ASWB Clinical Social Worker 4 — Questions and Answers
Question 1: A client presents with persistent low mood, hypersomnia, increased appetite, and feelings of worthlessness lasting three weeks. Which diagnosis is most consistent with these symptoms?
- Persistent Depressive Disorder (Dysthymia)
- Major Depressive Disorder (Correct answer)
- Bipolar II Disorder, depressive episode
- Adjustment Disorder with Depressed Mood
Correct answer: Major Depressive Disorder
The symptom cluster meeting DSM-5 criteria—five or more symptoms lasting at least two weeks—is consistent with Major Depressive Disorder.
Question 2: In systems theory, which concept refers to a family's tendency to return to a prior state of equilibrium after disruption?
- Differentiation
- Homeostasis (Correct answer)
- Triangulation
- Enmeshment
Correct answer: Homeostasis
Homeostasis describes a system's drive to maintain stability and resist change, even when change would be beneficial.
Question 3: A social worker using structural family therapy would most likely intervene by:
- Exploring childhood origins of each family member's attachment style
- Restructuring boundaries and subsystems within the family (Correct answer)
- Assigning paradoxical tasks to disrupt symptom maintenance
- Tracking intergenerational patterns using a genogram
Correct answer: Restructuring boundaries and subsystems within the family
Structural family therapy (Minuchin) focuses on reorganizing family structure, boundaries, and hierarchies.
Question 4: During an intake, a client discloses active suicidal ideation with a plan and access to means. The social worker should FIRST:
- Schedule a follow-up appointment for the next week
- Conduct a no-suicide contract and continue outpatient care
- Ensure immediate safety and arrange for the highest appropriate level of care (Correct answer)
- Notify the client's family without the client's consent
Correct answer: Ensure immediate safety and arrange for the highest appropriate level of care
Active suicidal ideation with plan and means requires immediate safety intervention and likely hospitalization.
Question 5: Which attachment style is characterized by an infant who shows distress when a caregiver leaves but is not comforted upon return?
- Secure attachment
- Anxious-avoidant attachment
- Anxious-ambivalent (resistant) attachment (Correct answer)
- Disorganized attachment
Correct answer: Anxious-ambivalent (resistant) attachment
Anxious-ambivalent attachment involves hyperactivation of the attachment system, leading to distress at separation and inability to be soothed on reunion.
Question 6: A social worker discovers they have a personal relationship with a prospective client's spouse. The best course of action is to:
- Proceed with treatment and disclose the relationship to the client at the first session
- Decline to accept the client and provide a referral to avoid a dual relationship (Correct answer)
- Accept the client only if the spouse signs a conflict-of-interest waiver
- Consult a colleague but proceed with treatment
Correct answer: Decline to accept the client and provide a referral to avoid a dual relationship
An existing personal relationship with a client's spouse creates a conflict of interest; referral is required to avoid a dual relationship.
Question 7: Which of the following is an example of a secondary trauma symptom in a clinician?
- Setting firm limits on after-hours calls
- Intrusive imagery from a client's traumatic narrative after a session (Correct answer)
- Maintaining good supervision attendance
- Using evidence-based trauma treatment models
Correct answer: Intrusive imagery from a client's traumatic narrative after a session
Secondary traumatic stress (compassion fatigue) can produce intrusive symptoms similar to PTSD in clinicians exposed to clients' trauma narratives.
ASWB Clinical Social Worker 4
A client presents with persistent low mood, hypersomnia, increased appetite, and feelings of worthlessness lasting three weeks.
Which diagnosis is most consistent with these symptoms?