of suicide by a client at any time will require addressing as soon as possible. While it's true that many mentions of suicide by patients are casual and do not indicate an intent to harm oneself, it is best to approach every mention of suicide with clarity and seriousness. It may or may not be necessary to notify law enforcement or to escalate to the possibility of inpatient treatment; however, the best course of action to take immediately is to remind the patient of the counselor's obligations in this regard; i.e., the need to take any possible mention of self-harm very seriously and to intervene if necessary.

134.

Use the following case study to answer this question.

What does the client seem to be most concerned about? 

  • Her marital relationship

  • Her employment situation 

  • Her baby's health 

  • Her mental illness 

Correct answer: Her marital relationship

It seems that this client has a special worry about the effect her symptoms are having on her marital relationship, especially in light of the fact that her spouse is so supportive. It is important to address, as has been done in this case, the issue that is most important in the client's mind. 

The other issues are important to the client, but not as important as the marital relationship, given the evidence. 

135.

Use the following case study to answer this question.

Which of the following is true about the utilization of services by people with delusional disorder? 

  • People with delusional disorder may not seek help 

  • People with delusional disorder generally overuse services 

  • People with delusional disorder over-utilize inpatient treatment 

  • People with delusional disorder are generally treated for another issue 

Correct answer: People with delusional disorder may not seek help 

Part of the difficulty in treating persons with delusional disorder is that, on one level, they may not think they need treatment, as in their mind the belief is not false. When they do seek treatment, it will likely be due to their feeling overwhelmed. 

People with delusional disorder generally do not overuse services. They may or may not be treated for another issue. 

136.

Use the following case study to answer this question.

What would be the best way to find out the level of this client's motivation?

  • Through assistance with his mother 

  • By direct questioning without the mother 

  • Through a formal rating scale 

  • By consulting school records 

Correct answer: Through assistance with his mother 

Selective mutism can be rooted in social inhibition. This client is reluctant to engage with you except minimally, and then only in the presence of his mother. If it is desired to discover the level of the client's motivation, it will be necessary to engage his mother in the process. Either she can ask key questions on the therapist's behalf, or she can volunteer information she knows about what motivates the client.

The client may not be willing to complete a formal scale, and school records would likely not contain the level of data desired. 

137.

Use the following case study to answer this question.

In the second session, which would be the best way to ask about the client's lack of progress?

  • "What do you think is holding you back from making progress?"

  • "Are you getting anything out of therapy?"

  • "I'm curious as to why you haven't used the coping skills we talked about."

  • "Would you like to come back another time?"

Correct answer: "What do you think is holding you back from making progress?"

The question of possible intoxication on the part of the client aside, it is ethical and responsible to confront issues of lack of progress as soon as possible in the most compassionate way possible. The open-ended nature of the question puts the burden on the client to account for their attitude and intentions about therapy.

The other questions are too open-ended, defer the problem, or narrow the focus of the conversation too much. 

138.

Use the following case study to answer this question. 

Which of the following kinds of counseling would be most effective with this client? 

  • Behavior therapy

  • Gestalt therapy 

  • Psychoanalysis 

  • Group therapy 

Correct answer: Behavior therapy

With its focus on reward and consequence for expressed behavior, behavior therapy is one of the only treatment modalities that may work with clients who have antisocial personality disorder. 

Gestalt therapy and psychoanalysis involve too much introspection to be as effective as a treatment grounded in feedback for immediate behavior. Group therapy can be useful, but for the most part, the focus should be on helping the individual manage their own impulses.

139.

Use the following case study to answer this question.

Does the client's labile presentation rule out genuine distress?

  • No, the client can be expressing genuine distress

  • Yes, as the client's expressions are superficial

  • No, as the client's expressions are hypomanic

  • Yes, as the client's expressions are psychotic 

Correct answer: No, the client can be expressing genuine distress

In cases where a client's style appears to be more superficial and labile, it's important to keep in mind that the underlying emotions are often real. The lability and apparent superficiality of the expressed emotion does not mean that the emotions are not valid, though it may take some effort to filter out demonstration and expression from the real feelings present.

The client's presentation is neither hypomanic or psychotic. 

140.

Use the following case study to answer this question. 

Why would you address anxiety about school as part of your treatment plan?

  • To address underlying causes of pica 

  • To discover if the client is untruthful 

  • To offer suggestions about educational support 

  • To determine if she is psychotic

Correct answer: To address underlying causes of pica 

Pica can have various underlying causes, among which are pregnancy, anxiety, and unresolved childhood trauma. Though less common in adults, when it occurs in adults, it tends to have one of these presentations. Addressing the client's main source of anxiety may impact the behavior of eating nonfood substances. 

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