Download Answer Key and Rationale

Advanced/Clinical Social Work Test 1: Answer Key and Rationale
1. C is correct: Because the client has asked the social worker to provide her with help on a legal matter and for some fairly
detailed legal information, the first thing the social worker should do is explain the limits of his professional role. He should tell
the client that offering assistance or advice on a legal matter is outside 'the scope of a social worker's professional practice. ETH
Answer A: It is a good idea for the social worker to provide the client with referrals to legal assistance agencies or professionals in
the community; before doing so, however, the social worker should explain why he, himself, cannot help the client file for
divorce.
Answer B: The question implies that the client has met the goals other treatment; her interest in filing for divorce demonstrates the
need for an outside referral to a qualified legal professional.
Answer D: Though the social worker could provide very basic information about divorce laws in his state, the client needs
assistance from a legal professional in order to actually file for a divorce, which .Is what she wants to do.
2. B is correct: These interventions would best address the issues presented in this case. Exploring the man 's medical history
(including conferring with his physician) would help both the social worker and the daughter to better understand the doctor's
recommendation. For example, it is true that recent studies suggest that some people can derive medical benefits from drinking a
moderate 'amount of wine. Learning about other losses the man has experienced and how he dealt with those losses would also be
useful; for example, his low appetite might be associated with prolonged bereavement and/or a major depressive episode. And
finding out about the man's Social support system would shed light on what resources he has available for coping with loss.
ASSESS
Answers A and C: Screening for alcoholism seems less important in this case for a couple of reasons: first the man does not
appear to have a pre-ex1~ting pattern of alcohol abuse (i.e., he is "suddenly" drinking wine); second he is drinking only a
moderate amount of wine and is doing so at the recommendation of his physician.
Answer D: Though comprehensive assessment may indicate the need for grief counseling, this recommendation is premature at
this time. Moreover, this intervention does not deal with the presenting issue-the daughter's concern about her father's "overuse"
of alcohol.
3. D is correct: In choosing an answer.. it was important to rely on only information presented in the question. Generalized
anxiety disorder is characterized by excessive worry and anxiety about numerous events or activities. The worry and anxiety are
relatively constant for at least six months and the sufferer finds it difficult to control them. Additionally, the worry and anxiety are
accompanied by at least three other symptoms - rest1essness or feeling keyed up or on edge, difficulty concentrating, being easily
fatigued, sleep disturbance, irritability, and muscle tension. DSM IX
Answers A and B: The question emphasizes persistent worries and fears, rather than symptoms more clearly indicative of a mood
disorder.
Answer C: To choose this, we would need evidence that the client experienced an ongoing psychosocial stressor about a year ago
(shortly before the onset of his symptoms).
4. A is correct: Stereotypes have been defined as inflexible preconceptions that are held about all individuals belonging to
another group (e.g., another race or culture); these preconceptions develop and persist despite obvious differences between
individuals belonging to the other group. A person who holds stereotypes often distorts information about, and experiences with,
the members of another group in order to make them consistent with his or her preconceptions. Therefore, the greatest danger
associated with stereotyping is considered to be devaluation of the individual (i.e., the failure to see distinct members of another
group as unique individuals). SPEC POP
Answers B, C, and D: These also may be consequences associated with stereotyping, but each can be said to result when someone
believes that all the members of another group have the same-usually negative and inferior-characteristics.
5. A is correct: Because any intervention will be more effective if it takes place immediately after the problematic behavior, the
social worker should have the residents come to her office right away to discuss what has happened, why their behavior was
inappropriate (e.g., a violation of rules), and how to behave more responsibly in the future. PROC
Answer B: The intervention in "A" is likely to include a discussion about safe sex, but this education by itself would not be an
adequate response to this situation.
Answer C: The residents' behavior is almost certainly a violation of the shelter's rules and some form of "reprimand" is probably
in order; by itself, however, this intervention is not an adequate response to this situation.
Answer D: This is not the best first response to this situation since it does not address the issue directly with the two residents.
After the social worker has addressed this situation directly with the residents, she will, in all likelihood, inform other staff about
the incident.
6. C is correct: According to DSM-IV- TR, pedophilia is diagnosed when over a period of at least six months an individual has
had recurrent and intense sexually arousing fantasies or urges or engaged in behaviors involving sexual activity with a
prepubescent child or children. Some individuals with pedophilia (or any paraphilic disorder) experience mild to severe feelings
of shame, guilt, and depression in response to their symptomatic behavior. The depression can lead to an increase in the intensity
and frequency of the pedophilic behavior. DSM
Answer A: "C" is more likely to be true. For some pedophiles, however, the symptomatic behavior is ego-syntonic (does not
disturb them or "feel wrong"); these individuals may claim that their only problem is that others react unfavorably to their
behavior.
Answer B: Unless their disorder is associated with sexual sadism, pedophiles tend to be quite attentive to their child-victims'
needs in order to obtain their affection, interest, and loyalty, and to prevent them from revealing the sexual activity.
Answer D: Some individuals with pedophilia (the "nonexclusive" type) are also sexually attracted to adults.
7. B is correct: The question does not say why the woman is eating other patients' food. Therefore, the social worker's best
approach is to gather more information about the problem (e.g.. its duration and cause), and the best way to do this is to speak
with the woman and her husband directly. PROC '
Answers A and C: If the woman is taking other pe9ple's food because she can't afford to buy food. then these actions might
eliminate the problem; however, the social worker does not know yet why the woman is taking the food.
Answer D: Simply saying this would not get at why the woman is taking the food or address the problem in a meaningful way.
8. D is correct: "Ample resources" is the best answer offered because it is the most comprehensive. In order to achieve its program
goals, an organization must have ample (or at least adequate) resources. Organizational resources include, among other things,
executive and support staff. Volunteers, consultants, money (including funding received through support by entities who make
funding decisions), time, equipment, and office space. SOC ENV
Answers A, B, and C: Each of these is included among an organization's resources.
9. A is correct: Clozaril, an antipsychotic medication, is associated with adverse hematological side effects, including white blood
cell dyscrasia. And the manufacturers of Clozaril require, weekly white blood cell counts for patients taking the drug. (Blood
dyscrasia is a medical term referring to pathological conditions in which certain blood constituents are abnormal or present in
abnormal quantities. As occurs, for example, in hemophilia and leukemia.) DSM
10. C is correct: The client's request suggests that she may misunderstand what goes on at an interdisciplinary team meeting.
Therefore, among our choices, the social worker's most appropriate and useful action would be to clarify relevant confidentiality
issues for the client. For example the social worker could explain that only information related directly to the provision of services
to the client Is discussed at these meetings and that this information is shared exclusively with individuals who are directly
involved in her case. ETH
Answer A: This implies that the social worker would comply with the client’s request; a failure to share relevant confidential
information about the client at the team meeting would, in all likelihood prevent the social worker from fully serving the client's
needs.
Answer B: While this answer includes a true statement, it essentially dismisses the client's request; i.e., it does not describe how
the social worker would address the concerns that may underlie the client's request.
Answer D: This answer is poor for several reasons. First, this client does not want any confidential information shared at the
meeting. Second, this action does not address the client's request in any direct way and fails to explore or address' the concerns
that may underlie it. Last, a social worker would always share as little confidential information as possible at a team meeting (i.e.,
only information directly related to the delivery of services to the client).
11. B is correct: A metaphor (i.e., implied comparison) is an analogy used to describe something in a non-literal way. Social
workers themselves often use metaphors to describe and clarify for clients some of their feelings, behaviors, personality
characteristics, etc. ASSESS
Answer A: "Flight of ideas" is characterized by racing thoughts that don't seem to be connected by logic. It is characteristic of a
manic episode.
Answer C: "Hyperbole" refers to exaggeration used as a figure of speech. This woman might be exaggerating, but from a clinical
standpoint it is more important that she has used an implied comparison to express how she perceives her son-i.e, her metaphor
can help the social worker understand the boy's behavior and his mother's perception of it.
Answer D: Loose associations are associated with disorganized speech; they are marked by haphazard jumping from one topic to
another and tend to produce an incoherent stream of speech. The speech of individuals with schizophrenia, for example, may
include loose associations.
12. D is correct: The details of child abuse reporting laws vary in different states; the situation in "D," however, would be
reportable in any state because one partner is under age 14 and the other is not: sexual activity with a person under age 14,
whether the activity is consensual or forced, is always considered a form of child abuse, unless the person's partner is also under
age 14. ETH
Answer A: Non-coercive sexual activity between two people who are both under age 14is not reportable as child abuse in most
states.
13. A is correct: The key is that the question says the couple has "decided to adopt a child." In addition, the question asks what the
social worker should emphasize when working with the couple. Because the couple has already made a decision to adopt, the
social worker's primary role is to help them with the adoption process. SPEC POP
Answers B, C, and D: If the social worker emphasized why the couple wants to adopt, whether they have considered their
decision carefully, or even parenting skills training, this might suggest to the couple that he or she does not support their decision
to adopt.
14. C is correct: This question is difficult unless you understand the hierarchical position of supervisors within an agency. Some
have referred to the position of a supervisor within an agency as the "hig11est level employee" and the "lowest level manager." In
his book Supervision in Social Work, Alfred Kadushin (1985) states that supervisors are members of both management and the
work group and serve as a bridge between them. SOC ENV
15. B is correct: The question indicates that the social worker is meeting for the first time with the family. The family is
confronting a rather serious psychosocial stressor and would benefit from receiving support and guidance from the social worker.
"Reframing" 1s often effective for reassuring clients, especially at the beginning of treatment. Reassurance, in turn, is a
sustainment technique that can be very effective for reducing anxiety and offering clients a feeling of hope about their situation;
lessened anxiety and greater hope, in turn, often help to free up clients' emotional and mental energies so that they can begin to
engage in problem-solving activities. PROC
16. D is correct: The NASW Code of Ethics states that social workers should not engage in dual or multiple relationships with
clients or former clients in which there is a risk of exploitation or potential harm to the client. Dual or multiple relationships occur
when social workers assume two or more roles at the same time or sequentially with a client (e.g., in this case, the social worker
be the woman's therapist and then her employer). Whenever a dual relationship exists, there is a risk that the client (or former
client) will be exploited; primarily because of the power differential that is a basic part of the therapeutic relationship. We cannot
know the degree of risk posed in this case (e.g., we have no idea how long ago this client terminated treatment or why she was in
therapy), but in any situation that could pose a risk to a client or former client, the wisest decision is to err on the side of caution;
in this case, the social worker should not hire his former-client. ETH
17. B is correct: This action has several benefits. In addition to taking seriously the client’s reluctance to go home by affording
him housing alternatives that may feel safer to him, it also allows the client to intervene on his own behalf. PROC
Answer A: Although this offers the client alternatives to moving back home, it does not allow him to participate in the
intervention.
Answer C: Here, the social worker has essentially dismissed the client's reluctance to go home. This arrangement might be
appropriate if, for some reason, moving back home were the client's only alternative, but there is nothing to suggest that this is the
case.
Answer D: This action would violate the client's confidentiality. Moreover, regardless of what the parents might say to the social
worker, the social worker's primary concern must be how the client feels about returning home.
18. D is correct: Based on the symptoms, "D" is the best answer. Because a manic episode can include psychotic symptoms, this
client may have bipolar I disorder, single manic episode or most recent episode manic. Schizoaffective disorder, however, also
includes both mood symptoms and psychotic symptoms. Specifically, it involves an uninterrupted period of illness, ' during
which, at some time, a patient has had a manic, major depressive, or mixed episode along with symptoms of the active phase of
schizophrenia. During an episode of the disturbance, the person has had prominent delusions or hallucinations in the absence of
mood symptoms for at least two successive weeks. The total duration of his mood symptoms, however, is not brief relative, to the
duration of his psychotic disturbance. In this case, the client's delusions are “not apparent" at this time, which suggests bipolar I
disorder; ~however, before determining a diagnosis, a clinician would want to gather more information about the client's
psychotic and manic symptoms (e.g., their duration, whether psychotic symptoms have ever been present without manic
symptoms for at least two weeks, whether other active phase symptoms ofschizophrei1ia may be present at this time). OSM
Answer A: In bipolar II disorder, there is at least one major depressive episode accompanied by at least one hypomanic episode.
A person with bipolar II disorder has never had a manic or mixed episode.
19. C is correct: "C" describes the best way to approach this situation: the social worker is respecting the client's rights, is not
putting undue pressure on the client, and is using his or his expertise to help the client make the best decision possible. While a
decision about when to terminate treatment is ultimately the client's to make (assuming that leaving treatment would not place the
client in danger), in a situation like this one, a social worker should discuss with the client the pros and cons of leaving treatment
prematurely and even make specific recommendations, if they are warranted. If the client still wants to terminate after this, the
Social worker should assist her in the transition (e.g., offer referrals. suggest future work that the client can do on her own). ETH
20. C is correct: Muscle relaxation training and other stress reduction techniques can be effective interventions for some patients
with Tourette's disorder. This is because the tics associated with Tourette's can be worsened by stress and sometimes can be
controlled through "will power"-i.e., muscle relaxation, stress reduction (The American Medical Association Encyclopedia of
Medicine, edited by C. B. Clayman, Random House. New York, 988, 1989). DSM
Answer A: Tardive dyskinesia is a condition caused by the long-term use of antipsychotic medication. Treatments for TD include
taking the patient off of the drug and, in some cases, giving the patient a GABA agonist.
Answer B: Impotence may be caused by physiological conditions, which must be ruled out first. Treatments for impotence which
is not caused solely by a medical condition or substance use include psycho-education, sensate focus, cognitive restructuring, and,
when indicated the resolution of unconscious conflicts interfering with erectile capacity.
Answer D: Muscle relaxation is unlikely to be recommended for a spinal cord injury, since such an injury frequently results in the
loss of muscle function and/or sensation. Spinal cord injuries typically require occupational and physical therapy and sometimesmental health counseling to facilitate psychological adjustment.
21. A is correct: The purpose of "random sampling" in research is to ensure that a sample (i.e.. the subjects selected for the study)
is representative of the entire population of interest. If selection is not random, the results of a study can be generalized only to the
population that has been sampled. For example, in a study for which the sample was selected from only undergraduates at one
particular university, the study's results should theoretically, be generalized only to other undergraduates at that university. When
"simple" random sampling is used, every member of a population of interest has an equal chance of being selected for the
research sample and the selection of one member from the population has no effect on the selection of another member. RES
Answer B: In cluster sampling (also a method of random sampling), naturally occurring groups of subjects, rather than individual
subjects are randomly selected for participation in a research study. Groups of subjects could include, for example, all the seniors
at different high schools in a given state or county.
Answer C: In stratified random sampling (also a method of random sampling), the researcher takes a random sample from each of
several subgroups of the entire target population. For instance, to study the effectiveness of a marketing strategy, a researcher
might divide the full population of interest into demographic subgroups (e.g., based on age) and then select a random sample from
each of these subgroups (rather than from the population as a whole). The purpose of stratified random sampling is to ensure
proportionate representation of each predefined population subgroup.
Answer D: In any random sampling, it is expected that the samples will differ even when they have been selected from the same
population. This occurs, no matter how large a sample is, because of "sampling error." Sampling error refers to the inaccuracy of
a sample value or more precisely, the difference between a sample value (a "statistic") and the corresponding population value
(the "parameter").
22. D is correct: This answer is not perfect because it says "release," thereby suggesting that the social worker cannot see this
client at all. By process of elimination, however, we can see that it is the best answer among the four because it is the only one
that would protect the client and avoid violating the laws that govern a social worker's scope of practice. The client has
severe mental health problems arid has not been taking the medication prescribed to manage her psychosis. Before providing any
form of clinical intervention himself or herself, the social worker must make sure that this crisis is handled by someone who is
qualified to counsel patients about their medication. So, for now, the client should be under the care of a psychiatrist. PROC
Answer A: It's probably true that drug abuse is affecting the client's stability; the social worker can't address this problem,
however, until the client has received the psychiatric and medical care she needs.
Answer B: Giving a client any advice about medication is beyond the scope of a social worker's license/certification and is
therefore illegal, unethical, and even dangerous. For instance, in this case, the client has stopped taking her antipsychotic
medication and is taking nonprescription drugs; when the client resumes taking her antipsychotic medication, there could be
dangerous reactions or interaction effects that the social worker knows nothing about.
Answer C: Because the client's current behavior is dangerous to herself and perhaps others, this would not be the social worker's
first step. This is a clinical issue that would be important to address later on, however, once the medical crisis has been resolved.
23. B is correct: 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. INT
Answer A: Addressing a client's emotions, including the overwhelming ones, is apart of crisis j 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, however does not predict that resolution of internal
conflict or the development of insight is a necessary condition for effective treatment of persons in crisis (for "problem-solving"
or "change").
24. A is correct: Analytic neutrality is a key component of psychoanalysis. The therapist (remains objective at all times and does
not take sides in the patient's conflicts. His or her primary job is to analyze the patient's transference, resistances, free
associations, and dreams. And analysis is best facilitated when the therapist adopts a genuinely nonjudgmental position in which
the patient's transference reaction can emerge in an uncontaminated way, and when the therapist refrains from yielding to the
patient's desire for transference gratification; such yielding would create temporary satisfaction, thereby lessening the patient's
motivation and making the process of analysis more difficult. INT
Answer B: Client-centered (Rogerian) therapy is based on the premise that if the right environment is provided by the therapist, then the
client will achieve congruence between self and experience and will be carried forward by his or her own inherent tendency toward selfactualization. In therapy, the "right environment" involves three facilitative conditions: unconditional positive regard (the therapist
genuinely cares about the client, affirms the client's worth as a person, and accepts the client without evaluation); accurate empathic
understanding (the therapist is able to see the world as the client does and to convey his or her understanding to the client); and
genuineness, or congruence (the therapist is genuine and authentic, since any lack of genuineness will undermine the client's trust; the
therapist honestly communicates his or her feelings to a client when it is appropriate to do so).
Answer C: In some forms of cognitive therapy (e.g., RET), the therapist may be quite confrontive, or challenging, regarding the
client's cognitions and behaviors.
Answer D: Reality therapy is a confrontive form of therapy. It views transference as detrimental to therapy progress; emphasizes value
judgments; and seeks to teach clients behaviors that will enable them to fulfill their needs in responsible ways. The therapist-client
relationship is considered a crucial aspect of therapy, and reality therapists are encouraged to exhibit the qualities of warmth, respect,
caring, and interpersonal openness. In addition, reality therapists model responsible behaviors for their clients.
25. D is correct: This situation does not sound like one that would prevent the social worker from seeing this client, so a referral does
not seem necessary. Instead, the best way to remedy this situation is for the social worker 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 Competence and Social
Diversity) states that social workers are obligated to get education to improve their knowledge and skills. SPEC POP
Answer A: If atten1pting to resolve this difficulty through self-education did not resolve the problem, then the social worker would
probably want to seek consultation to obtain further guidance and instruction.
Answer B: There is no therapeutic benefit associated with this intervention, in part because the question implies that the behavior is not a
problem for the client. Another difficulty with this intervention is that it suggests that the social worker would be imposing her own
cultural values on the client.
26. C is correct: The correct answer to this question is based on a social psychology theory known as the "contact hypothesis." The
contact hypothesis suggests that negative stereotypes and other forms of prejudice will diminish when contact between members of
different groups increases. Research on interventions designed to increase intergroup contact has found that contact by itself is not all
that effective for reducing prejudice; when certain conditions are met, however, contact can have long-term, beneficial effects.
Intergroup contact has been found to be most beneficial when cooperation between or among different groups is required in order for
individuals to achieve mutual goals; for example, it can be highly effective to establish "superordinate goals"-these are goals that can be
achieved only when all the members of different groups work cooperatively. HUM DEV
27. B is correct: The Social Work Encyclopedia (NASW Press, 1995) indicates that the modern era's focus on diversity and students'
rights has led the school social work profession to emphasize issues of parent involvement and school-family-community partnerships.
A modern school social worker generally adopts an ecological approach: the school social worker mobilizes all facets of a student's life
situation in order to foster a supportive learning environment and serves as a vital link between a student's school, home, and
community. ETH
Answer D: Addressing student misconduct was the primary function of a school social worker when the profession was established but it
is no longer the focus.
28. D is correct: Although this is not a core feature of factitious disorder, it is the best answer offered. Individuals with factitious
disorder intentionally produce or simulate physiological or psychological symptoms due to a psychological need to adopt the role of a
sick person or a patient. They often have unusually long medical histories, which commonly include a history of many hospital stays. A
childhood history of illness in the client or a family member IS also common. DSM
Answers A and B: These findings would make the social worker lean toward a diagnosis of malingering, in which a person feigns
symptoms for the purpose of obtaining an external benefit (e.g., financial compensation by winning a law suit).
Answer C: In both factitious disorder and malingering, the symptoms are under the client's conscious control.
29. A is correct: The question indicates clearly that the client needs to be in a hospital right now due to her mental condition; she,
however, is insisting on leaving. In a situation like this one, a client can be hospitalized against her will. ETH
Answer B: The right to refuse treatment is generally afforded to all inpatients. The client should be allowed to participate in the planning
of her treatment to the extent that she can and to refuse at least some forms treatment while she is at the hospital.
I
Answers C and D: Based on the information we have, we cannot assume that either of these answers is necessarily true. It may turn out
that the client can be medicated against her will or even restrained (though this is less likely). Beforehand, however, the acceptability of
these interventions would need to be determined by a medical professional, Some patients, when they have been involuntarily committed
to a hospital, can be medicated against their will, since it is assumed that these patients (at least temporarily) lack the ability to make
informed decisions about whether or not they need to be on medication. And, all patients are protected from the "unnecessary use" of
restraints.
30. B is correct: This is by far the best answer since seizures can be caused by a variety of neurological or other medical problems,
including some serious ones (e.g., head injury, cerebrovascular accident, brain tumor, metabolic disturbance, infection, alcohol
withdrawal). It would be very important for this man to undergo medical testing and, depending on what is discovered, to receive
medical treatment for his seizures. PROC
Answer C: This is not a bad intervention, but before doing this, the social worker must make sure that the client has received medical
attention. In addition, the social worker cannot really know the dangers of driving for this client without knowing the cause of his
seizures. And the doctor, once he or she has diagnosed the client's medical problem, would be better qualified than a social worker to
explain the hazards that might be associated with certain behaviors, such as driving a car.
31. C is correct: The correct answer balances three relevant issues. First, although this situation is not addressed explicitly in the
NASW Code of Ethics, the "spirit" of the code clearly indicates that confidential information should be treated with care. Second,
when a client's therapy fee is being paid by an insurance company, it is likely that the client has already signed a waiver on his or her
insurance form. Third, therapists are expected to cooperate with peer reviews. "C" best incorporates these three issues: The social
worker would be required to provide information to the insurance company as requested, but he should release only
relevant information and should take steps to ensure that the client's confidentiality will be safeguarded as much as possible. ETH
32. A is correct: The basic steps used in planning a social program are usually set forth in the following order: (1) Define and state
the target problem; (2) formulate policies and goals; (3) analyze resources; (4) select objectives; (5) define and designate how the
program will be carried out; and (6) evaluate the program. The incorrect answers describe tasks associated with analyzing the
program's resources (step 3); according to the question, the programmers have completed this step. "A," by contrast, describes step
4-selecting the program's objectives. SOC ENV
33. D is correct: In some cases of child maltreatment, it is in the child's best interest to initiate action to terminate parental rights. In
this case, a qualified entity has determined that this child should be removed permanently from his parents' care; in all likelihood, the
parents' complete lack of cooperation with their treatment plan has contributed to this decision. Under these circumstances, the social
worker's best action is to shift the focus of treatment to preparing the boy for the upcoming changes in his life; e.g., addressing his
feelings of loss, anger, guilt, etc., and helping him cope with the adjustment issues that are bound to arise. INT
Answers A and C: The parents' complete lack of cooperation with the treatment plan and the decision by the child protective services
agency to terminate their parental rights, presumably because doing so is necessary to protect their son, indicate that these actions are
inappropriate and unlikely to produce beneficial results. For instance, we can assume that the social worker has already attempted to
lessen the parents' resistance and, yet, they still are not cooperating with the interventions mandated by the agency; this suggests that,
for whatever reason, these parents are not motivated to change in a way that will enable them to care for and protect their son.
34. C is correct: All four disorders include either episodic or chronic displays of uncontrolled anger or aggression; only a person
with borderline personality disorder, however, would be expected to engage in self-injurious behavior, such as self-mutilation.
Among the key features of BPD are recurrent suicide gestures or threats and/or self-mutilating behaviors; these commonly occur in
response to perceived or actual abandonment by another person. Individuals with BPD are also highly impulsive and lack control
over their anger. DSM
35. D is correct: Respite care (e.g., homemaker services, day care, foster grandparents) is a resource offered to parents who need a
break from their ongoing childcare responsibilities, usually because of severe stress in the home. It is presumed that giving parents
such a break will prevent child abuse and reduce the risk that their children will need to be removed from their care. PROC I
36. B is correct: The client wants help dealing with her stress and you are asked to choose the social worker's first intervention to
meet this goal. Among the interventions1isted, teaching the " client relaxation techniques is the best approach. INT
Answer A: Additional support would benefit the client and probably help to lessen her stress, but this directive is too vague - it offers
no concrete information or guidance on how to expand her support system.
Answer C: It might be useful to explore this issue; later, if the client is interested, in order to discover how the circumstances
surrounding her divorce may be contributing to her present situation; this intervention, however, does not offer: an immediate
solution to her stress.
Answer D: Hypnosis can help to alleviate stress, but "B" has, the, added benefit of providing the client a skill that she can apply on
her own, once she has learned the techniques.
37. A is correct: When aversive conditioning is used to treat a fetish, an aversive stimulus - (such as a noxious odor) is paired with
the fetish object until the fetish object also comes to elicit the response of aversion. The fetish object is the conditioned stimulus,
because it comes to elicit a response of aversion through conditioning (pairings). INT
Answer B: The aversive stimulus is the unconditioned stimulus - it elicits aversion naturally, without conditioning.
38. B is correct: In this situation, the social worker's role is to first help the family members understand one another's feelings and
preferences and then help the client’s relatives to ~accept or make decisions that reflect not primarily or only their own preferences,
but, rather, those of the person most affected by the decision-the client. The social worker should not be the one to decide what is
best for the client or her family. PRQC
39. A is correct: The best answer is "A" in part because we can assume that a boy diagnosed with autistic disorder: has already
had a general health screening by a pediatrician ("D"). In, some cases, autism can develop in association with the neurological
condition. So, while the social worker and the professionals mentioned in the incorrect answers can all play a part in assessing an
autistic child's needs and in developing and/or implementing his treatment plan, the boy should see a neurologist now because his
behavioral ~symptoms are growing worse. DSM
40. C is correct: A major goal of play therapy is to address a child's feelings, primarily by helping the child become aware of her
feelings and more able to express them in appropriate ways. Play itself and specific play materials and interventions are used to
encourage the child self-expression. INT
41. D is correct: According to the 1991 Patient Self-Determination Act (P.L. 101-50B), inpatient health care facilities receiving
federal reimbursements must notify adult patients of their right (under state law) to have advance directives (i.e., living wills or
durable powers of attorney) if they want them. This notification must take place when a patient is admitted to a facility and, if a
patient has such a directive, this fact must be noted on his or her chart. "Living wills" enable patients to document in advance the
kind of care they want to receive or not receive at the end stage of their lives in the event that they are no longer able to communicate
their preferences at that time. Patients who choose "durable powers of attorney" name a decision-maker and spokesperson who will
act on their behalf if they become unable to communicate their medical preferences themselves. ETH
42. C is correct: "C" is best by process of elimination: the conflict might be resolved more easily if the two social workers maintain
an appropriate professional relationship (e.g., approach the conflict in a professional way and treat each other with respect), but
whether or not they have a "strong relationship" with each other has no real bearing on how quickly or effectively this conflict can be
resolved. SOC ENV
Answer A: In a situation like this one, it can be useful to bring in third party, such as a supervisor or consultant, to mediate and
facilitate a resolution to the conflict. For example, a consultant might-be hired if the supervisor is unable to maintain a neutral
position.
Answers Band D: The social workers' willingness to participate actively, cooperatively, and fairly in resolving this conflict is
important.
43. B is correct: A traditional Native American individual is likely to view direct eye contact as, an invasion of privacy. SPEC POP
Answers A and C: A traditional Native American individual is more likely to value discretion.
Answer D: A traditional Native American individual is more likely to put family (and tribe) before self.
44. D is correct: The best answer offered is "D" because this event should be used as an opportunity for intervention with the client
(e.g., to explore his angry feelings and more appropriate ways of expressing them). Because the social work intern witnessed the
event, she would be in a better position than the supervisor to offer this intervention. The supervisor's role would be to educate the
intern on the best way to provide this intervention. SOC ENV
45. A is correct: This question asks you to identify what a humanistic therapist would be least likely to do. Humanistic therapists
view therapy as involving an authentic, collaborative, and egalitarian relationship between the therapist and client. Humanistic
therapists do not usually interpret or go beyond a client's immediate, here-and-now experience. Instead, they emphasize accepting
and responding to the client's feelings in the moment in order to help the client learn to trust his own inner resources. INT
46. C is correct: Though binge eating is more commonly associated with bulimia nervosa, some people with anorexia nervosa also
engage in binge eating. Thus, OSM-IV-TR distinguishes between two subtypes of anorexia: restricting type and bingeeating/purging type. Anorexia nervosa, binge-eating/purging type, is diagnosed when the individual has regularly engaged in
episodes of binge eating and/or purging during the current anorectic episode. OSM
Answer A: Bulimia nervosa, nonpurging type, is diagnosed when during the current episode of bulimia, the patient has used certain
inappropriate compensatory behaviors (e.g.; fasting) to prevent weight gain, but has not engaged in self-induced vomiting or the
misuse of laxatives, enemas, or diuretics.
Answer B: The eating disorder, NOS category is used when the patient has a disorder of eating that does not meet the criteria for a
specific eating disorder.
Answer D: Anorexia nervosa, restricting type, is diagnosed when the patient's weight loss has been accomplished through dieting,
fasting, and/or excessive exercise, and the patient has not engaged in regular binge eating and purging during the current anorectic
episode.
47. D is correct: "D" describes the best course of action (for a discussion of this issue, see R. I, Simon, Clinical Psychiatry and the
Law, American Psychiatric Press, Washington, D.C., 1992). Although the laws vary from jurisdiction to jurisdiction, in general, a
therapist should not release information after a client’s death without proper authorization (e.g., from the executor of the client's
estate or the client's legal representative), ETH
48. D is correct: You are asked to choose what the social worker should do first. The key to selecting the correct answer is
recognizing that the social worker must gather more information before he or she can understand the girl's problem or what can be
done to help her, It would be premature for the social worker to determine either a diagnosis or course of treatment right now.
Meeting with the parents would enable the social worker tp get their permission to consult with other professionals and also to gather
additional information (e.g., about whether something has happened to trigger the girl's behavioral and mood changes, about how she
is behaving at home). The meeting would also allow the social worker to involve the parents in helping their child. Based on what he
or she learns at this meeting, the social worker can then determine what assessment procedures and interventions (e.g., testing,
referrals, behavioral methods) would be appropriate. PROC
Answer A: The social worker would need to gather more information before he or she could determine that the girl has, or may have,
school phobia (or any other diagnosis). In addition, we have no evidence that the girl is anxious or is resisting going to school. She
seems more depressed than anxious, although we can't know this for certain either.
Answer B: This would be premature-choosing "B" means that we've concluded on the basis of insufficient information that the girl is
depressed. Also, the social worker needs to get the girl's parents' permission before doing this.
Answer C: This would be premature since we don't know what's wrong with the girl (e.g., perhaps a medical condition accounts for
her symptoms). Also, the social worker: would need to involve the parents before implementing any course of treatment.
49. B is correct: Substance abuse involves a ma1adaptive pattern of substance use resulting in marked distress or impairment.
During a 12-month period the individual experiences one or more of the following symptoms: engaging in repeated substance use
that results in a failure to perform important role obligations at home, school, or work; the use of the substance is repeated despite
its physical hazards, experiencing of substance: -related legal problems, and social or interpersonal problems. Substance
dependence is more serious than substance abuse.
Substance dependence is "a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use
of the substance despite significant substance-related problems" (DSM-IV-TR). The difference between substance abuse and;
dependence is that for substance dependence, the individual displays, during a 12-month period, at least three of the following: signs
of tolerance and/or withdrawal symptoms, or continued use of the substance to reduce or avoid withdl1awal symptoms; the
substance is frequently taken in greater amounts or over longer periods of time than intended; the individual experiences a persistent
desire or makes unsuccessful attempts to control or reduce the substance use; a great deal of time is spent in activities related to
obtaining the substance, using the substance, or recovering from its effects; important social, occupational or recreational activities
are reduced or stopped because of substance use; and/or the individual continues to use the substance despite awareness of persistent
or recurrent psychological or physical problems. DSM
Answers C and D: As the above explanation shows, these symptoms are associated with substance dependence but not substance
abuse.
50. A is correct: Clinical social workers frequently attempt to increase their client's "insight"-in other words, their clients' selfunderstanding and awareness of their problems, feelings, and motivations. A common way of facilitating clients' insight is to Offer
timely and relevant interpretations of their statements, behaviors etc. Timeliness is important: the social worker must recognize
whether or not a client is ready to hear an interpretation and accept and assimilate the insight it might yield. For example, though a
social worker may have a relevant interpretation to offer a client he or she would not offer it immediately if the related material were
still far removed from the client’s awareness. When offered prematurely, interpretations and the insights they are meant to produce
are usually rejected by clients as inaccurate, meaningless, and/or irrelevant. PROC
51. C is correct: It was important to note that the social worker is in the initial stages of work with this client. A person who is
grieving usually needs to work through the feelings associated with his loss before he can develop new patterns of social interaction
in the absence of the person who died. Hoff (1984) describes the process of normal grief work as including the following goals: help
the client express his sorrow, pain, guilt, hostility, etc.; help the client accept his loss the pain associated with it; help the client
understand the intense feelings associated with his loss; and, finally. encourage the client to resume his normal activities and social
relationships in the absence of the person who died. PROC
52. C is correct: The research is far from consistent on this issue; a lack of parental supervision is frequently found as a correlate of
delinquency, however, along with a hostile relationship between the parent and the adolescent and parental rejection. Low SES. Low
IQ score. Single-parent homes, and harsh discipline have weaker relationships with delinquency. INT
53. A is correct: Family interventions are the most common form of treatment for conduct disorder and probably the best researched
method. Social learning family intervention targets coercive parent-child interactions and environmental contingencies, and includes
psycho-education for the parents, reinforcement of prosocial behaviors and discipline for unacceptable behaviors and training in
communication. It is also classified as a type of parent management training. INT
Answer B: Residential treatment or hospitalization for conduct disordered youth can be necessary in extreme cases, but we would
need more information before recommending it for this boy. When the client poses a clear danger to others, a brief period of
hospitalization or referral to a group home or residential treatment program is a better course. In this case, we don't have enough
information to know whether or not this boy has any of the characteristics that would suggest the need for residential treatment.
However, there is no indication that he poses a serious danger to others at this time, and his parents' concern and desire for him to
receive help suggest that outpatient family therapy would be an appropriate treatment-of-choice.
Answer C: Most of the literature on conduct disorder stresses family intervention based on social learning theory. Moreover, for
persons with conduct disorder, outpatient individual psychotherapy that encourages self-exploration and the expression of feelings
can actually have the unwanted effect of producing greater aggression.
Answer D: Although contingency management is often a component of treatment for conduct disorder, this limited intervention is
not the best choice available to us.
54. A is correct: The term "dual diagnosis" is used in different contexts, but it applies most accurately to patients who have more
than one mental disorder recorded on Axis I (e.g., both bipolar I disorder and substance dependence). OSM
55. D is correct: Answer "0" describes an ethical, as well as clinically beneficial, way of sharing test results with a client. A social
worker should explain the test results using words that the client will understand and that will not unduly upset him. For instance, it
would be unethical to give a client only the raw test data or to use technical jargon, because such information would probably mean
little to a client and could lead him to misunderstand his test results. ASSESS
Answer A: The Beck Depression Inventory-II is designed to provide the specific information the social worker was seeking-the level
of the client's depression.
Answer B: The client has the right to know the results of his test.
Answer C: Although the; social worker will, in all likelihood, re-administer the test after a period of treatment, the client has the right
to know the results of his first test.
56. B is correct: "Vicarious liability" refers to a social worker's liability when he or she is responsible for the services delivered to
clients by a supervisee or employee. A social worker would be "vicariously liable" for a supervisee's or employee's services
whenever there is a significant discrepancy between his or her training and experience and those of the supervisee or employee. In
such cases, the social worker with greater training and experience (e.g., a supervisor) is presumed to have some degree of control
over the client services provided by his or her supervisees or employees and, therefore, is ethically and legally responsible (liable)
for those services. ETH
57. B is correct: It is important to note the sudden onset of the client's most recent symptoms, as well as the fact that he has
experienced many losses during the past year (in addition to the loss of his wife and friends, the client is also facing losses associated
with moving from his home to a nursing home). Given this information "B" is the only answer that makes sense. It would be
important, however, for a medical doctor to rule out physiological causes for the man's behavior. DSM
Answer A: Since the question does not mention alcohol use, there is no reason to assume that this is the cause of the client's
symptoms.
Answer C: This is overly vague. Moreover, the client has been in the nursing home for just a short time and it is unlikely that a
physical illness or the aging process would cause him to deteriorate so quickly.
Answer D: These symptoms could indicate Alzheimer's disease; their sudden onset, however, makes Alzheimer's an unlikely cause.
58. C is correct: The social worker should View this situation as an opportunity to deal in a therapeutic way with a problem the boy
and his mother seem to have. "C" describes the best way of doing this. PROC
Answers A and D: While these actions are appropriate in and of themselves, they do not indicate that the social worker will talk to the
mother directly about her behavior. Therefore, they fail to capitalize in a direct or immediate way on the opportunity presented by this
situation.
Answer B: The question states that the social worker has seen the boy only four times; as such, it seems to premature to encourage the
boy to confront his mother himself. It would be better, so early in treatment, for the social worker to model assertive behavior for the
clients, as the intervention in "C" would do.
59. A is correct: Mental retardation is generally considered to be the result of an interaction between constitutional and
environmental factors. Approximately 50 to 75 percent of cases of mental retardation are attributable to genetic abnormalities,
congenital infections, or other prenatal factors. DSM
60. D is correct: Among our four choices, only privilege is a legal matter that can be affected directly by state legislators. Privilege
refers to an individual’s right to prevent (or attempt to . prevent) confidential information from being revealed in a legal proceeding
without his or her consent. State laws, however, define certain limits to this right. In most states, privilege is waived under the
following circumstances: a therapist is acting in a court-appointed capacity (e.g., has been appointed to evaluate a defendant); a client
has introduced his or her mental capacity as a defense in a civil or criminal suit; a client initiates a malpractice case or other lawsuit
against a therapist; a client has sought treatment from a therapist solely for the purpose of committing a crime; and a therapist
determines that a client needs to be hospitalized involuntarily due to a serious mental disorder. ETH
Answer A: Protecting a client's confidentiality is an ethical (not legal) obligation, and the limits ':0 confidentiality (including those
affected by state laws) are defined in a profession's code of ethics.
Answer B: Self-determination is also an ethical principle. It recognizes the client's right and need to be free to make his or her own
decisions and choices.
Answer C: The principle of anonymity requires professionals engaged in research to prevent disclosure of the identity of subjects who
respond to questionnaires by not revealing their names or any other identifying data.
61. D is correct: Social workers employed by EAPs should follow the same standards regarding client confidentiality as social
workers employed in other settings. Based on the information we have, informing the woman of her options would be the best course
of action. And, if the social worker discovered that sexual harassment was practiced in this corporation, he would have an ethical
obligation to work to eliminate it. ETH
Answers A and B: It would be inappropriate for the social worker to intervene directly at this time; one reason for this is that the
woman has not authorized him to disclose the content of their conversation.
Answer C: This is not the social worker's priority; in the process of exploring the complaint, however, he should attempt to determine
whether or not the woman is providing a complete and unbiased account of the situation.
62. B is correct: "B" best describes the primary function of a board of directors. SOC ENV
Answer A: The board of directors does hire, evaluate, and promote administrators and executive directors at an agency but this is not
their primary function.
Answer C: A board of directors plays a role in planning an agency’s short and long-term goals; rather than pursuing and achieving
these goals themselves, however, board members oversee and measure goal attainment by agency staff.
Answer D: This function is encompassed by "B:" which provides a more complete description of a board of directors' primary
function within an agency.
63. A is correct: A client's self-report can contribute to a full clinical picture and thereby playa role in determining an appropriate
DSM-IV-TR diagnosis; determining such a diagnosis, however, requires a complete clinical assessment that goes far beyond the
client’s self-report. ASSESS
Answers B, C, and D: If you used a process of elimination, this question might have been fairly easy-a self-report is clearly useful for
determining a client’s presenting problems, emotional state, and family history.
64. C is correct: "C" is the best answer we are offered: the social worker should bill the client according to his office policy. We
assume, of course, that he explained to the client his policy regarding missed sessions and cancellations at the beginning of treatment.
ETH
Answer A: There is no CPT code for "no-shows." A superbill is a type of receipt used by some medical and mental health
professionals: superbills allow providers to quickly code and capture charges for patient care services and are accepted by many
insurance companies for the purpose of reimbursements or payment for services rendered.
Answer B: This is acceptable, but whether or not the social worker would do this depends on his office policy. In other words, in a
situation like this one, a social worker is not required to have the client cover both the co-payment and the fee usually paid by the
insurance company.
Answer D: It is true that the social worker cannot bill the insurance company in this situation since social workers can bill clients'
insurance only for services they have actually provided. A social worker is not: however, prohibited from charging the client
something for a missed session. Whether or not the social worker charges this client would depend on what is outlined in his office
policy.
65. A is correct: Minuchin's structural family therapy focuses on modifying elements of the family structure (e.g., rules, boundaries,
coalitions) that underlie family dysfunction. Of the choices available, only "A" contains just interventions that are typical of structural
family therapy. "Enactments" are role-plays that Minuchin often used to evaluate and n1odify the family structure; homework is
commonly assigned as a means of bringing about concrete change in the family's behavior; and family maps, or diagrams of the
family's boundaries, are often constructed to help families and the therapist understand the family structure, INT
Answers B. C. and D: Each of these includes an intervention that focuses on the family's past (either taking a history or examining
multigenerational transmission processes). Structural family therapists focus on a family's present functioning. Minuchin was not
really interested in obtaining or promoting insight into a family's past.
66. D is correct: The social worker should not ignore this client's disability. The best approach is to acknowledge it openly and ask if
it contributes to his depression or interpersonal difficulties. SPEC POP
Answer A: It would be ungenuine and probably counter therapeutic to ignore the client's disability. This approach would also place
the burden of mentioning the disability on the client, which also would be inappropriate.
Answer B: This answer focuses too much on the fact that the client did not mention his disability; during the assessment, the focus
should instead be on how the disability might play a role in his depression and other difficulties. In addition, before rapport has
developed, a social worker would generally avoid confronting a client in this way.
Answer C: "C" suggests that the social worker is too eager to refer.
67. A is correct: While authorities in the field of group therapy often disagree about the characteristics they believe group members
should share, this question is about the one trait they do agree on. According to most research, intelligence level is the most important
factor to consider when selecting compatible members for a therapy group. INT
Answer B: There is no consensus among experts that group members should be matched according to SES.
Answer C: This is not considered to be the most important factor to match, and some experts (e.g., Yalom) actually believe that group
leaders should strive for maximum heterogeneity in the members' conflict areas.
Answer D: This would depend on the type of group being formed. For children's groups, the members should be no more than about
two years apart in age, but for adults' groups age is a less important variable.
68. D is correct: Only "D" describes one of three symptoms commonly identified as a "classic" sign of depression. Loss of appetite
(or overeating suddenly), sleep problems (insomnia or hypersomnia) and loss of energy and enthusiasm are considered to be the
classic symptoms of depression. These symptoms are sometimes called "vegetative" symptoms and are fairly objective indicators.
DSM
Answers A. B. and C: It is also important to collect and incorporate subjective data from the client (e.g.. regarding impaired
functioning, poor concentration. low self-esteem) when assessing his level of depression; these depressive symptoms however are not
among those considered "classic."
69. B is correct: Nathan's primary problems seem to involve social isolation and ridicule by his peers. Given his difficulties with
peers, group therapy would probably be the most valuable form of treatment. Therapy groups are associated with a number of
benefits: they provide members with opportunities to ventilate feelings in a safe environment, to receive feedback from others
experiencing similar problems, to decrease isolation, to increase self-esteem and to establish social support systems. INT
Answer A: Even though Nathan says he sometimes wants to "lash out," there is no clear indication that he poses a danger to himself
or others or that his emotions or behavior are otherwise out of control (e.g.. antisocial).
Answer C: Although Nathan might also benefit from individual therapy, the nature of his problems suggests that he would benefit
even more from an opportunity to establish supportive contacts with peers and to see that others have had experiences similar to his.
Answer D: The use of family therapy as a method for treating families with child abuse problems is based on the premise that
maltreatment is the result of family dysfunction rather the problems of a single identified patient. In this case, however the abusive
parent is in prison.
70. C is correct: "Power" refers to the probability of rejecting a false null hypothesis; i.e. the probability of detecting a true effect of
an independent variable. Decreasing error variance (increasing reliability) in the dependent variable increases power because it
reduces the probability that a researcher will "overlook" a true effect simply because his or her tests are not accurately measuring the
variable of interest. RES
Answers A. B. and D: These describe actions that would result in a decrease of power.
71. C is correct: Piaget rejected the assumption that cognitive development is the result of either biologically predetermined
maturation or environmental factors alone. Instead. he suggested that people adapt to their environment cognitively in the same way
that organisms adapt to their environment biologically. For Piaget such "adaptation" includes two complementary processes:
assimilation and accommodation. Accommodation refers to the modification of existing schemes to incorporate new knowledge.
HUM DEV
Answer A: Piaget did propose that individuals actively construct their knowledge through their interactions with the environment; this
assumption. However is known as "constructivism."
Answer B: The incorporation of new knowledge into existing cognitive structures or schemes is referred to as "assimilation."
Answer D: This describes "equilibration." Piaget proposed that the motivation for cognitive development stems from a drive toward
cognitive equilibrium-i.e. Development occurs when an individual uses &assimilation and accommodation to resolve a conflict
("disequilibrium") arising from a discrepancy between reality and his or her current understanding of the world (repertoire of
schemes).
72. A is correct: The key is that the social worker must determine the level of suicide risk before deciding on a course of action. A
social worker's primary objectives with a suicidal client are to assess the level of risk and then take protective action commensurate
with that risk level. The fact that this man is just emerging from a deep depression indicates a high risk, but further assessment is
needed before the social worker can decide what should be done to I protect him. Therefore, finding out whether the client has a
specific suicide plan (which is another indicator of high risk) is the best answer. ASSESS
Answer B: This describes something the social worker would do if he or she ultimately I identified that the suicide risk was relatively
low.
Answer C: This would be appropriate if the suicide risk turned out to be high.
Answer D: This is a poor answer-a suicidal person just coming out of a deep depression is often a grave risk.
73. B is correct: The most likely diagnosis is bereavement: individuals with bereavement may have hallucinatory experiences
that involve hearing the voice (or seeing the image) of the person they lost. If a bereaved person were experiencing any other
types of hallucinations, however, it would be important to explore whether she has developed a mental disorder in response to her
loss (e.g., perhaps major depression). DSM
74. B is correct: A solution-focused therapist would ask, "When is this problem not a problem?" in order to find exceptions to the
clients' problem. When clients can identify situations in which things go well for them, these situations can become resources, or
models for positive change. That is, when clients can identify and describe fully times or situations when their problem is less
serious or even non-existent, this often reveals things they can do to create more frequent "non-problem" experiences. INT
Answer A: While asking clients "When is this problem not a problem?" does suggest that a more positive view of their problem is
available; this question is not an actual reframing statement.
Answer C: "Challenging the dominant story" is an intervention from narrative therapy. Like solution-focused therapy, narrative
therapy is a post-modern approach.
Answer D: Restructuring clients' cognitions is a goal of cognitive therapy, and could be an outcome of asking, "When is this
problem not a problem?" As noted, however, the use of this specific question is an intervention associated with solution-focused
therapy.
75. B is correct: Although the shelter staff may take care of meeting their new residents' medical needs, the only appropriate
action among those listed is to make sure that the mother/wife has received medical attention for any injuries she might have
sustained. INT
Answers A, C, and D: Continuing to see this family as a unit (for whatever purpose) is not appropriate now that the social worker
knows there is spouse abuse and the wife has fled to a shelter. Most domestic violence experts maintain that the partners in an
abusive relationship should be treated separately, especially in the first stages of intervention, before the victim has had an
opportunity to begin her own recovery. (It is also important for the partners to be seen separately when the batterer denies the
abuse and/or when the abuse episodes are very unpredictable.) Additionally, in cases of domestic violence in which neither the
batterer nor the victim has received any treatment yet, a social worker should not base her decision about whether to have a family
session on whether the victim agrees to it ("A"). This is true for the reasons just cited, and also because the victim may agree to
come to a family or couple session simply to appease her abusive partner or, perhaps, to please the social worker, whether or not
she is comfortable with the idea.
76. C is correct: The WAIS-III Verbal subtests assess an examinee's verbal fluency and verbal memory, ability to work with
abstract symbols, and the impact of his or her education. Compared to scores on the Performance subtests, scores on the Verbal
subtests remain relatively stable over time. The Digit Span subtest measures memory for a series of digits. Poor performance on
this subtest suggests brain damage, mental retardation, impaired hearing, fatigue, or anxiety. According to the "classic aging
pattern," scores on the Digit Span sub test (of the six Verbal subtests) are most adversely affected by aging. However, scores on
all the WAIS-III Performance subtests are even more affected by aging. ASSESS
Answer A: The Arithmetic subtest measures arithmetic reasoning, ability to comprehend instructions, and freedom from
distractibility.
Answer B: Questions on the Similarities subtest ask what is alike about paired items. Low scores are associated with an inability
to think abstractly.
Answer D: The Comprehension subtest, sometimes called a test of common sense, asks questions about aspects of everyday living
and social situations. Low scores are associated with long-term deterioration, severe brain dysfunction, and emotional disorders.
77. A is correct: An important part of Gestalt therapy is encouraging clients to focus on present reality (i.e., on the here-and-now
of the sensory moment). Gestaltians consider the primary curative factor in therapy to be awareness, including awareness of the
environment, the self, and of the nature of the self-environment boundary. Gestalt therapy relies on a variety of techniques
designed to increase here-and-now awareness, integration, and personal responsibility, including: directed awareness (use of
simple questions, such as "what are your hands doing now?" to encourage clients to remain in the here-and-now); "I" statements;
dream analysis; and enactments, such as the empty chair technique. And because questions are thought to foster intellectualizing
and to conceal true feelings, clients are discouraged from asking questions, especially those beginning with "why." "Why"
questions are viewed as a way of keeping the focus off oneself and of avoiding one's "here-and-now" thoughts. INT
78. C is correct: This type of situation is addressed in the NASW Code of Ethics section dealing with conflicts of interest. It was
important to note that the social worker has been providing individual therapy to Nicole for eight months, a long period of time.
Because the social worker has a long-term therapeutic relationship with Nicole, his or her best action is to refer the
couple to another therapist for the conjoint work Nicole has requested. This would serve to protect the clients' interests; for
instance, if the social worker were to see the couple, - he or she would know much more about Nicole's perspective and would
have a better frame of reference for understanding her position in the couple's dispute. This might interfere with his or her ability
to provide objective couples therapy. ETH
Answer D: While it is true that the social worker should decline to see the couple, the social worker cannot simply dismiss
Nicole's request for couples therapy. Moreover, beyond helping the couple resolve their dispute, couples therapy might be very
useful for helping Nicole' consolidate the gains she has made ih individual therapy with the social worker.
79. A is correct: To answer this question, you needed to be familiar with several terms associated with Freud's personality theory.
The term "lacunae" means hole. Thus, parental superego lacunae essentially means there is a "hole" in the parent's superego. In
this case, the parent's superego gap has also become the child's gap (i.e., the daughter is imitating her father, who also steals from
work). INT
Answer B: Parentification refers to a process in a family system in which a family member, typically a child, is expected to take
on a significant parental role in the family. This is a dysfunctional pattern, but it does not describe the problem in this question.
Answer C: Sublimation is a defense mechanism in which a person transfers his or her- unacceptable impulses to socially desirable
behaviors.
Answer D: Rationalization, a defense mechanism, involves an individual interpreting his or her behaviors in away that makes
them seem more rational, logical, and socially acceptable.
80. D is correct: In this case, the woman's circumstances and symptoms, taken together, suggest PTSD. Refugees and immigrants
may have been exposed to traumatic incidents in their country-of-origin (e.g., persecution, war) or while escaping to the United
States, and the symptoms they describe often meet the criteria for PTSD. DSM
81. C is correct: The key words In this question are "taking Into account the son's age" and "help the family resolve their
disagreements." This Information Indicates that answer "C" is the best Intervention. It is developmentally appropriate because it
gives the teenage boy some of the Independence he needs; it offers the entire family an opportunity to improve their decisionmaking skills because the parents will listen to the boy's decisions but have the final say; also, the boy can learn to make better
decisions through his parents' Input; and it may reduce the potential for "someone getting hurt" because all family members will
be allowed to contribute to decision-making and have a forum for discussing decisions In a structured way. INT
Answer A: This solution would be more appropriate for a younger child.
Answers B and D: Having the mother or just the mother and son make the decisions might decrease the potential for danger since
Dad would be removed temporarily from a decision process that has become too tense; these Interventions, however, would not
help the family improve their ability to make acceptable decisions as a team.
82. B is correct: The important pieces of Information were the symptoms themselves and their duration or course-they were
present In the evening and gone the next morning. The patient's symptoms and their course most stro.1g1y suggest delirium, even
though we have no evidence of a medical condition or substance use that could account for these symptoms. Delirium
Involves a disturbance In consciousness with a change in cognition or perceptual ' abnormalities. The person exhibits diminished
awareness of the environment, shifts In attention, and distractibility; changes In cognition can Include memory loss, language
impairment, and disorientation to time and place. Associated perceptual abnormalities can include illusions, hallucinations, or
other misperceptions. Moreover, the symptoms of delirium usually fluctuate during the course of a day, and depending on the
cause of the disorder, they may remit within a few hours (as is the case with this patient) or persist for weeks. DSM
Answer A: This choice might be tempting since the patient's symptoms could be due to a substance-Induced delirium (either
Intoxication delirium or withdrawal delirium). "A" says substance "Intoxication," however, and the patient's symptoms exceed
those commonly associated with an Intoxication syndrome.
Answer C: An amnestic disorder should not be diagnosed if a person's memory impairment occurs In the course of a delirium; i.e.,
when, as is the case with this patient, the memory problems are accompanied by reduced consciousness or other cognitive deficits.
Answer D: In contrast to brief psychotic disorder, psychotic symptoms found in delirium fluctuate, are unsystematized and
fragmented, and occur during a period of diminished awareness of the environment, distractibility, and shifts in attention, as is the
case with this patient.
83. A is correct: Reduced to its basic components, this question might read, "What is the best way to begin work with a patient
who has paranoid delusions? A critical task when working with a delusional patient is to gain her trust-the therapist must perform
the artful task of accepting without participating in, the patient’s delusional system. For these reasons, "A" is the best answer; it is
the only one that offers a way of achieving is goal. DSM
Answer B: Asking the husband to be more supportive is unlikely to produce any change since the woman's statement reflects her
delusion thinking, not an actua1.lack of support from her husband.
Answer C: The woman has paranoid delusions; if the social worker were to point out her husband's concern for her-i.e.. were to
directly contradict the woman's beliefs-the woman might take this as threat.
Answer D: We have no evidence that conjoint therapy will not work. The woman's statement is expectable, given her diagnosis.
84. D is correct: To answer this question, you need to be aware that Beck's cognitive therapy incorporates cognitive and
behavioral techniques. Beck notes, that therapy may begin somewhat differently for individuals with a severe, rather than mild or
moderate, level of depression. For a client with severe depression, it may be necessary to start with behavioral techniques
designed to increase the client's overall activity level (e.g., graded task assignments). - For clients with mild to moderate
depression, cognitive techniques are introduced during initial sessions. INT
85. D is correct: Though brief, “D" is the best answer offered. Privilege suggests that, in the absence of some other legallydefined wavier, a social worker does not reveal confidential client information in the (~context of a legal proceeding without
consent from the client or the client’s legal representative. (There are exceptions to privilege, however, and a claim of privilege
may be rejected by the court.) ETH
86. C is correct: Potential reflection errors (Brammer, 1985) include the following: (1) Depth error: Reading more, or less, into a
client's statements than is actually there (as has occurred in this case). (2) Timing error: Reflecting every client statement or
waiting for a long monologue to finish and then trying to capture the whole message in one reflection. (3) Stereotyping error:
Beginning every response in the same way (e.g., "I hear you saying..."). (4) Language error: Using language inappropriate to the
client's educational or cultural experience or trying to use "fashionable" language (e.g., using current. slang with an adolescent
client). There is no reflection error called a "meaning" error; this answer is a distractor. PROC
87. C is correct: In the first stage of the policy process, known as "policy analysis and formulation," planners identify and seek to
understand the specific policy problem or issue. (A "policy problem" is said to exist when two or more parties, disagree over a
given policy or about the social conditions that a policy will affect.) Important tasks performed in the initial stage of the policy
process include defining the nature of the policy problem and its socioeconomic context. A needs assessment is commonly
performed as the policy problem is being defined - i.e., planners survey the community and establish indices of its needs. The
results / obtained allow policy planners to determine the community's needs and establish priorities for service. SOC ENV
Answer B: This process is associated with the second stage of the policy process-the "implementation" phase: In the second phase,
an approved policy is translated into practice.
88. B is correct: "B" is the appropriate intervention because the question states that, even though Keith has upset the other
members and disrupted the group, his intent was to offer constructive feedback. When managing an event that has disrupted a
therapy group, a group leader should generally intervene in an fairly active way; in this case, it would be effective to use the
technique of positive reframing, as "B" suggests. INT
Answer A: The social worker should take more direct action to defuse the situation. Moreover, while this intervention can be
beneficial for soliciting input from members when attempting to resolve a conflict within a group, the conflict here involves one
member "against" the rest of the -- group. Soliciting input from the entire group could make Keith feel as though he were being
attacked.
Answer C: If the social worker waited to address this matter in an individual meeting with Keith, he or she would neglect to
address how this event has affected the other group members.
Answer D: Siding with Neil could make Keith feel as though he is being attacked. Moreover, a group therapist should attempt to
maintain a working relationship with the entire group and with each group member, and should avoid siding with just one group
member in a conflict.
89. D is correct: treatment planning should be a joint process between a social worker and - client. One reason for this is that a
client's motivation to participate in and cooperate with treatment depends in part on the degree to which treatment addresses her
greatest felt needs. The social worker's goals and the client's goal are not mutually exclusive in this case: if the client develops
greater self-esteem and overcomes her depression, she may become more attractive to men. Thus, the social worker should
attempt to negotiate common treatment goals with the client, ones that incorporate his point of view, as well as the client's
primary goal. PROC Answer A: As the above explanation suggests, a referral does not seem necessary in this case.
Answer C: The social worker can explain the rationale for his view of what would be useful to work on in therapy; the social
worker should not, however, attempt to impose his treatment goals on the client. This would undermine the mutual problemsolving process of social work and violate the client's right to self-determination. It might also reduce her motivation to work on
her problems.
90. A is correct: The Tarasoff decision (Tarasoff v. Regents of University California) established a therapist's duty to protect the
intended victim when a client has made a threat of physical harm. Therefore, if in the social worker's presence, a client makes a
specific threat of violence against an identifiable person, a social worker (or other psychotherapist) must reasonably attempt to
protect the victim-in most cases, this attempt w1llinvolve notifying the police of the threat and reasonably attempting to warn the
victim. ETH
91. D is correct: Most suicide risk evaluations include both a direct assessment and an indirect assessment. In the direct
assessment, the social worker questions a client directly, emphasizing a number of factors associated with an elevated, more
imminent suicide risk: the social worker explores whether the client has communicated an intent or wish to commit suicide;
whether the client has a specific suicide plan; whether the client has the means to enact the plan; and, if the client has a plan and
the means, whether the client's plan is relatively lethal. ASSESS
Answers A. B. and C: Evaluating the various clinical, demographic, historical, and situational factors associated with a risk for
suicide are indirect means of assessment. An indirect assessment is also important, but the risk factors investigated during a direct
assessment are highly specific indicators that enable a social worker to more clearly and more quickly determine the level of risk.
92. A is correct: Exploring the reasons for the client's poor self-image is the only viable action among our choices. Finding out
why the client irrationally believes he is "destroying himself' will facilitate both assessment and treatment planning.
Answer B: Labeling the client's behavior as "self-destructive" might reinforce his irrational belief that he is "destroying himself."
PROC
Answer C: This might be an option later on, but there is nothing in the question to suggest that the man's weight problem is
serious. Also, given his self-esteem problems, the social worker would not want to immediately label him as an "overeater."
Answer D: There is no reason given that would lead us to believe the first doctor's opinion was wrong. In addition, the question
describes the client as "slightly overweight"-this supports the likelihood that the first doctor was right and the man does not have a
serious medical problem.
93. C is correct: Sexual dysfunctions are considered "primary" when they have existed since the onset of the client's sexual
functioning. Sexual disorders considered "secondary" are those that develop after a period of normal sexual functioning. These
terms are used by many authors in the field (e.g., Masters and Johnson), but DSM uses the word “lifelong” for primary sexual
dysfunctions, and the term “acquired” for secondary sexual dysfunctions. DSM
94. D is correct: It was important to read each response before choosing one: "A" is not entirely incorrect, but "D" is better.
Although social workers are not prohibited from seeing clients who are receiving services from another mental health
professional, a social worker would not want to duplicate the services of another professional for an extended period of time.
From both a clinical and an ethical perspective the best way to approach this situation would be for the social worker to help the
woman clarify her goals and needs with regard to the services provided by him and the other therapist, and then use that
information to determine the best course of action. ETH
95. D is correct: Most experts in the chemical dependency field believe intervention should be directed at helping individuals
both establish and maintain a substance-free lifestyle. Because this client has just completed treatment in a chemical dependency
facility, we can assume that he has yet to develop the coping resources he would need in order to avoid relapsing. To minimize
risks associated with li\1ng with a person who is using drugs, the social worker should help this client locate a sober living
environment. DSM
Answers A and B: The client will probably get relapse prevention training (from the social worker or elsewhere) and continue his
NA membership, but neither one of these interventions addresses his immediate need for a drug-free place to live.
96. D is correct: The Education of All Handicapped Children Act (P.L. 94-142) is now called Individuals with Disabilities
Education Act. The overriding purpose of P.L. 94-142 was to guarantee that all school children with special needs would receive
an appropriate free public education. A feature of the IEPs required by this1aw is that a student's plan must provide him or her
with the "least restrictive environment" at school. Contrary to answer "C," however, not all children with special needs are best
served by being mainstreamed (placed into classrooms with non-disabled children). ETH
Answer A: Elimination (or reduction) of bias in schools may be a favorable byproduct of P.L. 94-142, but this was not its purpose.
Answer B: While the requirement that each disabled student have a written IEP is a key feature of P.L. 94-142, guaranteeing these
plans is not the purpose or goal of this law.
97. B is correct: This question primarily requires you to use your reasoning ability and to read carefully. Answers "A" and "B"
are similar: "B" is better, though, because it says that the social worker would encourage the boy to choose a game himself. If the
boy refused to select a game, then the social worker might choose one and invite the boy to play it with her. INT
Answer C: This is a poor choice: Unlike the interventions in "A" and "B," this intervention does not include an effort to connect in
some way with the boy. This intervention is unlikely to be effective and would probably just feed into the dynamic of defiance.
Answer D: The social worker needs to find an active way to increase the boy's comfort and promote the development of rapport.
98. A is correct: Traditional Asian-American families tend to be hierarchical in structure, with males and older family members
occupying a higher status than other family members. SPEC POP
99. C is correct: A client's motivation is likely to diminish during the middle stage of therapy: this happens because a client feels
less anxious as a result of support from the social worker; because resistance emerges; and/or because a client begins to believe he
or she is "cured" because he or she feels better than at the outset of treatment. PROC
Answers A and D: These interventions may be needed with some clients; these issues, however, do not necessarily or always
emerge during the middle phase of treatment. A loss of motivation is more common.
Answer B: This is more important during the initial phase of treatment.
100. B is correct: While social workers should never discriminate against clients or potential clients, they must be able to
recognize when they lack objectivity and, therefore, may not be qualified to provide effective therapy to a particular client. Since
the social worker's biases in this case are likely to prevent him from serving the man's needs and interests, a referral to another
qualified therapist is appropriate. ETH
Answer A: The social worker should neither express his biases against homosexuality nor accept this man as a client.
Answer C: This answer indicates that the social worker recognizes his in ability to treat this man, which is good; it would be
unethical, however, for the social worker to disclose his negative biases to the man.
Answer D: Though referral is in order, the other therapist need not necessarily be gay in order to help the man.
101. C is correct: Systems theory has been incorporated into several disciplines including organizational psychology. They have
properties that allow them to be self-sustaining and to interact with the environment in ways that promote growth and change. In
fact, an open system is in dynamic interaction with its environment-i.e., it continually receives energy from and sends energy to
its environment. A closed system, by contrast, is isolated from its environment; compared to an open system, a closed system is
less adaptable to change. INT
102. D is correct: ]"'or many individuals with panic disorder, applied relaxation and respiratory training, as well as cognitive
therapy have been found to be effective for producing long-lasting remission of symptoms. The research also shows that for these
patients, a combination of cognitive or behavior therapy with pharmacotherapy is more effective than either therapeutic approach
alone. PROC
103. B is correct: DSM-N-TR indicates that autism is about four to five times more common in boys than in girls. DSM
104. C is correct: "C" offers a concise description of appropriate affect. Compared to mood, 'affect it is more reactive and
variable-it is an emotional state of relatively short duration. Affect is considered to be appropriate when an individual is in touch
with his emotions and can express them as he feels them in response to specific emotional or situational stimuli; e.g., he cries
when talking about something very sad. ASSESS
105. A is correct: All four processes may be performed during the first clinical interview with a new client but "A" best describes
the social worker's primary objective during this interview. Rapport refers to a "state of harmony, compatibility, and empathy that
permits mutual understanding and a working relationship between the client and social worker" (Barker, The Social Work
Dictionary, 1995). Most experts believe that rapport must begin to develop in the first meeting with a client because it is vital for
facilitating a productive assessment; e.g., for increasing the client's willingness to speak openly about self and his or her situation
and presenting problem. PROC
Answer D: This answer is encompassed by "A." Describing one's qualifications may contribute to the broader objective of
establishing rapport; when the client knows that a social worker is well qualified, he or she usually has more confidence in the
social worker's ability to understand him or her and to offer meaningful assistance.
106. C is correct: "A" is not a bad answer but "C" is better because it more completely addresses the issues presented in this case.
A question like this one reminds you to read every answer before making your selection. This case includes both medical
problems that are beyond the scope of a social worker's practice and relationship issues that a social worker is (usually) qualified
to treat. The wife's neurological problems require medical attention, but she and her husband have also presented with marital
problems that the social worker can address (moreover, the wife's recent medical diagnosis may result in additional psychosocial
issues that the social worker can address with this couple). So, while "A" is true in that the social worker can. work with the
couple on their marital problems, it is not as good an answer as "C" because it does not mention collaborating with a neurologist.
PROC
Answer B: The case presents issues that are within the scope of the social worker's practice.
Answer D: Involvement of the neurologist is necessary for the wife's neurological condition, but the social worker does not need
to allow a neurologist to "handle" the case; the case also presents marital issues that need attention and the social worker is
qualified to treat these.
107. A is correct: Because this question offers two plausible answers ("A" and "B"), you might have needed to use your testtaking and reasoning skills to determine why one is better than the other. The question is asking for your therapeutic approach
after a crisis has stabilized. The news of a person's illness and possible death usually evokes strong feelings in others, especially
family members. Typical reactions include fears about one's own mortality, guilt, anger, and, of course, profound sadness. The
intervention in "A" would be a good way to / address the needs of the entire family in relation to the ongoing stressor they are
facing. PROC
Answer B: This is not a bad idea, however, either the referral would be an adjunct to your services or you would be sending the
family for treatment elsewhere when, in fact, there is more work you can do with them.
Answer C: The issue is the illness and expected death of the father and how to cope with this; the clients don't need other issues to
work on.
Answer D: Unless you are unqualified to work with this family (which is unlikely, since you accepted their case in the first place),
this referral is not necessary or advisable because you have formed a therapeutic alliance with them.
108. A is correct: A number of personality characteristics have been linked with migraines - and other types of headaches.
Migraine headaches seem to occur most often among individuals who are intelligent, hard-driven, and orderly and who can be
characterized as perfectionistic. HUM DEV
109. D is correct: Because this client's unwanted behavior does not appear to be unusual or pathological, the most appropriate
intervention at this point is to normalize it; e.g., the social worker could reassure the client that many women have sexual fantasies
about people they know. PROC
Answer A: This might be a useful step after the social worker has normalized the client's fantasies.
Answer B: Even though the client believes she might have a sexual problem, finding out whether the client has a sexual partner at
this time doesn't seem relevant. Her primary concerns are about the sexual fantasies she is having.
Answer C: This intervention misses an opportunity to help the client and also comes off as a value statement. If the social worker
judges the parents like this, the client may just take their side and/or worry that the social worker will also judge her.
110. A is correct: According to the Encyclopedia of Social Work (NASW, p. 1927) the primary purpose of program evaluation in
social work is "to use scientific thinking, methods, and measurements, and analysis to improve the efficiency and effectiveness of
social programs and the quality of social work services." "Evaluation research" in general emphasizes the results achieved by a
program; in "program evaluation," however, social workers primarily emphasize the process, or formative, aspects of a program.
In social work, program evaluation is viewed as "developmental': and an important means of improving programs through
informed decision-making by program administrators. SOC ENV
~
Answer B: The outcome, or summative, aspects of a program are emphasized in most evaluation research, but program evaluation
in social work is primarily concerned with a program's formative aspects.
Answer C: The term "output variables" refers to the outcome of a program's services. A program evaluation does not usually focus
on output variables. Rather, the emphasis is more likely to be on "input variables" (i.e., those factors related to an agency's
structure and resources) and "throughput variables" (what happens to the client as a result of his or her contact with the program,
the methods used by the staff, available services and how they are used, etc.). Throughput variables as also known as "process"
variables.
Answer D: Although cost-benefit studies are common, they are not the primary emphasis of program evaluations in social work.
111. B is correct: Physical causes of symptoms should be ruled out before a mental disorder is diagnosed. Because hearing
deficits could account for the boy's symptoms, they must be ruled out before more serious conditions, such as autistic disorder or
mental retardation, are considered. PROC
Answer C: Reactive attachment disorder is characterized by either indiscriminate sociability or a failure to initiate or respond to
most social interactions. Though the boy is not responding to others, this diagnosis would be made only when the symptoms can
be attributed to grossly pathogenic care. Evidence of this is missing in this question.
112. C is correct: The social worker should not accept the client's social invitation. NASW's Code of Ethics prohibits asocial
worker from having a relationship with a client that may conflict with the client's best interests. In this case, even though therapy
is ending the social Worker should decline the invitation since accepting it would make it difficult for the client to return for
therapy if he needed to. In addition, there is an inherent power imbalance in a social worker-client relationship that creates a risk
for exploitation of the client in a social relationship with the social worker. In declining the invitation, the social worker can
explain the reasons why she can't see the client in a social setting. ETH
Answer D: This response includes the idea that the social worker should decline the invitation at this time; however, even "after
some time has passed" a social relationship with the client may not be in his best interests. In addition, it would be difficult to
determine exactly how much time needs to pass.
113. B is correct: The man is exhibiting a false belief and is unwilling to consider that the belief is untrue. This is the definition
of a delusion. Delusions of reference involve the belief, that events, objects, or other people in one's immediate environment have
a particular and unusual personal significance. ASSESS
Answer A: A delusion of being controlled involves the belief that one's feelings, thoughts, impulses, or actions are not one's own,
but are being imposed by an external force.
"
Answer C: Magical thinking is characterized by the belief that one's thoughts, words, or actions ~ can cause or prevent a specific
outcome in a way that defies normal laws of cause and effect.
Answer D: Obsessions are recurrent, persistent, and senseless ideas, thoughts, images, or impulses that are experienced as egodystonic.
114. D is correct: The presenting issue is the client's fear of contracting HIV/AIDS. Therefore the social worker should begin
by exploring what underlies the client's fear; it may be an irrational fear or perhaps the client has good reason to believe he
has been exposed to the virus. PROC
Answer A: An HIV support group would be useful only if the client turns out to have HIV 1 disease at some point.
Answer B: It is possible that the client lacks accurate information about HIV transmission or HIV/AIDS in general. By only
providing information, however, the social would be dismissing the client's fears and neglecting to find out what underlies them.
Answer C: The client might also be anxious about other things and this could be an appropriate area of investigation to pursue
later in treatment. "D," however, is a much better way of addressing the presenting problem-the client known fear of getting
HIV/AIDS.
115. B is correct~ Antisocial personality disorder is one of the few diagnoses which, by definition, cannot be given to a person
under age 18. A minor who displays characteristic signs of antisocial personality disorder would receive a diagnosis of conduct
disorder. DSM "
Answer A: An individual under age 18 may receive a diagnosis of borderline personality disorder if the characteristic features of
this disorder have be present for at least one year. This is true for all of the personality disorders, except for antisocial personality
disorder, \ which cannot be diagnosed until the individual is age 18.
Answer C: A person under age 18 can receive a diagnosis of dissociative identity disorder. For example, the DSM notes that in
preadolescents, clinicians should be cautious in assigning this diagnosis because its presentation may be less distinctive than in
adolescents and adults.
Answer D: A sexually-mature male under age 18 can receive a diagnosis of male erectile disorder.
116. D is correct: For the exam, you should know how to distinguish between oppositional defiant disorder and conduct
disorder. In particular, the latter involves more serious misconduct. Oppositional defiant disorder involves a pattern of
negativistic, hostile, and defiant behavior without the more serious violations of others' basic rights that are found in conduct
disorder. Shoplifting is a violation of others' rights. DSM
Answer A: This is an associated feature of oppositional defiant disorder.
Answers B and C: These behaviors may be a part of the negativistic, hostile and defiant behavior associated with oppositional
defiant disorder.
117. A is correct: Some people with major depressive disorder experience impairments in memory and cognition, and, as in this
case, the decline is usually abrupt and the individual is usually concerned about his impairments. In dementia, cognitive deficits
usually have a progressive course and the individual denies or is unaware of the impairments. These facts suggest that this client
may be suffering from major depression (pseudodementia); before making a diagnosis, however the social worker must refer the
man for a complete physical examination to rule out underlying medical conditions or the effects of a substance. In t addition, a
medical professional can determine whether the man should receive medication.
Answer B: A medical examination is more important at this time, in order to rule out, physiological reasons for his impairments.
DSM
Answer C: Treatments for dementia do combine group therapy (especially therapy that, emphasizes reality orientation and
reminiscence), antidepressant drugs to alleviate depression, behavioral techniques to reduce agitation and environmental
manipulation to enhance memory and cognitive functioning. However, the social worker would not recommend any form of
treatment before completing an assessment (and moreover, as noted above, it does not appear that this client has dementia}.
Answer D: Major depressive disorder can mimic dementia, especially in the elderly. In dementia, however, the onset of cognitive
symptoms is usually insidious and the individual denies his impairments or seems unaware of or unconcerned about them.
118. A is correct: The parent is using punishment, or the application of a stimulus following a behavior, in order to decrease the
probability that the behavior will occur again. A variety of factors affect the effectiveness of punishment. Punishment, like all
behavioral techniques intended to reduce undesirable behaviors, is most effective when used in conjunction with reinforcement
for alternative, desirable behaviors. In this case, the 25 cents would represent reinforcement (a stimulus that increases the
probability of a behavior) for the alternative, desirable behavior of being nice. HUM DEV
Answer B: Punishment is more effective when it is applied consistently (after every performance of a behavior) than when it is
applied intermittently.
Answer C: A gradual increase in the intensity of punishment can produce habituation. In other words, if the child has to spend
more and more time in his room, he may get used to it and won't mind it as much.
Answer D: This strategy will do nothing to decrease the occurrence of the behavior and may produce habituation.
119. C is correct: Boyd-Franklin (1989) and other experts recommend the use of a multisystems (ecostructural) approach when
working with African-American clients. This approach involves considering the multiple systems that impact individual and
family functioning. During both assessment and treatment, it targets the individual, the immediate and extended family, nonblood relations and friends, church and community services, social, service agencies, and other outside systems. Experts also
recommend the use of a time-limited, problem-solving approach and directive techniques, and focusing more on developing
concrete solutions to problems than on providing complex explanations about the origins of the problems. SPEC POP
Answer B: Family (rather than individual) therapy, especially extended family systems therapy, is usually the treatment-of-
choice.
120. C is correct: Eyen though the social worker has made the agreement described with the parents and the adolescent, the
parents still have a right to receive certain information about their child, such as general information about her progress in
therapy. Moreover, whenever a client (whether a minor or an adult) poses a threat to herself, as in this case, a social worker has an
obligation to take steps to protect her. A social worker is justified in violating a suicidal "' client's confidentiality if he determines
that doing so is necessary to protect the client from harming herself. In this case, the client's statement that she wants to kill
herself and the fact that she has a specific plan for doing so suggest a high risk for suicide. ETH
I
121. D is correct: In the beginning stage of therapy (the third session in this case), an object-relations therapist (and many other
therapists, as well) would simply make mental note of his feelings and reactions toward a client's tardiness and of his impressions
of the client. In particular, from an object-relations perspective, a therapist's responses to a client can reflect " projective
identification, which might provide insight into the client's internal world. INT
Answer C: A social worker would not offer an interpretation of a client's tardiness or other; behavior so early in treatment. In
addition, there is no pattern of tardiness at this point; the client has arrived late one time.
122. B is correct: The cognitive therapies, which often rely on verbal strategies, are used to help clients identify, test the reality
of, and modify their distorted cognitions and the habitual ~ dysfunctional beliefs that underlie those cognitions. "B" is associated
with Beck's cognitive therapy, which assumes that a client's symptoms can be removed by altering the cognitions "~ that underlie
them. "Questioning the evidence" is a technique used to modify clients' distorted cognitions: it involves teaching clients to
question the evidence on which they base their dysfunctional beliefs and to attend to all available information, not just
information supporting " their dysfunctional beliefs. INT
123. C is correct: On Holmes and Rahe's scale for measuring the severity of psychosocial stressors (called the Life Events Scale
or the Social Readjustment Scale), the only stressor with a higher rating than divorce is the death of a spouse or child. This scale
includes over 40 life changes; listed in order from most to least serious or debilitating, the first ten changes on the scale are:
death of spouse or child, divorce, marital separation, imprisonment, death of a close family member, personal injury or
illness, marriage, dismissal from work, marital reconciliation, and retirement. ASSESS
124. A is correct: Rogers maintained that psychological maladjustment is rooted in an incongruence between one's self-concept
and one's experience. When an individual's self-concept is inconsistent with the evaluations made by others, the individual may
deny, distort, or selectively perceive external information. INT
125. D is correct: Product data emphasizes "output variables," or the outcome of a program's services. Product data is also called
"summative" data. In summative evaluation, baseline data is collected before the program is initiated and then changes resulting
from the program are evaluated after the program has been applied. SOC ENV
Answer A: In program evaluations, "input variables" are factors related to the agency's structure and resources.
Answer B: "Throughput variables" refer to factors such as what happens to the client as a result of his or her contact with the
program, the methods used by the staff, available services and how they are used, etc. Throughput variables are also known as
"process" variables.
Answer C: Process data is also called "formative" data; it is used to evaluate the processes of a program. Examples of process data
include information from questionnaires, interviews, etc.
126. A is correct: The social worker might begin approaching this case in several different, ways from a clinical standpoint, but
the social worker's first obligation is to protect the client from having further contact with this man. Therefore, "A" is the best
answer. Compared to ~ other forms of child abuse, it is more difficult to report and legally prosecute child maltreatment (i.e.,
sexual and emotional abuse) via the Internet. The Internet has become an increasingly popular means of recruiting children for
sexual purposes because it provides not only easy access to children but also a reduced risk to offenders of being identified. For
example, following a child abuse report, a child protective services agency can intervene relatively easily in cases when the abuse
has occurred in the child's home or elsewhere in her primary environment; but in cases involving only a web address, it is
difficult, if not impossible, for a clinical social worker or CPS caseworker to identify with certainty who or where the perpetrator
is. To protect a child in a case like this one, however, in which an abuser is persistently pursuing a child via the Internet, a social
worker can encourage the child and her parents to report the situation to the police or the FBI. The latter agency, in particular has
a task force charged with investigating cases of child maltreatment via the Internet. In this case, the social worker would be
justified in breaching the girl's confidentiality in order to protect her; the social worker would want to let the girl know that he or
she needs to talk over this, issue with her parents. The social worker would then discuss with the parents the option of, notifying
the police, as well as ways to more closely monitor their daughter's use of the Internet and/or to control the content she can access
when she is online. ETH
127. D is correct: Yalom has described both advantages and disadvantages of using co-therapists in group therapy. According to
Yalom, a potential disadvantage of the co-therapy format is that co-therapists may be overly competitive and pursue their own
interpretations, rather than supporting inquiries begun by the group. If this occurs, the group will be distracted and unsettled. The
other choices describe potential advantages of the use of co-therapists. INT
128. C is correct: When a chronic user stops taking cocaine or begins to use less of it, she may drop into a deep depression.
According to DSM-IV-TR, a cocaine withdrawal syndrome is ~ associated with the following symptoms, which result in clinically
significant distress or, impairment in functioning: Dysphoric mood and two or more of the following physiological changesfatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and/or psychomotor retardation or
agitation. These changes develop within a few hours to several days after the person stops or reduces heavy, prolonged cocaine
use. In addition,
craving is considered to be the most significant and disturbing symptom of stimulant-either cocaine or amphetamine-withdrawal.
Users experience two types of craving: "Anhedonic" craving stems from boredom and a general desire to get high. "Conditioned"
("evoked" or "cued") craving is produced by cues in the environment that remind the user of the gratification derived from using a
stimulant. Conditioned craving is more intense for stimulants than for stimulants most other drugs because stimulants are
particularly powerful reinforcers. DSM
129. B is correct; Physiological causes, such as a medical condition, must be ruled out before the social worker can decide how to
treat this case.
Answer A: Although this is a common treatment for bed-wetting, the social worker would not recommend this before the boy has
had a complete medical examination. Functional enuresis is often treated using the "bell-and-pad method," an operant technique
in which a bell causes a child to wake up when he wets his bed. DSM
Answer C: Physiological causes for the symptom must be ruled out first. Moreover, even if the boy's enuresis turned out to be
functional, having a psychiatrist uncover its underlying causes would not be the treatment of choice. Although some experts
maintain that functional enuresis is due to intrapsychic conflict stemming from disturbed family relationships, in most cases, this
disorder can be treated successfully using support, education (e.g., having the parents reduce the child's fluid intake), and
behavioral conditioning techniques (e.g., the bell-and-pad ': method).
~
Answer D: It is true that 75 percent of enuresis have a relative who has or had the disorder, j but exploring this question is not
nearly as important as referring the boy for a medical examination. And although it can be useful to explore family factors in a
case like this one, the factors of interest would be more likely to include recent or ongoing stressors in the boy's life.
130. A is correct: Because two days is a short period of time to prepare such a report, it would be appropriate for the social
worker to request an extension.
Answer C: By itself, this solution does not adequately address the problem.
Answer D: The supervisor will need adequate time to review the records. ETH
131. B is correct: According to NASW's Code of Ethics, social workers must take appropriate action against unethical conduct
by a colleague. Social workers must also (with a few exceptions) maintain the confidentiality of their clients. The latter principle
overrides the former in this case: the best action is for the social worker to introduce the client to all of the options available to
her, so that the client can make an informed decision about how to proceed with the matter. Once the client is aware of her
options, she may decide to give the social worker permission to break her confidentiality so that a report can be filed with an
ethics committee. ETH
132. C is correct: Self-efficacy theory is associated with Bandura. This theory emphasizes, changing a person's beliefs about his
or her ability to control events or outcomes. It proposes that a person's belief about his or her own self-efficacy is the
primary mediator of his or her adjustment HUM DEV
133. A is correct: When using an eclectic approach, a social worker does not apply just one practice theory to a case;
instead, the social worker selects from a number of models and theories based on how well they match a client's
problem situation and the extent to which empirical research has found the associated interventions to be effective. INT
134. B is correct: This question is asking us to choose the social worker's "first" responsibility; to do this, we had to identify the
best answer since the answer we might have t expected is not listed. With any client who has just been raped, a social worker
should "emphasize listening and providing emotional support certain medical and legal procedures need to be carried out after a
rape, as well (e.g., medical care, gathering of evidence for possible prosecution); while these procedures should not be
emphasized at the expense of providing emotional support, we're not offered an answer choice that mentions giving emotional
support. So, we needed to focus on how the social worker might help the client access resources to deal with medical and legal
procedures. The woman has said that she does not want to pursue any legal processes; therefore, the social worker could focus on
helping her understand the importance of seeking medical attention. For example, the woman may have sustained injuries or been
exposed to a communicable disease. ETH
Answer A: Rape is not a mandated report, unless the victim is a minor. Therefore, the social worker could not call the
authorities without permission from the client. Moreover, at this point, the client has said that she does not want to involve the
police or press charges.
Answer C: Of course the social worker will treat this woman and maintain her confidentiality. This answer is overly general,
however. The better answer describes a specific, early intervention that a social worker would want to make with a client
who has just been raped.
~
Answer D: Even if the woman wanted the social worker to speak with her husband, contacting him would not be the social
worker's best first intervention. Moreover, it is not a social worker's role to discuss "social responsibility" with any client or
client's family member.
135. C is correct: Quality assurance is used to verify that services and programs are effective, efficient, and available. It involves
comparing services rendered to the accepted standards of quality in the professional field. ETH
Answer D: No quality assurance review can "guarantee" anything, so this choice is wrong.
136. C is correct: 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 ot her performance during the treatment phases. RES
137. B is correct: Because a social worker is not qualified to make recommendations about, medication, Evan must see his
psychiatrist. The frequent, involuntary facial tics suggest that he .may have tardive dyskinesia, a serious side effect that can
develop in a person who has been taking antipsychotics for a long time. DSM
Answer A: Yes, the tics probably are a side effect of Evan's medication, but it would be irresponsible to simply reassure him in
this way. Evan must see his psychiatrist so that his symptoms can be evaluated by someone qualified to determine what should be
done to reverse them, if they are medication side effect.
Answer C: The fact that Evan has been taking antipsychotics for a long time does not prevent him from developing tardive
dyskinesia now: tardive dyskinesia is a late-occurring side-effect of these medications. Because tics are a sign of tardive
dyskinesia, it is critical for the social worker to get Evan evaluated by his psychiatrist. If the psychiatrist rules out tardive
dyskinesia (and a physician rules out other medical problems), the social worker can then explore whether the tics are a sign of
anxiety.
~
Answer D: Tardive dyskinesia occurs while a patient is taking a phenothiazine - it is not a sign of withdrawal from the drug.
138. D is correct: Reaction formation, isolation of affect, and undoing are associated with the, obsessive-compulsive personality.
In reaction formation, an individual deals with unacceptable impulses by substituting unwanted thoughts, behaviors, or feelings
with their opposites. Isolation of affect involves severing the conscious psychological connection between an unacceptable
impulse or behavior and its original memory source-i.e., the person remembers the experience, but separates the experience from
the affect associated with it. Undoing involves repeatedly engaging in a behavior in order to undo the effects of a past
action that one finds unacceptable. The repeated behavior is usually the opposite of the unacceptable action. INT
139. A is correct: These parents should relax. First words are typically spoken at any time from 10 months of age to 16 months of
age. HUM DEV
140. B is correct: The correct answer should address in a direct way the wife's threat to leave the session, including the reasons
that may underlie it. The wife is essentially an involuntary client (she feels as though her husband forced her to come in), and her
threat may be an expression of her negative feelings about being in treatment. In addition, it was important to notice that this is
the first session and that the husband describes communication problems. Answer "B" best addresses both the situation and the
interests of both clients. It suggests a way of beginning to help the couple improve their communication by emphasizing that each
person should be allowed to speak and also indicates that the social worker would convey support and empathy for the wife by
reassuring her that she, too, will be given time to express her feelings and her view of the problem. PROC
Answer A: Interrupting the wife would model and reinforce poor communication skills. It may also reinforce the dynamic of
resistance by dismissing her negative feelings. The woman has threatened to leave while her husband is sharing his point of view,
and the social worker must address this problem in a direct and supportive way.
Answer C: This action overlooks an opportunity to address the wife's negative feelings and to facilitate the development of rapport
with her. The social worker should respond to the wife's threat and the feelings that may underlie it in a more direct way.
Answer D: Since the social worker has agreed to see these clients, we can assume that he or she is qualified to work with couples.
141. C is correct: Borderline personalities tend to have unstable interpersonal relationships, and this characteristic often shows up
in the therapeutic relationship: borderline patients often cooperate on an overt level while also displaying covert resistances, such
as non-compliance with the therapeutic contract. Resistance may be overt as well; for instance, the patient may suddenly
become angry and storm out of a session (Goldstein, 1990). DSM
Answer A: The preferred length of treatment for borderline personality disorder varies from patient to patient. While this
answer suggests that treatment must be long-term, short-term individual therapy is used with some borderline patients: such
treatment focuses on well-defined goals, such as reducing self-destructive behaviors.
Answer B: Many borderline patients have dysfunctional family patterns, such as over-involvement and dependency. In these
cases, family therapy may be an important part of treatment. Treatment of these patients, however, does not necessarily have to be
family-oriented.
Answer D: Negative countertransference often occurs in the treatment of borderline personalities, since these patients are
sometimes seen as manipulative, demanding, and controlling. In fact, Goldstein has noted that therapists sometimes use the
borderline diagnosis t itself as a means of expressing negative countertransference feelings.
142. B is correct: Behavioral family therapists apply learning theory techniques that were developed for treating individuals. The
first thing a behavior therapist does is an analysis of the ~ target behavior in order to clarify exactly what the behavior
consists of, what reinforces it and what environmental factors play a role in creating or maintaining it.. A family's problem
would, be defined in overt behavioral terms and each family member would be considered to be involved in the symptom (i.e., in
creating and/or maintaining it). INT
143. A is correct: The man's agitation: incoherent' speech, and psychotic symptoms are suggestive of several disorders. All
important aspect of this question, however, is that it is asking what we would want to rule out first Psychotic symptoms (as well
as other symptoms, such as depression, anxiety, sleep disturbance, and sexual dysfunction) may be due directly to a physiological
cause (a medical condition or the effects of a substance) or may reflect a "primary mental disorder" (one for which no known
physiological factor accounts directly for the disturbance). Thus, whenever such symptoms are present, it is important to rule out
physiological cause: Amphetamine use can lead to psychotic symptoms and it would be important to make sure that this man's
symptoms are not due to this drug.
Answers B and C: While the man's symptoms could reflect either a delusional disorder or, mania you would first want to rule out
amphetamine overdose before assigning either diagnosis. DSM
Answer D: Factitious disorder involves the intentional production or simulation of symptoms and may involve drug use as a
means of inducing the symptoms. There is no evidence, however, that this man has an intrapsychic need to "assume the sick role,
which is characteristic of this disorder.
144. D is correct: Reminiscence therapy is designed to help a client (often ~ elderly client) come to terms with his or her life
(e.g., deal with unfinished business, grieve losses. relive past successes) and eventual death (Butler" 1963). Cues (e.g.
photographs) are used to prompt the client's memories. INT
Answer A: When a client has cognitive impairments, a model known as "reality orientation" may be used to increase his or her
independence and orientation (e.g., it may involve, restructuring the client's physical environment).
Answer B: In Gestalt therapy the empty-:chair technique, role-playing, and other games of dialogue are used to help the
client become aware of and integrate aspects of his or her I personality that he or she has disowned or denied.
Answer C: Life script analysis is associated with transactional analysis. This model assumes that a person's life script is developed
from decisions made during childhood and comprises the core of his or her identity and destiny. The choice of a life script is
affected mostly by early experiences that indicate a person's worth and place in life.
145. B is correct: Circular questioning, which has been described as an indirect form of reframing, involves asking each family
member to describe specific behaviors, feelings, or relationships within the family system and then pointing out the differences in
their accounts. The goal is to help family members see the similarities and differences in their perceptions; this, in turn, enables
family members to view their problems in a different light (i.e., increases their flexibility in viewing their problems). INT
146. C is correct: An initial referral to a physician or psychiatrist can be very important in order to confirm a diagnosis and/or
obtain a medication evaluation. Laura's symptoms strongly suggest bipolar I disorder, and the social worker would need to refer
her for additional evaluation by a qualified professional and probable medication before proceeding with his or. her own treatment
plan. DSM
Answer A: This intervention could be useful later (targeting especially the effects of Laura's disorder on their relationship and
helping Jerry understand her disorder). The social worker, however, needs to confirm his or her tentative diagnosis first, and his or
her treatment of the couple would probably be an adjunct to pharmacotherapy for Laura.
Answer B: Having this information can be useful in managing bipolar I disorder, and patients with bipolar I disorder and their
loved ones are often the best source of information about what triggers the 'patient's manic episodes. This is not social worker's
best first step, however.
Answer D: Laura needs to see a psychiatrist for the reasons cited above. In addition, if she does have bipolar I disorder,
psychotherapy without medication would not be the treatment-of-choice, and even with medication, an insight-oriented approach
that emphasizes identifying the roots of the disorder would not be useful. For bipolar I disorder, individual therapy is more
effective when it emphasizes the role of stressors in precipitating or exacerbating the symptoms; helping the client cope with the
illness; addressing the client's concerns about personality changes caused by medication to treat the disorder; addressing
underlying distress and other dynamics that might trigger additional mood episodes (e.g., by leading the client to skip her
medication); and monitoring the client's medication compliance;
147. C is correct: According to the concept of homeostasis, all systems strive to maintain a sense of dynamic balance and resist
any stimulus that threatens to disrupt or alter this balance. Families, like all systems, have a built-in mechanism that works to
restore balance when it has been disrupted. This mechanism a "feedback loop" (a reciprocal pattern of actions and reactions)serves to maintain the homeostasis. In an alcoholic family, a feedback loop is operating when a nonalcoholic wife brings alcohol
home when her alcoholic husband is trying to abstain. This illustrates that a family's homeostasis does not necessarily reflect a
healthy underlying structure: problems, such as addiction in a family member, often play a central role in maintaining a family's
sense of balance. Therefore, when the addiction ceases (e.g., when an alcoholic family member quits drinking), the family's sense
of balance is disrupted, and dysfunctional behaviors will operate to restore the balance. INT
148. A is correct: "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. SPEC POP
149. B is correct: You might have answered this question by using sound clinical thinking and a process of elimination. It also
helped to recognize that this girl is probably suffering from PTSD and to know some of the common interventions in cases of
PTSD. As noted, the girl seems to have PTSD)-- nightmares of the event, decreased interest in one's usual activities, and
difficulties sleeping and concentrating are core symptoms of the disorder; headaches and stomachaches are (common
associated features of PTSD in children. Affective discharge (i.e.. the release of one's feelings} is usually an important component
of treatment for PTSD. OSM
Answer A: The need for a psychiatric evaluation is not pressing in this case, since a mild sedative has already been prescribed and
it is seems as though this problem is Within a social worker's scope of practice.
Answer C: Although a certain amount of reassurance is appropriate "reassuring the girl that everything is going to be okay"
sounds as though the social worker would be discounting the girl's distressing feelings.
Answer D: There is no pressing need to assess family dynamics that underlie the girl's reaction: it's already reasonably clear what
accounts for her reaction-a traumatic accident. ':
150. B is correct: Group therapy is contraindicated for clients who are in a state of acute crisis (Goldenberg, 1983; Mahler. 1969).
For example, such clients maybe disruptive to the group process and create a climate of high anxiety and arousal. PROC
151. C is correct: it has been difficult to check the accuracy of "repressed memories" retrieved under hypnosis and so far there is
not a great deal of empirical research on this topic. However, the research on memory in general suggests that memories are often
constructed (or reconstructed) to some degree rather than simply recalled and that hypnosis can exacerbate this process. Thus,
answer "C" is the best conclusion that can be drawn about repressed memories retrieved under hypnosis: while some memories
may be accurate, care must be, taken in accepting memories retrieved under hypnosis because hypnosis seems to make individuals
particularly susceptible to suggestion and to believing that false memories are in fact true. INT
152. D is correct: The best answer to this question is not perfect, but it is more complete and more appropriate than the other
choices. "D" protects the victim; provides a setting where the batterer can be confronted directly by other abusers with similar
experiences and allows each partner to begin exploring the abuse in their relationship, separately. (An even better answer would
clarify how the social worker would avoid being in a triangle. for instance, by having the, clients see two different individual
therapists.) INT
Answer A: Most experts in the domestic violence field maintain that the partners should be treated separately, especially in the
early stages of intervention and particularly when the abuse incidents are unpredictable and/or the batterer denies the abuse. This
man admits that he hits his wife, but he blames her for the abuse and the abuse seems habitual. Seeing the couple - together, even
with a contract prohibiting further abuse may give the husband additional opportunities to control his wife and might make it
difficult for her to speak openly about her feelings.
153. D is correct: According to studies, the sexual orientation of parents does not have predictable effects on their
children's adjustment. A review of the literature (Victor and Fish, 1995) found that lesbian mothers and heterosexual mothers and
their children do not differ in any significant way: lesbian and heterosexual mothers are similar in terms of maternal
attitudes, parenting style, problems associated with child rearing, and overall psychological adjustment; and children of divorced
lesbians do not differ from children of divorced heterosexuals in terms of worry, fears, physical complaints, conduct, sociability,
popularity, hyperactivity, gender identity or sex-stereotyped play. Findings are similar for gay fathers and their children. Gay and
heterosexual fathers are similar in terms of parenting style, attitudes toward parenting, and level of involvement with their
children (Bigner and Jacbossen, 1992). Children of gay fathers do not differ significantly from children of heterosexuals on
measures of adjustment (Gottman, 1990), and the sons of gay parents are no more likely to be homosexual than the sons of
heterosexual parents (Bailey et al., 1995). HUM DEV
154. A is correct: A process of elimination was useful for this question since is really no way of choosing among the incorrect
answers. The issue underlying this question is that an advocate's actions must always be based on the client's wishes-e.g, an
advocate should do no more than the client wants him to do. Therefore, the social worker's first step should be to meet with the "
man and plan the action, SPEC POP
155. B is correct: Providing education would be the best intervention at this time. Even though the question offers a limited
amount of information, it is reasonable to conclude that these young parents may lack accurate knowledge about normal
childhood development and may have unrealistic expectations about how a child should behave at age 22 months (e.g., a 22month-old is likely to be more active, mobile, curious, and independent than he was before). HUM DEV
156. A is correct: Ethics refer to correct or appropriate practice (professional behavior) while values are concerned with what is
considered good and/or desirable. Ethics and values are related in that the former are often derived from the latter; e.g., the value
of privacy is reflected in the ethical standard that requires social workers to obtain a client's informed consent before releasing
confidential information. ETH
Answers Band D: These are not necessarily true.
Answer C: As noted above, values do not explicitly define appropriate professional conduct
157. C is correct: Community organization (CO) emphasizes the social-as opposed to psychological or emotional-needs of
community members. SOC ENV
Answers A, B, and D: These answers are too narrow: they describe or allude to specific techniques, rather the overall focus of CO,
Techniques used in CO include identifying problems in a community and their causes; developing strategies for addressing the
problems; finding and mobilizing resources; identifying and recruiting community leaders; and promoting relationships among
community leaders to facilitate problem-solving within the community.
158. D is correct: Exam questions often ask you to select the first step a social worker should take; this item, by contrast, asks for
the social worker's best approach. "D" is a comprehensive answer that includes interventions targeting both the couple's
immediate needs and their long-term needs. PROC
Answer A: This intervention is important; "D," however, is more complete approach and it encompasses a suicide evaluation
under crisis intervention.
Answer B: While it is true that individuals and families often have underlying issues that are exacerbated during a crisis, pointing
this to the couple Will not help them get through this difficult period.
Answer C: This does not address the couple's immediate safety needs -i.e., the social worker needs to explore the clients'
symptoms of anxiety and depression and rule out the possibility of clinical risk.
159. C is correct: Behavioral rehearsal is a technique used to demonstrate or suggest a desired alternative behavior to a client and
then encourage the client-through role-playing and/or other demonstrations:--to behave in a similar way. INT
160. A is correct: The question tells us that this is the "final" therapy session and we can assume, therefore, that termination has
been agreed to in an earlier meeting. The client's new complaints probably reflect a natural resistance to ending treatment. Of the
choices listed, "A" offers the best way of dealing with this. PROC
Answer B: There is no real indication that the client needs more therapy since he and the 'social worker have already determined
that he is ready to terminate. It is more likely that his "new problems" represent his reluctance to end treatment. Moreover, if the
social worker were to determine that the client really does have new problems, he or she could re-contract for further sessions
with the client rather than referring him.
Answer C: This might turn out to be necessary. However, from the information we have, it seems more likely that the client and
social worker simply need to spend the session exploring and dealing with the client's feelings about leaving therapy.
Answer D: This is not appropriate since part of the termination process includes being sensitive to the client's feelings about
ending therapy. While the social worker may well remind the client of his new skills, this intervention, by itself, is insufficient
and dismisses the client's feeling about leaving treatment.
161. B is correct: The typical behavioral indicators found in children who have been sexually abused include the following: says
that he or she has been sexually assaulted; appears to mistrust or fear adults; a sudden, unexplained change in behavior (e.g.,
depression, anxiety); fear states; night terrors; regressive behaviors; Withdrawal into a fantasy world; psychosomatic illness;
antisocial (or "delinquent") behavior (e.g., truancy, running away); social Isolation/poor peer relationships; overly-sophisticated
knowledge about sex; promiscuity or being overly-sexualized; unwillingness to participate in physical activities; suicide attempts;
and alcohol or drug use. INT
Answer A: Aggression maybe Present, but aggression is more often an indicator of physical abuse
162. D is correct: Although we need more information in order to be sure what underlies this - family's problems, given the
cultural context presented in the question, "D" is the most reasonable (and safest) choice. According to Casas and Vasquez
(1989), differences in degree of acculturation within the family are frequently a source of family and individual problems among
Hispanic immigrants. SPEC POP
163. D is correct: By using a process of elimination and selecting the answer that makes the ~ most clinical (and legal) sense, we
end up with "D": the foster parents' request would be addressed best by having a meeting with all the parties involved
Answers A, B, and C: Typically, foster children are dependents of the court; therefore, when working with a foster child, it is not
necessary to have the biological parents sign releases or to get their consent for medical treatment or psychotherapy, as it would
be if the child were still living with them. ETH
164. A is correct: In many cases, an involuntary (e.g., mandatory) client will be less motivated than one who has come in by
choice. Involuntary clients also may be hostile, defensive, manipulative, and unwilling to communicate with the therapist or
cooperate with treatment. If treatment is to be successful, a social worker must attempt to overcome these obstacles as early as
possible. A particularly effective way of doing this is to acknowledge the client's negative feelings about treatment and the social
worker and to allow the client to talk about: them. PROC
Answer B: While motivation may be a key issue with such a client, merely identifying the client's motivation, is not an active way
of engaging the client.
Answers C and D: Neither of these is a good initial approach with a client whose motivation is likely to be low.
165. D is correct: This boy is exhibiting symptoms of ADHD, including disruptiveness and what seems to be impulsivity (i.e.,
due to high levels of impulsivity, some children with ADHD engage in potentially dangerous behaviors and have frequent
accidents). DSM
Answer A: The question does not describe any of the key symptoms of autistic disorder (e.g. severe social and communication
deficits, stereotyped motor mannerisms, and preoccupation with one narrow interest).
Answer B: Though risk-taking behavior may be associated with conduct disorder, in order to assign this diagnosis, we would need
evidence that this boy has been engaging in a pattern of serious misconduct that violates others' right; e.g., physical fighting,
destruction of property, deceitfulness or theft.
Answer C: Like ADHD, attention deficit disorder (ADD) is characterized by attention deficits; ADD does not, however, include
the high levels of impulsivity found in ADHD.
166. B Is correct: "B" describes the best course of treatment: both problems require medical attention; the cocaine dependence
would need to be treated initially via an inpatient program and the client would need to attend l2-step meetings as an ongoing
adjunct; and because the client may have a dual disorder (the major depression may persist even after the client has stopped using
drugs), he or she may need ongoing individual therapy to address residual mood symptoms and sustain his or her addiction
recovery. This explanation shows why the other approaches would be insufficient. DSM
167. A is correct: During live supervision, the supervisor is either physically present in the room while the supervisee provides
therapy to a client or observes the supervisee by some other means, such as on a closed circuit TV monitor or through a one-way
mirror. The supervisor offers advice and feedback, as needed, during the session. SOC ENV
Answer C: The supervisor is not a co-therapist when providing live supervision-the supervisee has primary responsibility for
conducting the session.
Answer D: This answer is too limited because it describes only one way that live supervision is offered.
168. B is correct: Because this question is presented as a clinical case, you may have evaluated the answer choices according to
their clinical benefit for the client. The primary issue, however, is confidentiality. A social worker should not even acknowledge
to a caller that he is seeing a particular person in therapy. Thus, the social worker should refuse to discuss anything with the
client's ex-husband.
Answers A, C. and D: Each of these actions would reveal to the caller that the woman is seeing the social worker, and this would
violate the client's confidentiality. Social workers 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 one's client). ETH
169. C is correct: If we consider all the information in the question, a process of elimination can point us to the correct answer.
Given the daughter's misgivings, "C" is the most appropriate step. After she is familiar with the surroundings where she will
leave her father the daughter may begin to view the staff as something other than "strangers" and may feel more comfortable
leaving her dad in their care. She may also be able to see that the facility is better equipped to meet her father's needs than she is.
PROC
Answer A: "A" doesn't seem helpful since the question already makes it clear that the client's father needs care beyond what his
daughter can provide on her own. In addition, the physician has just referred the client to the social worker.
Answer B: This is too confrontive and ignores the daughter's normal concerns and feelings about placing her dad in a nursing
facility.
Answer D: Compared to "C," this is less constructive and not as immediately helpful. In addition, the question suggests that the
dad may not be capable of participating in a meaningful way in a therapy session.
170. D is correct: Bandura and his colleagues' social (observational) model of learning r proposes that an individual can simply
observe another person-the model-perform a r behavior and. without reinforcement, subsequently display that behavior.
Based on the results of his research, Bandura concluded that observational learning involves foul processes: attention, retention,
reproduction, and motivation. Attention and retention are cognitive processes: attention entails attending to and accurately
perceiving the modeled behavior, and retention involves symbolically processing the modeled behavior in memory via visual
imagery, or verbal coding. HUM DEV
Answer A: This is the opposite of what is true. Bandura has suggested that reinforcement is ~ more important for performance
than for learning.
Answer B: This is not an assumption of Bandura's social learning theory. According to Bandura, the learner must be motivated to
perform the modeled behavior (i.e., performance is more likely to occur if the learner is reinforced); however, reinforcement can
be either internal \ (self-reinforcement) or external Answer C: This is not an assumption associated with Bandura's social learning
theory.