Question 1: D
Rationale: The MMPI-2 is one of the most widely used self-report inventories for the assessment of personality. Its clinical and validity scales provide information about an examinee's characteristic traits and behaviors, including symptoms, major needs, perceptions of the environment, reactions to stress, self-concept, sexual identification, emotional control, interpersonal relationships, and psychological resources.
Question 2: B
Rationale: Ego psychology focuses on adulthood development and the individual's capacity to resolve problems and deal with social realities. It also emphasizes certain tasks that people must master during each developmental stage. Although psychoanalytic theory underlies ego psychology, the latter stresses the growth and development of ego functions and processes, independent from the unconscious drives that Freud emphasized. Answer A: The development of ego functions and processes is an emphasis of ego psychology. The ego autonomous functions, for example, include memory, language, judgment, decision-making, and other reality-oriented functions. Answer C: Ego psychology emphasizes present concerns over the past; in other words, as noted above, it emphasizes adult development. Answer D: Ego psychology emphasizes the role of the social environment in either helping or preventing people from mastering certain developmental tasks important for healthy functioning.
Question 3: A
Rationale: The question says that you've met with this client once, that you've determined she needs long-term therapy for whatever problem she has presented, that her insurance covers only 10 sessions, and that she can't afford to pay even your lowest fee. These facts suggest that your best action would be to refer the client to a low-fee clinic now so that she can begin treatment with a therapist who will be able to see her for the full course of the treatment she needs. Generally, in situations in which a managed care company refuses to authorize payment for services that you believe are necessary, you should appeal the managed care (MC) company's decision and make a plan with the client to address this issue in the event that the MC company denies your appeal. This plan can include continuing treatment at a lower cost (which this client can't afford), reducing the frequency of sessions (because this client needs long-term therapy, she'd still need to pay you a fee she can't afford after the 10 sessions are up), or referring the client to a lower-fee provider. While referral should be avoided after treatment is underway and a therapeutic relationship has developed, in this case, you and the client have met only once. Answers B and C: You shouldn't see this client for therapy. Doing so would create the possibility that her treatment will need to be interrupted if your appeal to the managed care company ends up being denied. Remember, this client can't afford to pay even your lowest fee. Answer D: It would be unethical to treat a low-income client until her insurance runs out and then refer her to a low-fee community clinic.
Question 4: D
Rationale: Carbamazepine (Tegretol) is an anticonvulsant used to treat epilepsy and has also been found effective for some patients with bipolar I disorder. Individuals with bipolar I disorder who cycle rapidly (change from mania to depression and back again over the course of hours or days, rather than months) seem to respond particularly well to carbamazepine. The anticonvulsant divalproex sodium (Depakote) has also been approved by the FDA for bipolar I disorder; clinical trials have shown it to be as effective at controlling manic symptoms as lithium; it is effective for both rapid-cycling and non-rapid-cycling bipolar I disorders. Answer A: Antipsychotics, including risperidone (Risperdal), have been found to decrease hyperactivity, stereotypical behaviors, withdrawal, and aggression in some people with autism. Some other antipsychotics that have been approved by the FDA for this purpose include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). (Only risperidone has been investigated in a controlled study of adults with autism, however.) Answers B and C: Studies have found that for people with autism, certain antidepressants - fluoxetine (Prozac), clomipramine (Anafranil), and fluvoxamine (Luvox) - may reduce the frequency and intensity of repetitive behaviors and may decrease irritability, tantrums, and aggressive behavior. And in some children with autism, these medications may also improve eye contact and responsiveness to others.
Question 5: A
Rationale: "Acculturation" refers to a process of change that occurs when two cultures come into contact. For an individual, acculturation occurs when he or she adopts the cultural traits (e.g., beliefs, attitudes, values, language) of his or her new culture. Most contemporary models of acculturation emphasize that it is an ongoing process, involving both adopting the traits of the "mainstream" society and giving up the traits of the indigenous culture. These aspects of acculturation are not necessarily correlated, however: An individual can adopt the traits of the dominant culture without abandoning the traits of his or her native culture. Note, too, that some experts suggest that the best possible outcome of acculturation is the ability to function well in both one's culture of origin and the dominant (mainstream) culture. In order to become "biculturally competent," immigrants need the following: knowledge of the new culture's beliefs and values; a positive attitude toward both cultures; the belief that they can live happily and successfully in both groups without compromising their sense of cultural identity; supportive and reliable social networks in both groups; a broad range of culturally and situationally appropriate behaviors and roles; and communication competency.
Question 6: B
Rationale: Because this question is presented as a clinical case, you may have evaluated the answers according to their clinical benefit for the client. The primary issue, however, is confidentiality. The question doesn't indicate that you have permission from the client to speak to her ex-husband. The rule is that you should not even acknowledge to a caller that you are (or are not) seeing a particular person in therapy unless you have prior permission from your client to speak to the caller. Thus, you should refuse to discuss anything with your client's ex-husband. Answers A, C, and D: These actions would either reveal or confirm to the caller that the woman is your client, which would violate her confidentiality. You are obligated to keep not only the content of therapy confidential, but also the fact of the therapeutic relationship (i.e., the fact that someone is or is not your client).
Question 7: B
Rationale: "A" and B" both have merit. Given the presenting problem, however - a conflict between the client and members of her family - "B" would be the most useful area to explore initially. Arranged marriages are fairly common in Arab societies, but the client is resisting her father and grandfather's request. Several patterns found in traditional Arab or Arab American families may play a role in the client's presenting problem, her perception of it, and her approach to resolving it, and it would be useful for the social worker to understand the extent to which these are operating in the client's family. Some of the cultural features that may be influencing this problem include the following: (1) Arab societies are "high context," which means that they emphasize the collective over the individual - i.e., a strong sense of obligation to the family is expected to override one's individual preferences. (2) A high value is placed on respecting one's elders, and adults are considered to be the source of wisdom and authority. (3) Arab societies tend to be patriarchal - the father is the head of the family and the legitimate authority for all family matters; the father, in turn, is subordinate to his own father, who in turn defers to the head of the clan. (4) The family unit is paramount and family members tend to be highly involved with one another ("enmeshed"). Individuals are raised to depend on their family for support, and both nuclear and extended family members are consulted when one has a problem or crisis (this client, however, appears unable to rely on her family at this time). (5) A key part of the kinship structure in Arab societies is the "hamula," which includes several generations in a patrilineal line that have a common ancestor. (See, Alean Al-Krenawi, Culturally Sensitive Social Work Practice with Arab Clients in Mental Health Settings, "Health and Social Work," February 1, 2000.) Answer A: While also important, this assessment is more narrow than the one in "B." In addition, one key aspect of gender-role definitions is encompassed by "A" - the fact that the client's father is probably in charge of the household and that he, in turn, probably defers to his own father. Regarding gender roles, gender differences in Arab societies do tend to be strong: A woman's social status is usually dependent on being married and raising children, especially boys; in a traditional Arab family, the women are expected to devote a lot of their time to caring for family members; and even women with careers may defer to their spouses or families for major decisions (Al-Krenawi, 2000). Answer D: In providing treatment to Arab clients, social workers should consider the clients' levels of acculturation. As in this case, common sources of family conflicts for Arab clients are issues such as arranged marriages and children's social activities, and this is particularly true when acculturation differs from one family member to another (Al-Krenawi, 2000). In this case, however, gathering information about the client's family and its values will provide more useful data initially: The question essentially tells you that the client is probably more acculturated than her parents and grandfather - the father and grandfather are exerting their authority on the subject of her marriage and she is resisting it.
Question 8: B
Rationale: In this example, an event outside of the study, impacted participants’ responses from only one of the groups (the more affluent neighborhood). For this reason, this threat to internal validity can be identified.
Question 9: C
Rationale: In this situation, the student attempting to inappropriately touch a peer as well as experiencing enuresis are potential warning signs of having experienced sexual trauma. When working with children who adults or staff may not know a lot of background information about, it is best practice to come from a trauma-informed lens. Answer A is a consideration and perhaps a second-best answer if there were not reason to suspect sexual abuse. Answer B is inaccurate and can be eliminated. There is no significant evidence in the case to support answer D and should also be eliminated.
Question 10: B
Rationale: Although she is stretched thin, the fact that the child’s mother is deeply engaged in his care indicates that he has a strong support system. This is a likely protective factor that indicates positive outcomes for him long-term. A is not correct; many studies indicate that having a family member involved in the justice system is a risk factor rather than a protective factor for children. Simple having siblings (D) is not a protective factor unless their close relationship helps provide a strong support system for the child. There are not enough details here to choose this response, just as C is not the best answer because although strong social skills are a protective factor, there is no way to draw conclusions about this child’s social skills from the information provided.
Question 11: A
Rationale: Social workers using a brief therapy model adopt a strengths perspective, which means they recognize that both the social worker and the client possess resources that can be used during treatment to facilitate change. The client is presumed to have resiliency, knowledge, abilities, and coping and problem-solving skills: She is temporarily stuck or overwhelmed and unable to fully use her own strengths, and the social worker's role is to help her access and use these resources so that she can move forward and find solutions. This assumption has been described by the term "utilization," which refers to conducting the work with what the client brings. Other key tenets of this model include the following: The relationship is collaborative and avoids hierarchy; the social worker's role is to be an active and engaged participant; and the goal is to empower the client. Answer C: Measurable goals are the key focus of brief therapy. Goals should be small steps toward an end and meaningful to the client, and measures should be used before, during, and at the end of treatment to document progress. Answer D: This refers to "expectancy," which is a key part of the brief therapist's stance. The objective is to set the client up for a self-fulfilling prophecy.
Question 12: D
Rationale: The fact that the parents are paying for the client's therapy does not afford them any special access to confidential information about the client; instead, you should make information available to the parents only at the client's request or when the client has consented to have it released at the request of another and only when disclosure is in the client's best interests. At the beginning of your relationship with this client, you should have clarified with the client and her parents the conditions surrounding the release of confidential information to the parents. Answer A: The client holds the privilege, not her parents (whether or not they are paying your fee).
Question 13: B
Rationale: Your response is basically a more concise version of what the client has just said. A paraphrase restates the essence of a client's message - it is a selective restatement of the main idea that resembles the client's statement but is not identical to it. Particularly when they are used with responses that highlight the client's feelings (such as empathic responses), paraphrases are effective for encouraging the client to continue expressing herself. They are also useful for bringing focus to an idea or a situation that you'd like the client to consider.
Question 14: C
Rationale: Therapists should allow adult clients who are being abused by an intimate partner to set their own time-frame for freeing themselves from the abuse. In the meantime, these clients should be provided with education about ways of better protecting themselves from additional violence. Because this client is at risk, you should begin your work with her by helping her establish greater safety for herself (e.g., developing an escape plan) and offering her relevant education and resources. Taking appropriate steps to address potentially serious safety concerns affecting your client is always a priority in therapy.
Question 15: D
Rationale: This situation doesn't sound like one that would prevent the social worker from working with this client, so a referral doesn't seem necessary. Instead, the best way for the social worker to remedy this situation is to educate herself (e.g., read about the behavior in question and learn about its meaning within the client's culture). NASW's Code of Ethics (Cultural Awareness and Social Diversity) states that social workers are obligated to get education to improve their knowledge and skills.
Question 16: B
Rationale: Crisis theory proposes that individuals in crisis will pass through a predictable response sequence, and that this response can be interrupted or changed through education and assistance with developing more adaptive coping behaviors. An important goal of crisis intervention is to help clients learn more effective coping behaviors so that they will be able to respond more adaptively to future crisis situations. Answer A: Addressing a client's emotions, including the overwhelming ones, is a part of crisis intervention; crisis theory and crisis intervention, however, also emphasize the cognitive and behavioral elements of a crisis. Answers C and D: Crisis theorists do suggest that crisis intervention is more effective when clients come to understand the crisis situation (e.g., how their behavior may have affected the crisis). Crisis theory does not predict, however, that either the resolution of internal conflict or the development of insight is a necessary condition for effective treatment of people in crisis (for "problem-solving" ["C"] or "change" ["D"]).
Question 17: C
Rationale: Single-subject designs (e.g., ABAB design, multiple baseline design) study the effects of a treatment on the behavior of one subject. They differ from group designs in two primary ways: the number of subjects used and the use of repeated measures of the dependent variable during baseline and treatment phases of the study. In a single subject research design, the subject serves as his or her own control. In other words, the subject serves as his or her own comparison group - i.e., the subject's performance during the baseline (no treatment) phases is compared to his or her performance during the treatment phases.
Question 18: A
Rationale: Social workers using a brief therapy model adopt a strengths perspective, which means that they recognize that both the social worker and the client have resources that can be used during treatment to facilitate change. The client is presumed to have resiliency, knowledge, abilities, and problem-solving and coping skills - she is temporarily stuck or overwhelmed and unable to fully use her own strengths, and your role is to help her access and use these resources so that she can move forward and find solutions. This assumption has been described by the term "utilization," which refers to conducting the work with what the client brings. Answer C: Measurable goals are the key focus of brief therapy. Goals should be small steps toward an end and must be meaningful to the client, and measures should be used before, during, and at the end of treatment to document progress. Answer D: This refers to "expectancy," which is a key part of the brief therapist's stance. The objective is to set the client up for a self-fulfilling prophecy.
Question 19: B
Rationale: Functional analysis is a key part of behavioral assessment used to evaluate the target behavior itself and the stimuli that precede it (antecedents) and the consequences that follow and maintain it. The common term for these antecedents and consequences is "contingencies" - i.e., a behavioral therapist is interested in determining the stimuli and situations upon which the target behavior is contingent, and a goal of behavior therapy is to manipulate these contingencies in order to change the behaviors associated with them. In other words, functional analysis allows the therapist and the client to determine how the target behavior can be predicted and controlled - for example, the analysis can show what changes in antecedent stimuli would result in a change of the behavior.
Question 20: C
Rationale: Kadushin and Harkness ("Social Work Supervision," 4th Edition, 2002, p. 454) provide the following definition of peer group supervision: "A group of professionals in the same agency meet regularly to review cases and treatment approaches without a leader, share expertise and take responsibility for their own and each other's professional development and for maintaining standards of [agency] service." The peer group controls the meetings, and, if a supervisor attends the meetings, he or she is just another member of the group. Social workers attending the meetings decide for themselves what to do with the suggestions and advice offered by their peers.
Question 21: B
Rationale: "B" demonstrates your concern about the client's problems and needs and also conveys to her that her feelings about her situation are normal. It's also an example of the skill called "putting a client's feelings into words" which involves articulating what a client is apparently feeling but has stopped short of expressing in words. Its purpose is to give the client a supportive invitation to verbalize what she is feeling but is reluctant to say out loud.
Question 22: A
Rationale: Social isolation increases the likelihood of an elder being preyed upon by people willing to take advantage of their loneliness. Many elders come from a background where it is considered rude to hang up the phone on a telemarketer, or to be suspicious of unfamiliar people. Cognitive changes that occur with many elders may mean that they are less able to handle their own affairs, leading to their turning to someone else, scrupulous or unscrupulous, to manage their finances. And, poor physical health contributes to dependency and potential vulnerability. ing adult children might protect an elder against financial exploitation (B), however, it may not necessarily do so, as sometimes adult children are the ones doing the exploiting. Predatory lending and theft of services are types of financial exploitation (C), not risk factors. Being on a fixed income does not necessarily increase an elder’s vulnerability to exploitation, however, all the other elements in the answer D are risk factors.
Questions 23: C
Rationale: As a social worker, you are concerned with a client's entire person-in-situation configuration. Because this client is African American, it's possible that his problems, needs, or concerns are related in some way to experiences he has had with racism. Answer B: This may be true, but "C" is better because it explains how discussing these issues can facilitate the treatment process. Answer D: This is a "truism" that doesn't offer a reason why discussing these issues can facilitate treatment.
Question 24: D
Rationale: Short periods of silence during an interview don't always require you to intervene. Your decision about whether and how to break a period of silence depends on the situation and the client. In this case, the client's passive refusal to cooperate with you is part of a behavioral pattern that he also demonstrates in other interpersonal situations. You should help the client recognize that he is also demonstrating this pattern with you and explore effects on himself, his relationships, and other people. Answer A: This is an appropriate response to some silences, but it's not the best approach in this case. This client's silence appears to be related to a pattern of behavior, rather than to an emotional reaction to something that just happened in the session. Answer B: You should avoid being drawn into a pattern in which you ask questions and a client repeatedly refuses to answer or changes the subject. In this case, simply encouraging the client to talk is likely to feed into his pattern of passively refusing to cooperate. Answer C: This can be an appropriate way to address silence caused by a client's resistance, but the approach in "D" better addresses the problem described in this question.
Question 25: D
Rationale: Assimilation occurs when individuals change their thinking and behavior to fit their social milieu (i.e., when they are absorbed into a new culture). For Berry and colleagues (1987), assimilation is one of four possible acculturation modes (or statuses); and it occurs when a person accepts the majority culture while relinquishing her own culture.