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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 9 of 33

161.

Use the following case study to answer this question.

You begin to feel as though the client has romantic feelings for you. How would you respond?

  • By addressing the issue openly 

  • By waiting for the client to address it

  • By ignoring the issue

  • By referring to a different therapist 

Correct answer: By addressing the issue openly 

Clients sometimes develop romantic feelings for their therapists. This expression can have many underlying causes, but if it is going to affect the therapeutic process, it is probably best to address the issue openly so that it can be dealt with in some way.

Referral to a different therapist may not be necessary. The important point is to supportively call attention to anything that can affect the treatment process.

162.

Use the following case study to answer this question.

What would be a response to the client in the second session that would indicate genuineness?

  • "I don't think you're making anything up, and I don't think you're crazy."

  • "Where did you have an opportunity to try the breathing technique?"

  • "Body and mind are mysterious things."

  • "What you're experiencing isn't actually real."

Correct answer: "I don't think you're making anything up, and I don't think you're crazy."

A response indicating genuineness should address the immediate concerns of the client as reflected in their intensity. In this case, it is best to immediately address the client's feeling of being "crazy" and untruthful, as neither of these things is actually true. 

The other responses do not meet the client where they are immediately concerned, or might confuse the client.

163.

Use the following case study to answer this question.

What does the client's self-report indicate about possible therapeutic direction? 

  • The client indicates there is family conflict causing stress 

  • The client's self-report does not indicate any therapeutic issues 

  • The client indicates he is lonely and in need of friends 

  • The client's self-report indicates a desire for employment 

Correct answer: The client indicates there is family conflict causing stress 

Though it is not always possible to take a client's word for it as to their own issues, it is always important to hear what is important to the client in their own words. In this case, there is some indication that there is family conflict causing stress to the client, who, by his own self-report, simply wants to be accepted for how he likes to live. 

The client has not indicated that he is lonely or that he is in need of employment. 

164.

Use the following case study to answer this question.

To which other disorders is disruptive mood dysregulation disorder most congruent? 

  • Oppositional defiant disorder 

  • Conduct disorder 

  • Antisocial personality disorder 

  • Intermittent explosive disorder 

Correct answer: Oppositional defiant disorder 

Disruptive mood dysregulation disorder (DMDD) is a new disorder, but it is most like oppositional defiant disorder and bipolar disorder in its overall presentation and symptomology.

DMDD does not share the same diagnostic similarity as conduct disorder, antisocial personality disorder, or intermittent explosive disorder.

165.

Use the following case study to answer this question.

How many personalities does one need to have in order to qualify for the disorder? 

  • At least two

  • At least three 

  • No more than four 

  • No more than six 

Correct answer: At least two 

In order to be diagnosed with dissociative identity disorder, the number of manifested personalities must be more than one. There is no established upper limit to the number of personalities one might have with this disorder. 

166.

Use the following case study to answer this question.

What do you make of the client's relative silence in the second session?

  • Without more information, it is impossible to draw conclusions

  • The client does not have ADHD

  • The client is being abused by the father

  • The client is not willingly adhering to the plan of intervention

Correct answer: Without more information, it is impossible to draw conclusions

The client is relatively quiet in the second session, but we do not know why. This relative silence could be from any number of factors; the client might simply be shy, the client may not be happy about being in therapy, the client may not like the counselor, and so on. Without more information, it is impossible to draw any conclusions, such as the belief that the father is abusing the child.

The client is adhering to the plan of intervention, and it seems to be working. Diagnostically, the client clearly seems to have ADHD.

167.

Use the following case study to answer this question.

Which of the following would not be a cognitive behavioral strategy with this client? 

  • A system of rewards for managing behavior

  • Relaxation techniques

  • Identifying patterns of anger

  • Exploring distorted thinking patterns

Correct answer: A system of rewards for managing behavior 

Cognitive behavioral therapy (CBT) is a treatment technique that attempts to identify the relationship between a client's thinking and their emotions, with a view toward greater control of both. In this case, a system of rewards for managing behavior would be more like a behavioral plan in tune with behavioral therapy.

The rest of the items listed would be congruent with CBT.

168.

Use the following case study to answer this question.

Which of the following would be most congruent with a cognitive behavioral approach to intervention in this case? 

  • Identifying and changing negative thoughts 

  • Developing coping skills 

  • Developing communication skills 

  • Exploring past traumatic issues and their influence 

Correct answer: Identifying and changing negative thoughts 

Cognitive behavioral therapy (CBT) is concerned with the relationship between thoughts and feelings and the ability to take control of the interaction between thinking and emotion. Identifying and changing negative thoughts would be congruent with this approach.

Developing coping skills, communication skills, and exploring past traumatic issues and their influence would not be as congruent with CBT.

169.

Use the following case study to answer this question.

What is the appropriate next step for this patient after hospital discharge?

  • Continued treatment to address his traumatic issue 

  • It should be up to the client and his husband 

  • Further treatment for florid psychosis 

  • Self-help resources in the community 

Correct answer: Continued treatment to address his traumatic issue 

When this patient releases, the psychosis will most likely be resolved or mitigated sufficiently with medication. The underlying cause of the psychosis will still likely need clinical attention, and treatment for this should continue. Ultimately, the issue will be decided by the client and his husband, but the appropriate next step in treatment is further attention to the traumatic loss. 

Self-help resources are appropriate, but not as important as continuing to address the issue that provoked inpatient admission.

170.

Use the following case study to answer this question.

Is helpful intervention possible when confronted with malingering?

  • Yes, in which case, it is no longer malingering

  • No, those engaged in malingering do not need help

  • Yes, malingering is treatable

  • No, those engaged in malingering are pathological liars

Correct answer: Yes, in which case, it is no longer malingering 

It is possible that a person engaged in malingering may have an underlying issue that may come out during treatment and could be addressed. However, in that case, the situation has changed, and the person is no longer malingering but engaged in a helping process about the real issue. 

Those engaged in malingering may or may not need help; as malingerers, however, they are not honestly seeking it. Malingerers may or may not be pathological liars; but malingering, in itself, contains no psychopathology. Malingering is not treatable, as it is not really a mental illness.

171.

Use the following case study to answer this question.

Is this client in current danger from suicide?

  • It is impossible to tell without the client's input

  • Yes, the client is in imminent danger of self-harm

  • No, the client seems to be stable

  • No, the client has denied suicidal ideation 

Correct answer: It is impossible to tell without the client's input

There is no way to tell if a client is currently feeling suicidal without some form of input from the client. Though the client shows signs of euthymia in the second session, he still is clinically depressed, with all of the attendant risk factors. Suicide can, in some contexts, be an impulsive decision. It is best to assess this issue in some way with frequency, particularly with those clients who pose heightened risk.

172.

Use the following case study to answer this question.

To what degree should you document your conversations with this child's mother?

  • As much as the client 

  • You should not document these conversations 

  • You should only document conversations about school 

  • Whatever the mother agrees to

Correct answer: As much as the client 

In cases where the client has a support system that is integral to their care and is actually in sessions, as in this case, or in cases where a significant other is functioning as guardian in some way, it will be necessary to document those conversations in the same detail as one would with the client. 

This documentation should not only have to do with matters related to school, and it is not a matter of what the mother agrees to per se, if all the proper notifications and releases are in order. 

173.

Use the following case study to answer this question. 

Would you share your MSE findings with this client? 

  • Yes, as it may help the client make decisions 

  • No, as an MSE is too clinical in nature 

  • Yes, as the client has a right to the information 

  • No, as the client may react badly to findings

Correct answer: Yes, as it may help the client make decisions 

The Mental Status Exam (MSE) is a clinical snapshot of how the client appears at the current time. Though not explicitly designed as a therapeutic tool, its findings can be shared with clients, as should the data from other assessments, if the counselor feels it will help the client make decisions.

An MSE is not too clinical to share with a patient. Though they do have the right to most of the information used in therapy, this is not the reason to offer a client the results of the MSE. A client may or may not react badly to findings, but the findings should be shared if they will benefit the client. 

174.

Use the following case study to answer this question.

Which of the following is most likely to be a cultural issue affecting this patient's treatment?

  • Her family's lack of acceptance 

  • Her feelings about pharmaceuticals

  • Her specific coping strategies

  • Her attitude toward therapy 

Correct answer: Her family's lack of acceptance 

There are many layers of cultural issues that can affect the treatment of clients. In this case, one possible cultural issue is this client's family's lack of acceptance of mental illness. This may or may not be a reflection of Asian culture, but it is definitely part of the family culture in which she was raised. 

The client's individual feelings about pharmaceuticals, her specific coping strategies, and her attitude toward therapy probably do contain some degree of cultural influence, but in this case, the most clear cultural influence on the client's treatment is a family attitude about mental health. 

175.

Use the following case study to answer this question.

The client indicates that she would like a different counselor after the second session. How should you respond?

  • Probe for details, but honor the request 

  • Refuse the request, as it is too early 

  • Honor the request immediately 

  • Ask the client to wait for the next session

Correct answer: Probe for details, but honor the request 

Any client has the right to seek out a different therapist, which is something that the referring therapist must honor to the best of their ability in terms of cooperation. However, it does no harm to try to find out why the client wishes to make this choice, though the client is not obligated to provide an explanation of any kind. If the client offers you information about why they want to terminate the relationship, it may help in future interactions and may be valuable feedback for you.

You should not refuse the request even for a delay, and it might be a lost opportunity to let the client move on without trying to find out why.

176.

Use the following case study to answer this question.

If the client were undergoing dialectical behavioral therapy (DBT), which of the following would be the most likely intervention? 

  • Mindfulness 

  • Hypnosis

  • Exploration of past trauma 

  • Focus on grief 

Correct answer: Mindfulness 

Dialectical behavioral therapy (DBT) is a treatment modality focused on a skills-based intervention set including mindfulness and emotional regulation of impulsivity.

Hypnosis, traumatic exploration, and a focus on grief issues are not usually considered part of DBT. 

177.

Use the following case study to answer this question.  

What would be the best strategy to ensure compliance to the treatment plan for this client?

  • Engage the client's motivation 

  • Suspend sessions until compliance occurs

  • Change the treatment plan

  • Refer to another therapist 

Correct answer: Engage the client's motivation 

Ultimately, clients must find their own motivation for treatment plan compliance. Compliance to a treatment plan, even in involuntary settings, is always subject to the client's own sense of motivation. What would be most useful in this case is to address why the client came for help in the first place and attempt to link the mutually-agreed upon treatment goals to this motivation.

Suspending sessions would not deal with the issue of compliance at the client's motivational level. Referring to another therapist, similarly, would probably not result in compliance with an existing treatment plan. Changing the treatment plan may be necessary, but finding the client's motivation is the necessary first step. 

178.

Use the following case study to answer this question. 

Would you engage with the client's contacts as accountability partners for this client's progress?

  • Yes, if the client wishes it 

  • No, under no circumstances 

  • Yes, as the client will require monitoring 

  • No, unless the client is in crisis

Correct answer: Yes, if the client wishes it 

Clients can have good insights into their ability to commit to treatment. In some cases, the significant others or contacts of the clients can be helpful in reinforcing the goals of treatment if the client feels they will struggle. This might be especially significant in cases of ASD, in which clients might have existing resources that might be strengths and function as accountability partners.

In any case, the client is in charge of who they want to include in their treatment as part of their own life. It is up to the counselor how much to utilize these resources. The client may or may not require monitoring, but if it will be a helpful adjunct to treatment, it can be engaged in. Utlizing the client's supports can happen in or out of crisis. 

179.

Use the following case study to answer this question.

What would be the most congruent statement to the client after the second session? 

  • "I'm here to help and support you, but I need to know more."

  • "You are right, it's best to try to defend oneself."

  • "Don't try to defend yourself with force."

  • "You're experiencing psychosis. I'm sorry."

Correct answer: "I'm here to help and support you, but I need to know more."

Congruence in counseling means meeting the client where they are in terms of their distress and reason for seeking treatment. The above reply allows the client to feel supported, and solicits further information that will likely be useful to further treatment without compromising the therapeutic bond.

The other replies either play substantially into the delusion, or put the client at a distance by classifying them as psychotic.

180.

Use the following case study to answer this question.

What is the biopsychosocial issue of most interest not addressed in the information provided about this client? 

  • Substance use issues 

  • Family relationships

  • Spiritual awareness 

  • Physical illness 

Correct answer: Substance use issues 

Though all of the listed choices would be of some interest in a biopsychosocial assessment, in this case, given the client's diagnosis, one would be sensitive to the issue of substance use. Even addressing something like casual use of a substance that is used to regulate mood would give the counselor valuable information about self-medication and ancillary risks.

Family relationships, spiritual awareness, and physical illness are all important things to assess as well.

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