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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 8 of 33

141.

Use the following case study to answer this question.

Diagnostically, is trauma necessary for a diagnosis of schizoid personality disorder? 

  • No, trauma is not a diagnostic criterion for schizoid personality disorder 

  • Yes, trauma is a diagnostic criterion for schizoid personality disorder 

  • Not unless the trauma can be linked to specific symptomology 

  • Yes, if the trauma has come from a close family member in the home of origin 

Correct answer: No, trauma is not a diagnostic criterion for schizoid personality disorder 

Schizoid personality disorder does not have a criterion specifying traumatic involvement of any kind to establish a diagnosis. What is diagnostic to this disorder is the pattern of lack of social interest, solitary life and activity, and flattened affect.

142.

Use the following case study to answer the question.

The client wants to know how long it will take therapy to be effective. What is the most ethical response?

  • "Everyone is a little different, and your effort is a major factor."

  • "Therapy is guaranteed effective in most cases, but it takes time."

  • "No one really knows, and it's actually up to you."

  • "What we do together will help you in the short term."

Correct answer: "Everyone is a little different, and your effort is a major factor."

Clients sometimes want to know details of therapy that it may be difficult to state, such as how long it will take to be effective. Rather than promise results, or overemphasize the idiosyncrasies of all therapeutic relationships, it would be best to be both honest about outcomes and candid about how important the client's effort is likely to be. 

The other responses do not meet these conditions. 

143.

Use the following case study to answer this question.

If you were to follow up with this client a month after discharge, what would be the most reliable indicator that counseling helped? 

  • The client reports a decrease in symptoms of distress 

  • The client reports having a significant other 

  • The client reports doing better at work 

  • The client reports that he has joined a bowling league 

Correct answer: The client reports a decrease in symptoms of distress 

Each choice presents a desirable outcome for the client. However, rather than individual signs of progress that may or may not be sustainable in seeking out relationships with groups or individuals, the client's report of a generalized decrease in symptoms of distress due to his social anxiety would be the most reliable indicator that counseling has worked. 

144.

Use the following case study to answer this question.

Why is the reward system for eating edible food a behavioral strategy? 

  • Because it deals with rewarding specific behavior

  • Because it addresses substance use indirectly

  • Because it suggests positive behavior

  • Because it addresses the client's thoughts 

Correct answer: Because it deals with rewarding specific behavior

Behavioral strategies deal with directly addressing the client's behavior. In this case, the behavior to be addressed is the eating of nonfood substances, and the behavioral strategy is to reward a behavior that is desired over one that is not desired.

This behavioral strategy does not address the client's substance use. Behavioral strategies do not necessarily suggest positive behavior, and in general do not address thoughts per se. 

145.

Use the following case study to answer this question.

Are seasonal symptoms sufficient to diagnose seasonal affective disorder? 

  • The client must meet criteria for major depression during specific seasons

  • The client need only meet five symptoms during specific seasons 

  • The client only need meet three symptoms during specific seasons 

  • The client must only have seasonal criteria in the specific season 

Correct answer: The client must meet criteria for major depression during specific seasons

The diagnosis of seasonal affective disorder addresses a major depressive episode that takes place at a certain time of year. It therefore must meet clinical criteria for major depression but the symptoms are tied to that time of year.

146.

Use the following case study to answer this question.

Given this client's diagnosis, are they still protected under HIPAA for this episode of care? 

  • Yes, they have equal protection under HIPAA

  • No, due to the diagnosis of factitious disorder 

  • No, due to their overuse of medical resources 

  • Yes, they are protected by a special waiver 

Correct answer: Yes, they have equal protection under HIPAA

Persons with factitious disorder who present for treatment are due the same protections under HIPAA as any other client seeking treatment. 

There is no special waiver involved, and this protection is not contingent upon their disorder or their overuse of medical resources. 

147.

Use the following case study to answer this question. 

If you were in supervision during the time of these sessions, could you discuss this client with your supervisor?

  • Yes, without divulging personal details 

  • No, it would violate supervisory ethics

  • Yes, as supervisory contracts protect client information 

  • No, you cannot discuss the client's case

Correct answer: Yes, without divulging personal details 

As a counselor in supervision, it will sometimes be necessary to use case examples or work experience as learning opportunities in supervision. In general, this is permissible as long as confidentiality is assured for the client, meaning no personal details would be shared.

Sharing cases does not violate supervisory ethics, but supervisory contracts would not cover the disclosure of personal details of clients. 

148.

Use the following case study to answer this question. 

The client decides they want to do social skills training "their own way" and becomes agitated when you express reservations. You suspect that this is a strategy to avoid doing social skills "homework." 

What should you do?

  • Educate about the purpose of a treatment plan

  • Stop treatment and refer the client 

  • Accept the client's recommendations

  • Wait until a later session to address the issue 

Correct answer: Educate about the purpose of a treatment plan

If it is suspected that the client, for whatever reason, is avoiding adherence to a treatment plan, it will be important to discover why this might be. In some cases, the treatment plan will need revision, which should take place with the client's input. However, many clients will try to find ways not to adhere to a treatment plan for whatever reason; they might not like the structure, they may not be ready for the effort, or their illness itself may pose challenges. Treatment should not be stopped, and the client's recommendations in this case should be examined carefully to see if they are a way to avoid doing things the client finds challenging. 

The client should be educated about the purpose of a treatment plan in the context of their services. 

149.

Use the following case study to answer this question.

Which of the following is the most important to establish during the initial interview?

  • Therapeutic rapport 

  • Presenting problem 

  • Social supports 

  • Therapeutic history 

Correct answer: Therapeutic rapport 

There are many objectives during an initial interview, and every client is somewhat different. However, the necessity of establishing some kind of therapeutic rapport is the most important task to accomplish for a few reasons. First, without the establishment of this rapport, the research seems clear that therapy will be far less effective and may end early as the client seeks out someone with whom they have a connection. Second, establishing therapeutic rapport will make every other important task easier, such as intervention, treatment planning, and information gathering.

Understanding the presenting problem, assessing social supports, and going into the client's therapeutic history are all important as well, and most often take place within the initial interview. However, none of these is as important as the initial establishment of rapport.

150.

Use the following case study to answer this question.

Should this patient be referred to another level of care? 

  • No, as there is no need for inpatient care 

  • Yes, as the client may become dangerous

  • No, as the client has met his goals

  • Yes, as the client needs medication support 

Correct answer: No, as there is no need for inpatient care 

The decision to transfer to another level of care hinges on the patient's safety and ability to meet treatment plan goals. At this time, though negative consequences have occurred due to the client's past behavior, improvement has been noted. The client does not appear to present any safety issues at home or in school or with peers, therefore outpatient care is very likely the best fit at the current time.

There is little evidence to suggest the client might become dangerous. The client meeting his goals is not enough to discount another level of care if safety issues are present. At the current time, no medication support is indicated.

151.

Use the following case study to answer this question.

Which of the following would be the most relevant question to ask during a cultural formation interview of this client? 

  • "What can you tell me about military culture?" 

  • "Can you tell me about the experience of being white?"

  • "What has being divorced been like for you?"

  • "Do you have trouble connecting with your children?"

Correct answer: "What can you tell me about military culture?" 

A cultural formation interview is meant to address cultural influences in the client's life and to inform a more educated perspective on the part of the counselor. In this case, the most significant, specific known cultural influence on the client is that of his membership in military culture. Especially if the counselor does not share this culture, it will be important to find out more about how it has affected the client.

The experience of being white, divorced, and having college-age children all contain cultural components, but none of these is as likely to have had a specific cultural effect as the client's membership in military culture. 

152.

Use the following case study to answer this question.

What would be an example of a negative symptom a client with schizophreniform disorder might have?

  • Loss of interest in activities 

  • Psychomotor agitation

  • Oddities of cognition 

  • Inappropriate social cues 

Correct answer: Loss of interest in activities 

Negative symptoms of disorders such as schizophreniform disorder are such things as a loss of interest in activities previously enjoyed, social withdrawal, and affective flatness that is not the result of medication. 

Psychomotor agitation, oddities of cognition, and inappropriate social cues are not negative symptoms. 

153.

Use the following case study to answer this question. 

Does the pace of the change of the client's "alters" invalidate the diagnosis?

  • No, as changes in personality are highly variable

  • Yes, as the pace of change should be no quicker than once a month 

  • No, as changes in personality are random

  • Yes, as the pace of change should be no quicker than once every six months 

Correct answer: No, as changes in personality are highly variable

There is no standard, accepted rate of change between individual "alters" in the presentation of a client suffering from dissociative identity disorder. The way a personality shifts with such a client is highly idiosyncratic and may be a response to stress, circumstances, relationships, or other stimuli.

154.

Use the following case study to answer this question.

How would you respond if this client accuses you of misusing their information during a session?

  • Empathize with their concern and patiently engage 

  • Deny the accusation and continue with the session

  • Show agency policy about HIPAA

  • Ignore the accusation, as it is symptomatic of illness 

Correct answer: Empathize with their concern and patiently engage 

Persons suffering from paranoia, either as part of an established paranoia diagnosis or some other, require a great deal of patience and empathy. With this type of client, trust is very difficult to establish and maintain. It is important to engage with the client in an empathetic way, as this may defuse some of the paranoia and help build the relationship of trust that is the key to success. 

It will not be enough to offer a rote response about HIPAA as one might to a casual question about this issue from a different type of client. It is exactly because of the type of illness this person has that one should not ignore the accusation. One should not gloss over the accusation by a simple denial; the trust that emerges from a thoughtful and empathic response to this paranoid client may be of more value than anything planned for the session in terms of psychotherapy per se.

155.

Use the following case study to answer this question.

How would you diagnose the client's use of substances?

  • As a separate diagnosis, given qualifying criteria 

  • It would not be diagnosed at this time 

  • As part of the schizoaffective diagnosis 

  • The client only has a substance use issue 

Correct answer: As a separate diagnosis, given qualifying criteria 

It is not uncommon for clients to present with co-occurring disorders. Depending on the policy of the jurisdiction and the agency, reporting requirements and procedures may vary; but a substance use diagnosis would be important to establish on its own, given qualifying criteria. 

It would not be undiagnosed, and there is no specifier under the schizoaffective diagnosis for a substance use issue. The client has more than a substance use issue at this time. 

156.

Use the following case study to answer this question. 

Which of the following would be a special risk to this client's treatment plan compliance? 

  • The client's own motivation for treatment is unclear 

  • The client is using substances 

  • The client may enter crisis at any moment 

  • The client will likely terminate treatment prematurely 

Correct answer: The client's own motivation for treatment is unclear 

In this case, the client's own motivation for seeking treatment is unclear, except in that she wishes to please another by engaging in it. Treatment plan compliance is therefore at risk, as the client's own desire for treatment seems attached to the wishes of another. 

It's unclear from the information given whether or not the client is using substances, and there is no special indication the client is about to be in crisis. The client may or may not end treatment prematurely, but their motivation (or lack of it) will determine treatment plan compliance. 

157.

Use the following case study to answer this question.

Is this client distressed more in the first or the second session?

  • There is more distress in the second session

  • There is more distress in the first session 

  • The two sessions are equivalent 

  • There is more distress at intake 

Correct answer: There is more distress in the second session

This client is more distressed in the second session, as we know he just experienced a distressing event that has exacerbated the already existing problems with sleep, which has apparently given him a degree of guilt as well as anxiety.

The client does not appear distressed as much in intake and the second session, where there is merely gaze avoidance and various signs of fatigue. 

158.

Use the following case study to answer this question. 

What would be the most likely expression of transference in this client?

  • A rigid understanding of the process of therapy 

  • A lack of treatment adherence 

  • An overcommitment to recovery 

  • A pervasive feeling of sadness 

Correct answer: A rigid understanding of the process of therapy 

Clients with obsessive compulsive personality disorder (OCPD) are prone to rigid understanding of rules, schedules, and commitments. Transference, when the client brings in "extra" feelings from other relationships, is most likely in this case to manifest as a rigid understanding of the process of therapy and irritation with items that seem vague or ill-defined. 

OCPD is not as likely to result in a lack of treatment adherence, an overcommitment to recovery, or a pervasive feeling of sadness. 

159.

Use the following case study to answer this question.

What would be the point of exposure therapy for this client? 

  • To reduce separation anxiety through desensitization 

  • To create space for the child to speak on their own 

  • To distance the child from the parent 

  • To discover the stress tolerance of the child 

Correct answer: To reduce separation anxiety through desensitization 

Exposure therapy can take many forms, one of which would be the exposure of this child to the carefully managed circumstance of separation from his father. This would be done in such a way as to create at each stage a sense in the child that they can handle the separation, and thus reduce the separation anxiety through desensitization. 

The point of exposure therapy in this case would not be to create space for the child to speak on their own, to distance the child from the parent, or to discover the stress tolerance of the child. 

160.

Use the following case study to answer this question.

What is the most likely course of malingering?

  • The client will either get their needs met or terminate therapy

  • The client will manifest a different disorder

  • The client will attempt to be involuntarily committed

  • The client will continue treatment

Correct answer: The client will either get their needs met or terminate therapy 

Malingering is defined as the manufacture of symptoms in order to avoid something, such as work, or for gain, such as insurance fraud or some other motive. The most likely course of events for such a client is that they will either get their needs met or terminate therapy altogether.

Such patients will most likely not manifest a different disorder, and they will most likely not wish to be involuntarily committed. If they continue treatment, it will be for the sole motive of meeting whatever need they have.

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