California Law and Ethics Examination (CLEE) — Questions and Answers

Question 1: When documenting a suicide risk assessment, a therapist should include:

A comprehensive account of risk and protective factors, clinical reasoning, interventions taken, and the follow-up plan (Correct answer)
An attestation that the therapist consulted with a supervisor during the assessment
A signed no-harm contract from the client as the primary documentation
Only the final conclusion of low, moderate, or high risk

Correct answer: A comprehensive account of risk and protective factors, clinical reasoning, interventions taken, and the follow-up plan

Thorough suicide risk documentation must capture the clinical reasoning process, all relevant risk and protective factors, actions taken, and the follow-up plan—not just the risk level conclusion.

Question 2: Which of the following is an appropriate method for disposing of client records that have reached the end of their required retention period?

Shredding paper records and using certified data destruction for electronic records (Correct answer)
Returning records to the client for their own disposal
Recycling paper records in standard recycling bins
Storing records indefinitely to avoid any risk of improper disposal

Correct answer: Shredding paper records and using certified data destruction for electronic records

Proper disposal requires shredding paper records and using HIPAA-compliant certified destruction for electronic media to prevent unauthorized access.

Question 3: Under HIPAA, psychotherapy notes stored separately from the general medical record:

May be disclosed to insurers without authorization for billing purposes
Must be released with the medical record upon any patient request
Require separate, specific patient authorization for release beyond standard TPO disclosures (Correct answer)
Are not subject to HIPAA protections

Correct answer: Require separate, specific patient authorization for release beyond standard TPO disclosures

HIPAA's privacy rule gives psychotherapy notes (process notes) heightened protection, requiring a specific authorization separate from the general medical record authorization.

Question 4: In California, who is qualified to provide supervision hours that count toward MFT licensure?

Any doctoral-level clinician regardless of license type
Any licensed mental health professional with 2 years of experience
Only licensed MFTs may supervise MFT associates
A licensed MFT, LCSW, LPCC, or psychologist who meets BBS supervisor requirements (Correct answer)

Correct answer: A licensed MFT, LCSW, LPCC, or psychologist who meets BBS supervisor requirements

BBS regulations allow licensed MFTs, LCSWs, LPCCs, and psychologists with appropriate qualifications to provide supervision that counts toward MFT licensure.

Question 5: Under California Tarasoff law (Civil Code §43.92), a therapist's duty to warn is triggered by a patient's threat toward:

Only the therapist themselves
Any member of the general public
Only immediate family members
A reasonably identifiable third-party victim (Correct answer)

Correct answer: A reasonably identifiable third-party victim

The Tarasoff duty requires the victim to be 'reasonably identifiable' — vague threats against unnamed or unidentifiable persons do not trigger the duty.

Question 6: For minor clients in California, mental health records must be retained until the minor reaches age 18 or for how long, whichever is longer?

7 years after last service (Correct answer)
10 years after last service
5 years after last service
3 years after last service

Correct answer: 7 years after last service

Records for minors must be kept until the minor turns 18 or for 7 years from the last date of service, whichever period is longer.

Question 7: A therapist in a small community runs into a client at a local grocery store. The client begins to share personal issues, seeking advice. What is the most ethical response?

Continue the conversation but keep it casual to avoid boundary crossing.
Offer brief advice in the moment since it is a public setting.
Encourage the client to schedule an appointment to discuss the issue privately. (Correct answer)
Avoid the conversation by quickly leaving the store.

Correct answer: Encourage the client to schedule an appointment to discuss the issue privately.

Encountering a client in public requires maintaining confidentiality and professional boundaries. Engaging in a therapeutic discussion in a public place compromises the client's privacy and the professional setting of therapy. The most ethical response is to acknowledge the client briefly and redirect them to the appropriate professional setting for discussion, ensuring their privacy and the integrity of the therapeutic process.

Question 8: A mandated reporter's duty to report child abuse is triggered when they:

Observe physical injuries firsthand
Have absolute proof that abuse occurred
Know or reasonably suspect that abuse or neglect has occurred (Correct answer)
Receive a confession from the alleged perpetrator

Correct answer: Know or reasonably suspect that abuse or neglect has occurred

The 'reasonable suspicion' standard means the reporter does not need proof — they only need information that would cause a reasonable person to suspect abuse.

Question 9: When a mandated reporter suspects that a child is being abused by someone outside the family, who should receive the report?

Only the school principal or administrator
The California Department of Health
The child's parents or guardians
Child Protective Services and/or law enforcement (Correct answer)

Correct answer: Child Protective Services and/or law enforcement

CANRA reports go to Child Protective Services (CPS) or local law enforcement regardless of whether the suspected perpetrator is a family member or someone outside the family.

Question 10: Which of the following is an essential element of valid informed consent for psychotherapy in California?

Consent given by the therapist on behalf of a client who seems reluctant
The client's signature on a standard form is sufficient without explanation
Verbal agreement only is sufficient for informed consent
Disclosure of the nature of treatment, risks, benefits, alternatives, and the client's right to withdraw (Correct answer)

Correct answer: Disclosure of the nature of treatment, risks, benefits, alternatives, and the client's right to withdraw

Valid informed consent requires the client to understand the nature of treatment, its risks and benefits, available alternatives, and that they may withdraw consent at any time.

Question 11: Regarding the duty to report under CANRA, a therapist's suspicion of child sexual abuse must be reported:

Only when the perpetrator is a family member
Regardless of whether the child has made a direct disclosure (Correct answer)
Only when physical evidence is present
Only after obtaining the child's direct disclosure

Correct answer: Regardless of whether the child has made a direct disclosure

CANRA does not require a direct disclosure or physical evidence; reasonable suspicion from any source — including behavioral observations — is sufficient.

Question 12: What is the primary purpose of progress notes in a clinical record?

To provide a verbatim transcript of each session
To document the client's progress, clinical reasoning, and treatment response over time (Correct answer)
To fulfill insurance billing requirements only
To serve as a legal contract between therapist and client

Correct answer: To document the client's progress, clinical reasoning, and treatment response over time

Progress notes document the client's clinical status, response to treatment, therapist reasoning, and progress toward goals, forming the core of the clinical record.

Question 13: Which action does NOT fulfill a therapist's 'duty to protect' obligation under California law?

Notifying local law enforcement of the threat
Warning the potential victim directly
Seeking voluntary or involuntary hospitalization for the client
Terminating the therapeutic relationship without any follow-up or protective action (Correct answer)

Correct answer: Terminating the therapeutic relationship without any follow-up or protective action

Simply ending treatment without taking affirmative protective steps does not satisfy the duty to protect; therapists must take reasonable action to safeguard identifiable victims.

Question 14: A therapist who is licensed as a Marriage and Family Therapist (LMFT) is approached by a client seeking treatment for a complex neurological disorder that is beyond the therapist's expertise. What is the therapist's responsibility in this situation?

Refer the client to a specialist who has experience with neurological disorders. (Correct answer)
Take on the case and conduct research to learn about the disorder.
Accept the client but limit the therapy to emotional support.
Consult with a colleague who specializes in neurological disorders while continuing therapy.

Correct answer: Refer the client to a specialist who has experience with neurological disorders.

Therapists are ethically bound to practice within their scope of competence and expertise. If a client presents with an issue beyond the therapist's training or experience, such as a complex neurological disorder, the therapist's responsibility is to refer the client to a qualified specialist. This ensures the client receives appropriate, effective, and specialized care, prioritizing their well-being.

Question 15: In a group therapy setting, what is the therapist's ethical obligation regarding confidentiality?

Group members automatically waive confidentiality by participating
The therapist should instruct group members about confidentiality but cannot guarantee it (Correct answer)
Confidentiality applies only between the therapist and the group as a whole
Confidentiality does not apply in group therapy settings

Correct answer: The therapist should instruct group members about confidentiality but cannot guarantee it

Therapists must inform group members of the confidentiality expectation, but cannot legally compel other group members to maintain it.

Question 16: An MFT associate must use which designation when identifying themselves to clients?

Licensed Marriage and Family Therapist
Registered Psychological Assistant
Marriage and Family Therapist Intern
MFT Associate or Associate Marriage and Family Therapist (Correct answer)

Correct answer: MFT Associate or Associate Marriage and Family Therapist

California updated the title to 'Associate Marriage and Family Therapist' (AMFT) — using the term 'intern' is no longer permitted as it may be misleading to clients.

Question 17: When providing teletherapy services, informed consent must additionally address:

Only technical aspects like software requirements
Technology platform risks, emergency procedures, and jurisdiction-specific considerations (Correct answer)
The client's internet speed and device capabilities
No additional information beyond standard in-person consent

Correct answer: Technology platform risks, emergency procedures, and jurisdiction-specific considerations

Teletherapy informed consent must include technology-related risks (privacy, platform limitations), emergency protocols for remote sessions, and any interstate practice considerations.

Question 18: A California therapist receives a request from a coroner investigating a client's death. The therapist should:

Refuse to release any records due to the psychotherapist-patient privilege
Release records only if the deceased client's estate provides authorization
Cooperate with the coroner's request, as the privilege may be waived in death investigations (Correct answer)
Release records only with a court order

Correct answer: Cooperate with the coroner's request, as the privilege may be waived in death investigations

California law permits disclosure to coroners and medical examiners investigating a death, and courts have found privilege may yield to a coroner's lawful investigation.

Question 19: Which of the following is NOT a permissible disclosure of confidential information under California law?

Providing emergency medical information when the patient is incapacitated
Discussing a patient's case in detail at a social gathering (Correct answer)
Sharing records with a new treating therapist with patient authorization
Reporting child abuse to the appropriate agency

Correct answer: Discussing a patient's case in detail at a social gathering

Discussing a patient's case at a social gathering is a breach of confidentiality regardless of whether identifying information is used.

Question 20: A therapist receives a written authorization from a patient to release records to their attorney. The therapist should:

Release records only if a court orders it regardless of the authorization
Release the records as specified in the valid written authorization (Correct answer)
Refuse because attorney communications are unrelated to treatment
Release only a summary, not the actual session notes

Correct answer: Release the records as specified in the valid written authorization

A valid written authorization from the patient allows the therapist to release records to the specified recipient as described in the authorization.

Question 21: Under California law, practicing psychotherapy without a license or registration is a:

Violation handled only by the BBS administratively
Minor regulatory violation with a small fine
Civil infraction with no criminal penalties
Misdemeanor or felony depending on the circumstances (Correct answer)

Correct answer: Misdemeanor or felony depending on the circumstances

Unlicensed practice of psychotherapy in California violates Business and Professions Code §4980.02 and can be charged as a misdemeanor or felony.

Question 22: When must a California MFT disclose their license status to clients?

Only in writing on the office door or waiting room
At the outset of treatment as part of informed consent disclosures (Correct answer)
Only when a client specifically asks
Disclosure is recommended but not required

Correct answer: At the outset of treatment as part of informed consent disclosures

California law requires therapists to provide clients with information about their license type and status as part of the required disclosure statement at the start of treatment.

Question 23: A therapist receives a friend request from a current client on a social media platform. What is the most ethical course of action?

Decline the request and explain that it is important to keep professional boundaries. (Correct answer)
Accept the friend request to build rapport with the client.
Create a separate, professional social media profile and accept the request there.
Ignore the request without addressing it in therapy.

Correct answer: Decline the request and explain that it is important to keep professional boundaries.

Accepting a client's social media friend request creates a dual relationship, blurring professional boundaries and potentially exposing the client to personal information about the therapist, or vice versa. This can compromise the therapeutic relationship and client confidentiality. Ethically, therapists must maintain clear professional boundaries, which includes separating personal and professional online interactions to protect the client and the therapeutic process.

Question 24: A therapist wishes to video record sessions for training purposes. The therapist must:

Obtain consent only if the recording will be shown outside the agency
Obtain specific written informed consent for recording, separate from general therapy consent (Correct answer)
Obtain supervisor approval only — client consent is optional
Notify the client in the initial disclosure but no separate consent is needed

Correct answer: Obtain specific written informed consent for recording, separate from general therapy consent

Recording sessions requires separate, specific informed consent beyond the general therapy consent, as recording is not a routine part of treatment.

Question 25: The 'dangerous patient' exception in California allows a therapist to warn a threatened third party when:

The patient presents a serious and credible threat of violence against an identifiable victim (Correct answer)
The patient refuses to take prescribed medication
The patient expresses general anger toward people
The patient has a criminal history

Correct answer: The patient presents a serious and credible threat of violence against an identifiable victim

California Civil Code §43.92 requires a serious, credible, and imminent threat against a specifically identifiable victim before the duty to warn is triggered.

Question 26: A client who has signed an informed consent form later states they did not understand what they agreed to. The therapist's responsibility is to:

Note the client's statement in the chart and continue treatment unchanged
Remind the client they signed the form and the matter is settled
Have the client sign a second form acknowledging the original
Revisit the consent information, answer questions, and ensure true understanding (Correct answer)

Correct answer: Revisit the consent information, answer questions, and ensure true understanding

Informed consent is an ongoing process; therapists must ensure that clients genuinely understand the information throughout the treatment relationship.

Question 27: When a patient dies, who holds the psychotherapist-patient privilege in California?

The patient's spouse
The patient's estate or personal representative (Correct answer)
The therapist
No one — the privilege terminates at death

Correct answer: The patient's estate or personal representative

Upon the patient's death, the privilege is held by the personal representative (executor or administrator) of the patient's estate.

Question 28: What is the maximum caseload ratio of supervisees to supervisor under California BBS regulations for MFT supervision?

The supervisor may supervise up to 10 supervisees concurrently
The supervisor may have no more than 3 supervisees at any time
No specific limit is set (Correct answer)
5 supervisees per supervisor

Correct answer: No specific limit is set

California BBS regulations do not specify a maximum supervisee-to-supervisor ratio but require that supervision be adequate and that each supervisee receives sufficient oversight.

Question 29: A therapist lives in a rural area where it is common to encounter clients in various social or community settings. Which of the following is the most ethical approach?

Stop providing therapy services in the community to avoid dual relationships.
Develop clear boundaries and communicate them with clients at the start of therapy. (Correct answer)
Only see clients who do not live in the same area to prevent dual relationships.
Avoid engaging with clients outside of therapy, even if encountered in social settings.

Correct answer: Develop clear boundaries and communicate them with clients at the start of therapy.

In rural areas, encountering clients in social or community settings is often unavoidable. The most ethical approach is to proactively establish and communicate clear boundaries with clients from the outset of therapy. This includes discussing how incidental encounters will be handled to protect confidentiality and maintain the professional nature of the therapeutic relationship, ensuring client comfort and ethical practice.

Question 30: Electronic health records (EHRs) used by California mental health providers must comply with:

Voluntary industry standards only, as no specific laws govern EHRs
Only California state record-keeping laws
Only HIPAA — California has no additional EHR requirements
Both HIPAA security standards and California's data privacy laws, including CMIA (Correct answer)

Correct answer: Both HIPAA security standards and California's data privacy laws, including CMIA

EHRs must comply with both HIPAA's Security Rule and California's Confidentiality of Medical Information Act (CMIA), which has additional protections beyond HIPAA.

Question 31: Which of the following is a reportable form of elder abuse under California law?

Disagreements between family members about elder care decisions
Financial abuse, including theft or misuse of an elder's funds (Correct answer)
An elder declining recommended medical treatment
Natural cognitive decline associated with aging

Correct answer: Financial abuse, including theft or misuse of an elder's funds

Financial abuse — including theft, fraud, or misuse of an elder's property or funds — is explicitly reportable under EADACPA.

Question 32: Which resident right is being violated if a nursing assistant enters the hospital cafeteria and hears another assistant talking about a resident with co-workers?

the resident's right to know who is involved in their medical care
the resident's right to be present when their care is discussed
the resident's right to make decisions regarding their own care
the resident's right to privacy (Correct answer)

Correct answer: the resident's right to privacy

Discussing a resident's personal medical information in a public place, such as a cafeteria, constitutes a violation of their right to privacy and confidentiality. Healthcare professionals are legally and ethically bound to protect patient information, and such discussions should only occur in private settings among those directly involved in the resident's care, adhering to HIPAA regulations.

Question 33: In California, which board licenses Marriage and Family Therapists (MFTs)?

California Board of Psychology
Department of Consumer Affairs only
Board of Behavioral Sciences (BBS) (Correct answer)
California Medical Board

Correct answer: Board of Behavioral Sciences (BBS)

The California Board of Behavioral Sciences (BBS) is the regulatory agency responsible for licensing MFTs, LCSWs, LPCCs, and LEPs.

Question 34: A therapist may disclose confidential information without patient consent when:

The patient has not attended sessions for 60 days
There is a serious and imminent threat to an identifiable third party (Correct answer)
Another therapist requests records for a referral
The patient owes an unpaid balance

Correct answer: There is a serious and imminent threat to an identifiable third party

Under the Tarasoff duty (Civil Code §43.92), a therapist must take reasonable steps to protect an identifiable third party facing a serious and imminent threat.

Question 35: A therapist may withhold a client's records if:

The client has an outstanding balance for services
The therapist determines the client does not need the records
Disclosure would cause substantial harm to the client or others, as documented (Correct answer)
The records are more than 5 years old

Correct answer: Disclosure would cause substantial harm to the client or others, as documented

California Health and Safety Code §123115 permits withholding records if the treating provider documents that access would cause substantial harm to the patient or a third party.

Question 36: Which of the following are indicators that you may be having boundary troubles?

Wanting to punish or control a client.
Wanting to save or rescue a client.
All of the above (Correct answer)
Having a hard time saying “no” to a client.
Sharing unnecessarily personal stories with a client.

Correct answer: All of the above

Indicators of boundary troubles often involve a shift in the professional's internal experience and behavior towards a client. Difficulty saying 'no,' a desire to 'save' or 'rescue' a client, sharing excessive personal details, or wanting to control or punish a client all signal that professional boundaries may be eroding or have already been crossed. Recognizing these signs is crucial for ethical practice.

Question 37: Which of the following would not be considered a boundary violation?

A staff person lending, borrowing, giving or receiving gifts, money or personal property from a client.
A staff person talking to a client about the client’s personal problems at home. (Correct answer)
A staff person engaging in physical horseplay with a client.
A staff person sharing personal religious views, taking clients to a staff member’s church and proselytizing to clients.
Staff disclosing to a client personal problems, drug or alcohol use and work-related gossip.

Correct answer: A staff person talking to a client about the client’s personal problems at home.

Discussing a client's personal problems at home is a core function of a helping professional, as it directly relates to the client's well-being and the purpose of the professional interaction. In contrast, lending money, engaging in physical horseplay, or sharing personal religious views with clients are clear examples of boundary violations. These actions compromise professional integrity and can exploit or harm the client.

Question 38: When must a mandated reporter make an initial report of suspected child abuse in California?

Within 72 hours of suspicion
Within 5 business days in writing
Immediately or as soon as practically possible by phone (Correct answer)
Only after consulting with a supervisor

Correct answer: Immediately or as soon as practically possible by phone

CANRA requires mandated reporters to make an immediate telephone report to a law enforcement agency or child protective services upon having reasonable suspicion.

Question 39: A mandated reporter who fails to report known or suspected child abuse in California may face:

A fine of up to $10,000
Criminal misdemeanor charges and/or civil liability (Correct answer)
License suspension only
No legal consequence — reporting is voluntary

Correct answer: Criminal misdemeanor charges and/or civil liability

Under California Penal Code §11166, failure to report by a mandated reporter is a misdemeanor and may also result in civil liability.

Question 40: When you walk in to begin your shift, a resident is being put in restraints by the charge nurse. This means ____.

you need to avoid the patient so as not to escalate his or her agitation
you need to call the family and notify them at once that restraints are being used
you need to check the resident at least every two hours to assess basic needs, circulation, and bathroom necessities (Correct answer)
you need to leave all of this resident's care in the hands of the charge nurse until the restraints have been removed

Correct answer: you need to check the resident at least every two hours to assess basic needs, circulation, and bathroom necessities

When a resident is in restraints, nursing assistants have a critical responsibility to ensure their safety and well-being through frequent monitoring. This includes checking the resident at least every two hours (or more frequently per facility policy) to assess basic needs, circulation, skin integrity, and comfort. This diligent observation helps prevent complications and ensures humane care while restraints are in use.

Question 41: Informed consent for therapy in California must be documented by:

Notarization of the consent document
A witness signature on the consent form
Written consent, with the signed form kept in the client's file (Correct answer)
Verbal agreement recorded in session notes only

Correct answer: Written consent, with the signed form kept in the client's file

California law requires written informed consent documentation to be maintained in the client's record.

Question 42: California Welfare and Institutions Code Section 5150 authorizes an involuntary 72-hour psychiatric hold when a person:

Requests hospitalization voluntarily but then changes their mind
Is a danger to themselves, others, or is gravely disabled due to a mental disorder (Correct answer)
Has been diagnosed with a serious mental illness by two independent physicians
Has a history of mental illness and voluntarily stops taking medication

Correct answer: Is a danger to themselves, others, or is gravely disabled due to a mental disorder

WIC 5150 authorizes a 72-hour evaluation hold when a person, as a result of a mental disorder, poses a danger to self, others, or is gravely disabled.

Question 43: Which California statute governs the confidentiality of mental health records for licensed therapists?

Civil Code §56.10 (Correct answer)
Welfare and Institutions Code §5150
Evidence Code §1014
Business and Professions Code §4980

Correct answer: Civil Code §56.10

California Civil Code §56.10 (part of the Confidentiality of Medical Information Act) governs the disclosure of medical and mental health records.

Question 44: A therapist is uncertain whether a situation constitutes reportable child abuse. Under CANRA, the therapist should:

Consult with a supervisor and only report if the supervisor agrees
Wait until they are certain before making any report
File a report only if the child asks them to
Report if they have reasonable suspicion, as the threshold is low (Correct answer)

Correct answer: Report if they have reasonable suspicion, as the threshold is low

The reasonable suspicion standard is intentionally low; when in doubt, therapists should report and allow child protective services to investigate.

Question 45: When does the Tarasoff duty to warn or protect NOT apply?

When the client is themselves a licensed mandated reporter
When the client verbally denies any intent to harm another person
When the client has an established history of prior violent behavior
When the threat is nonspecific, vague, or the potential victim is not identifiable (Correct answer)

Correct answer: When the threat is nonspecific, vague, or the potential victim is not identifiable

The Tarasoff duty requires both a serious and imminent threat and an identifiable potential victim; vague, nonspecific threats without an identifiable target do not trigger the duty.

Question 46: A California therapist is required to inform clients of the limits of confidentiality:

Once per calendar year in writing
Only when confidentiality must actually be broken
At the beginning of the therapeutic relationship (Correct answer)
Only when mandated reporting is likely

Correct answer: At the beginning of the therapeutic relationship

California law and ethical standards require therapists to disclose confidentiality limits — including mandated reporting, duty to warn, etc. — at the outset of treatment.

Question 47: A California licensed therapist who changes their name must notify the BBS within:

60 days (Correct answer)
30 days
90 days
6 months

Correct answer: 60 days

California BBS regulations require licensees to notify the Board of a name change within 30 days to keep their license record accurate.

Question 48: A California therapist receives a call from an adult client's parent expressing concern that the client is suicidal. The therapist's BEST response is to:

Refer the parent directly to the client's primary care physician
Share all treatment information with the parent to coordinate care and protect the client
Acknowledge the parent's concern and encourage them to call 911 if the client is in immediate danger, without confirming or denying the therapeutic relationship (Correct answer)
Contact the client's insurance company to arrange crisis services on the parent's behalf

Correct answer: Acknowledge the parent's concern and encourage them to call 911 if the client is in immediate danger, without confirming or denying the therapeutic relationship

Without the client's consent, the therapist cannot confirm the therapeutic relationship but should encourage the parent to contact emergency services if immediate danger exists.

Question 49: It is appropriate for the nursing assistant to share personal client information with ____.

the client's roommate
the client's wife
the client's children
the nursing assistant on the next shift (Correct answer)

Correct answer: the nursing assistant on the next shift

Client information is confidential and should only be shared with healthcare professionals directly involved in the client's care. Sharing information with the nursing assistant on the next shift is appropriate and necessary for continuity of care, ensuring the client receives consistent and informed support. Sharing with family or roommates without explicit consent violates privacy regulations like HIPAA.

Question 50: A patient discloses that they were abused as a child but the abuse ended years ago and the perpetrator is now deceased. The therapist's reporting obligation is:

Must consult with a supervisor before deciding
Must report to law enforcement within 36 hours
Must report immediately regardless of timing
No current reporting obligation since the perpetrator is deceased and there is no ongoing risk (Correct answer)

Correct answer: No current reporting obligation since the perpetrator is deceased and there is no ongoing risk

CANRA reporting is intended to protect children from ongoing or future harm; historical abuse with no current risk and a deceased perpetrator generally does not create a mandatory reporting obligation.

Question 51: If a patient requests access to their own mental health records in California, the therapist must generally respond within:

30 calendar days (Correct answer)
15 business days
60 days
5 business days

Correct answer: 30 calendar days

Under HIPAA and California law, covered entities must provide access to records within 30 days of the request, with one possible 30-day extension.

Question 52: Which of the following does NOT constitute child abuse under CANRA?

General parenting disagreements without harm (Correct answer)
Unlawful corporal punishment causing injury
Physical injury inflicted by a parent
Willful cruelty or unjustifiable punishment

Correct answer: General parenting disagreements without harm

General disagreements about parenting practices without resulting harm, injury, or neglect do not meet CANRA's definition of reportable abuse.

Question 53: What is the standard of proof required for a mandated reporter to file an elder abuse report?

Reasonable suspicion (Correct answer)
Beyond a reasonable doubt
Clear and convincing evidence
Preponderance of the evidence

Correct answer: Reasonable suspicion

Like child abuse, the standard for reporting elder abuse is reasonable suspicion — certainty is not required before making a report.

Question 54: A therapist's client is acutely suicidal and refuses voluntary hospitalization. The therapist's MOST appropriate response is to:

Immediately terminate the therapeutic relationship to avoid liability
Consider initiating a 5150 hold if criteria are met and less restrictive options have not been sufficient (Correct answer)
Honor the client's autonomous decision, as competent adults have the absolute right to refuse hospitalization
Obtain a court order before taking any involuntary action

Correct answer: Consider initiating a 5150 hold if criteria are met and less restrictive options have not been sufficient

When a client meets 5150 criteria and less restrictive alternatives have been insufficient, the therapist may initiate an involuntary hold to prevent imminent harm.

Question 55: A California therapist receives a subpoena for a patient's records. The correct first step is to:

Immediately release the records to comply with the subpoena
Destroy the records to protect the patient
Contact the opposing attorney directly
Notify the patient and obtain their consent or wait for a court order (Correct answer)

Correct answer: Notify the patient and obtain their consent or wait for a court order

A subpoena alone does not override privilege; the therapist must notify the patient so they can seek to quash the subpoena, unless a court order compels release.

Question 56: Under California law, a therapist may breach confidentiality without client consent when:

The client misses multiple appointments without explanation
The client discloses past criminal activity
There is a serious and imminent threat of harm to an identifiable third party (Correct answer)
The therapist believes the client is withholding information

Correct answer: There is a serious and imminent threat of harm to an identifiable third party

California's Tarasoff duty requires therapists to take reasonable protective steps, including breaching confidentiality, when a client poses a serious and imminent threat to an identifiable third party.

Question 57: A therapist discovers an error in a client's medical record. The correct way to make a correction is to:

Destroy the original record and create a new one
White out or delete the error and rewrite the entry
Draw a single line through the error, add the correction, and date and initial the correction (Correct answer)
Leave the error in place and note the correction only in the next session's notes

Correct answer: Draw a single line through the error, add the correction, and date and initial the correction

Proper record amendment requires a single line through the error, with the correction, date, and initials added — never obscuring or deleting original entries.

Question 58: A client with a serious mental illness lacks capacity to provide informed consent. The therapist should:

Provide only crisis stabilization and no ongoing therapy
Seek consent from a legally authorized representative and/or pursue appropriate legal processes (Correct answer)
Proceed with treatment without consent since the client needs help
Discharge the client immediately to a higher level of care

Correct answer: Seek consent from a legally authorized representative and/or pursue appropriate legal processes

When a client lacks decisional capacity, therapists must seek consent from a legally authorized representative (LAR) such as a conservator or authorized family member.

Question 59: Informed consent in therapy must be obtained from a client before:

Treatment begins, with updates when significant changes in treatment occur (Correct answer)
The client can see any clinical notes
Each individual session throughout treatment
The therapist discloses their fees

Correct answer: Treatment begins, with updates when significant changes in treatment occur

Informed consent must be obtained at the start of treatment and revisited when significant changes occur, such as a change in treatment modality or scope.

Question 60: Under California law, a patient's right to access their own mental health records is governed by:

The Tarasoff Act only
The BBS licensing statutes exclusively
The Welfare and Institutions Code for all clients
HIPAA and California Health and Safety Code §123111 (Correct answer)

Correct answer: HIPAA and California Health and Safety Code §123111

Both HIPAA and California Health and Safety Code §123111 establish patients' rights to access and inspect their own health records.

Question 61: A resident in your care tells you that he does not like his current physician and wishes to be seen by another doctor. Your response to this should be ____.

to help the resident contact the social worker or RN for assistance in this matter (Correct answer)
to acknowledge the resident's concerns and suggest a different medical provider
to reassure the resident that his doctor is qualified and capable and encourage the resident to respect the doctor
to gently tell the resident that the doctor has been assigned to him and he cannot change physicians without a legal procedure

Correct answer: to help the resident contact the social worker or RN for assistance in this matter

Residents have the right to choose their physician. If a resident expresses dissatisfaction and wishes to change doctors, the nursing assistant's role is to advocate for them and facilitate their request through appropriate channels. This typically involves contacting the social worker or Registered Nurse (RN), who can then guide the resident through the process of changing physicians, respecting their autonomy.

Question 62: When may a therapist use client records for training or case consultation without client authorization?

Never — authorization is always required for any disclosure
When the consultation is conducted in writing, not verbally
Only within the same agency or practice setting
When information is de-identified so the client cannot be identified (Correct answer)

Correct answer: When information is de-identified so the client cannot be identified

De-identified information is no longer considered protected health information under HIPAA and may be used for training and consultation without authorization.

Question 63: When reporting elder abuse in California, the initial report must be made to:

The patient's primary care physician
Adult Protective Services or local law enforcement (Correct answer)
The California Medical Board
The nearest hospital emergency room

Correct answer: Adult Protective Services or local law enforcement

Reports of elder or dependent adult abuse must be made to Adult Protective Services (APS) or, in facilities, the appropriate licensing agency and law enforcement.

Question 64: In California, which of the following situations requires a mandated report of child abuse?

A child expresses sadness about their parents divorcing
A child says they got a bruise falling off their bike
A teenager admits to recreational marijuana use
A parent describes intentionally burning a child as discipline (Correct answer)

Correct answer: A parent describes intentionally burning a child as discipline

Deliberate physical injury inflicted as 'discipline' meets the definition of willful cruelty and reportable physical abuse under CANRA.

Question 65: Which of the following clients may NOT provide their own informed consent for outpatient therapy under California law?

A 14-year-old minor seeking treatment for sexual assault (Correct answer)
A 30-year-old adult with mild depression
A 12-year-old consenting to treatment per Family Code §6924
An emancipated minor aged 16

Correct answer: A 14-year-old minor seeking treatment for sexual assault

A 14-year-old is generally not able to independently consent unless they qualify under Family Code §6924, are emancipated, or meet another exception — but sexual assault victims aged 12+ can consent under specific provisions.

Question 66: Which exception allows a therapist to disclose confidential information to prevent a patient from self-harm?

The duty-to-warn exception for third parties only
The imminent danger to self exception under Civil Code §43.92 (Correct answer)
There is no exception; self-harm is fully protected
The Tarasoff exception

Correct answer: The imminent danger to self exception under Civil Code §43.92

California Civil Code §43.92 and the duty-to-warn statutes permit disclosure to prevent serious and imminent harm to the patient themselves.

Question 67: A patient waives the psychotherapist-patient privilege when they:

Place their mental condition at issue in a legal proceeding (Correct answer)
Ask the therapist for a copy of their records
Request a change in treatment modality
Miss multiple scheduled appointments

Correct answer: Place their mental condition at issue in a legal proceeding

A patient waives privilege when they place their mental or emotional condition at issue in litigation, such as claiming emotional distress damages.

Question 68: A California MFT who wants to add telehealth services must ensure that:

Clients receiving telehealth are located in California unless the therapist holds licensure in the client's state (Correct answer)
Telehealth sessions do not count toward supervised hours
They obtain a separate telehealth license from the BBS
All telehealth platforms must be approved by the BBS

Correct answer: Clients receiving telehealth are located in California unless the therapist holds licensure in the client's state

Therapists must hold licensure in the state where the client is physically located during telehealth sessions, meaning out-of-state clients generally require licensure in that state.

Question 69: In California, the written follow-up report for child abuse must be submitted within how many hours of the initial phone report?

12 hours
24 hours
48 hours
36 hours (Correct answer)

Correct answer: 36 hours

California Penal Code §11166 requires the written report (Form SS 8572) to be submitted within 36 hours of the initial telephone report.

Question 70: An MFT associate in California must complete the supervised experience requirement within how many years of receiving associate registration?

3 years
5 years
7 years (Correct answer)
10 years

Correct answer: 7 years

California Business and Professions Code requires that MFT associates complete their 3,000 supervised hours within 7 years of initial associate registration.

Question 71: A therapist's clinical notes may be subpoenaed in a custody dispute. The therapist's best practice is to:

Provide a summary but withhold original session notes
Refuse to cooperate with any subpoena related to family law matters
Release records immediately to demonstrate cooperation with the legal process
Notify the patient, consult with an attorney, and seek to protect records unless a court orders release (Correct answer)

Correct answer: Notify the patient, consult with an attorney, and seek to protect records unless a court orders release

Therapists should notify the client, assert the privilege, and consult legal counsel before releasing records pursuant to a subpoena — a court order may ultimately be required.

Question 72: A therapist has a long-term client who runs a business offering services that the therapist could benefit from. The client offers a discount on their services to the therapist. How should the therapist respond?

Politely decline and explain the importance of keeping professional boundaries. (Correct answer)
Accept the discount but avoid discussing it during therapy sessions.
Accept the discount as a sign of mutual respect.
Refer the client to another therapist to avoid the dual relationship.

Correct answer: Politely decline and explain the importance of keeping professional boundaries.

Accepting a discount on services from a client creates a dual relationship and can introduce conflicts of interest or feelings of obligation, compromising the therapeutic relationship's objectivity. Ethical guidelines require therapists to avoid situations where personal gain could influence professional judgment. Politely declining the offer respectfully reinforces professional boundaries and maintains the integrity of the therapeutic process.

Question 73: What is a 'covered entity' under HIPAA as it applies to a California therapist in solo private practice?

Only therapists who accept Medicare or Medicaid
Any health care provider who transmits health information electronically in connection with covered transactions (Correct answer)
Therapists who use EHR systems but not those using paper records
Only therapists who work in hospitals or large organizations

Correct answer: Any health care provider who transmits health information electronically in connection with covered transactions

HIPAA's covered entity definition includes health care providers who transmit health information electronically for standard transactions such as billing — this includes most solo practitioners.

Question 74: How many hours of supervised experience are required for MFT licensure in California?

2,000 hours
1,500 hours
3,000 hours (Correct answer)
4,000 hours

Correct answer: 3,000 hours

California Business and Professions Code §4980.43 requires 3,000 hours of supervised post-degree experience for MFT licensure.

Question 75: It is important to use your co-workers and supervisors to discuss clients or situations that bring up uncomfortable and confusing feelings. Small lapses in judgment or confusion about proper conduct can usually be handled at the supervisor level without bigger problems developing.

False
True (Correct answer)

Correct answer: True

Open communication with co-workers and supervisors is crucial for maintaining ethical boundaries and professional integrity. Discussing uncomfortable or confusing client situations allows for peer supervision, guidance, and early intervention. This collaborative approach helps prevent small lapses in judgment from escalating into more serious ethical violations, ensuring responsible client care.

California Law and Ethics Examination (CLEE)

The California Law and Ethics Examination (CLEE), administered by the Board of Behavioral Sciences (BBS), tests licensed therapists (LCSWs, LMFTs, and LPCCs) on California laws and professional ethics governing behavioral health practice, including confidentiality, mandated reporting, and scope of practice.

Questions

90 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

bbs.ca.gov — Renewal, fees, eligibility, retake policy, score validity, retake fee · verified Oct 2026
home.pearsonvue.com — Registration deadline · verified Oct 2026
pearsonvue.com — Test delivery, score release, time limit · verified Oct 2026