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

Question 1: A therapist's client discloses they are a licensed gun owner and has been experiencing suicidal thoughts. Under best-practice guidelines applicable in California, the therapist should:

Avoid discussing firearms entirely due to Second Amendment considerations
Contact the DOJ to initiate firearms confiscation proceedings immediately
Incorporate means restriction counseling—such as advising the client to have someone else safely store the firearms—into the safety plan (Correct answer)
Report the client to law enforcement because gun ownership combined with suicidal ideation is automatically a 5150 criteria

Correct answer: Incorporate means restriction counseling—such as advising the client to have someone else safely store the firearms—into the safety plan

Means restriction counseling, including encouraging clients to reduce access to lethal means such as firearms, is an evidence-based component of suicide prevention and appropriate clinical practice.

Question 2: A therapist may disclose confidential information without patient consent when:

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

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 3: Which of the following is NOT required in the written disclosure statement under California Business and Professions Code §4980.54?

The therapist's theoretical orientation and approach
The right to ask questions about treatment
The therapist's license type and number
The therapist's personal religious or spiritual beliefs (Correct answer)

Correct answer: The therapist's personal religious or spiritual beliefs

While therapists may choose to disclose personal beliefs, California's mandatory disclosure requirements focus on professional credentials, approach, fees, and client rights — not personal religious beliefs.

Question 4: A therapist is working with a high-profile client who is a public figure. A media outlet contacts the therapist, offering payment for information about the client’s treatment. What is the therapist's ethical and legal responsibility?

Share the information anonymously to avoid direct involvement.
Accept the payment but only share non-specific information.
Decline the request and maintain strict confidentiality. (Correct answer)
Ask the client if they are comfortable with releasing certain information.

Correct answer: Decline the request and maintain strict confidentiality.

Therapists have a fundamental ethical and legal duty to maintain strict client confidentiality, regardless of the client's public status or any financial incentives. Sharing client information with media outlets is a severe breach of confidentiality and professional ethics. The therapist must decline such requests to protect the client's privacy, maintain trust, and uphold the integrity of the therapeutic relationship.

Question 5: 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 12-year-old consenting to treatment per Family Code §6924
An emancipated minor aged 16
A 30-year-old adult with mild depression

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 6: Which of the following undermines the voluntariness of informed consent?

The therapist provides a written copy of the consent form
The therapist reviews the consent document verbally with the client
A client is told their benefits will be cut if they refuse therapy (Correct answer)
The therapist answers all of the client's questions about treatment

Correct answer: A client is told their benefits will be cut if they refuse therapy

Coercion — including threats to cut benefits or face consequences for refusal — violates the voluntariness requirement for valid informed consent.

Question 7: Which of the following is a PRIMARY dynamic (modifiable) risk factor for suicide?

Family history of completed suicide
History of childhood abuse or trauma
Current hopelessness and acute psychological pain (Correct answer)
Male gender

Correct answer: Current hopelessness and acute psychological pain

Current hopelessness and psychological pain are dynamic factors that can change with clinical intervention, making them key targets in suicide risk reduction.

Question 8: A therapist is closing their private practice. What is their ethical obligation regarding client records?

Ensure records are transferred or stored in a way that preserves client access and confidentiality (Correct answer)
Records can be destroyed since the practice is closing
Notify clients verbally but no written transfer plan is needed
Turn all records over to the California BBS for storage

Correct answer: Ensure records are transferred or stored in a way that preserves client access and confidentiality

When closing a practice, therapists must make arrangements for proper record storage or transfer that maintains confidentiality and client access rights.

Question 9: A therapist's client is acutely suicidal and refuses voluntary hospitalization. The therapist's MOST appropriate response is to:

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

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

An elder declining recommended medical treatment
Financial abuse, including theft or misuse of an elder's funds (Correct answer)
Disagreements between family members about elder care decisions
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 11: 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 12: A California therapist receives a request from a coroner investigating a client's death. The therapist should:

Cooperate with the coroner's request, as the privilege may be waived in death investigations (Correct answer)
Release records only if the deceased client's estate provides authorization
Refuse to release any records due to the psychotherapist-patient privilege
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 13: An MFT associate must use which designation when identifying themselves to clients?

Marriage and Family Therapist Intern
Licensed Marriage and Family Therapist
Registered Psychological Assistant
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 14: Electronic health records (EHRs) used by California mental health providers must comply with:

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

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 15: 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:

Contact the client's insurance company to arrange crisis services on the parent's behalf
Share all treatment information with the parent to coordinate care and protect the client
Refer the parent directly to the client's primary care physician
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)

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

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

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 17: 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?

Consult with a colleague who specializes in neurological disorders while continuing therapy.
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.

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

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

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

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

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

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

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 21: A client asks to see their signed informed consent form. The therapist should:

Provide access only after the therapeutic relationship ends
Require the client to submit a written request and wait 90 days
Decline since the form is part of confidential clinical records
Provide a copy promptly, as clients have the right to access their own records (Correct answer)

Correct answer: Provide a copy promptly, as clients have the right to access their own records

Clients have the right to access their own records, including signed consent forms, under both California law and HIPAA.

Question 22: When must a mandated reporter make an initial report of suspected child abuse in California?

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

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

5 business days
30 calendar days (Correct answer)
60 days
15 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 24: The 'duty to protect' established in Tarasoff v. Regents of the University of California requires therapists to:

Report all violent thoughts to law enforcement automatically
Consult with a supervisor whenever a client discusses interpersonal conflict
Immediately hospitalize any client who expresses anger toward another person
Warn or protect identifiable potential victims when a client poses a serious threat (Correct answer)

Correct answer: Warn or protect identifiable potential victims when a client poses a serious threat

Tarasoff established that therapists must take reasonable steps—including warning identifiable potential victims—when a client poses a serious, credible threat.

Question 25: 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 report to law enforcement within 36 hours
No current reporting obligation since the perpetrator is deceased and there is no ongoing risk (Correct answer)
Must consult with a supervisor before deciding
Must report immediately regardless of timing

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 26: Under California law, what must a therapist's initial disclosure statement include?

Insurance panel participation and billing procedures only
License type and number, educational background, therapeutic approach, and limits of confidentiality (Correct answer)
Only the therapist's fee schedule and cancellation policy
Only the HIPAA Notice of Privacy Practices

Correct answer: License type and number, educational background, therapeutic approach, and limits of confidentiality

California Business and Professions Code §4980.54 requires disclosure statements to include license information, education, therapeutic approach, and confidentiality limits.

Question 27: A 'No-Harm Contract' or 'Safety Contract' in suicide risk management is best understood as:

An evidence-based intervention that definitively and independently reduces suicide risk
A legally binding document that protects the therapist from malpractice liability
A mandatory requirement under California law for all clients with suicidal ideation
A clinical tool that may be useful as part of a broader safety plan but is insufficient on its own (Correct answer)

Correct answer: A clinical tool that may be useful as part of a broader safety plan but is insufficient on its own

Safety contracts are clinical tools that can supplement a safety plan but carry no legal protection, are not mandated by California law, and have not been shown to independently reduce suicide risk.

Question 28: Under California law, a therapist's duty to protect under the Tarasoff decision can be fulfilled by:

Warning the threatened individual, notifying law enforcement, or taking other reasonable steps (Correct answer)
Documenting the threat in the patient's record without further action
Terminating the therapeutic relationship with the patient
Only notifying local law enforcement

Correct answer: Warning the threatened individual, notifying law enforcement, or taking other reasonable steps

California Civil Code §43.92 provides a safe harbor when the therapist warns the victim and/or notifies law enforcement, but other reasonable protective steps may also satisfy the duty.

Question 29: A California therapist is required to inform clients of the limits of confidentiality:

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

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

To fulfill insurance billing requirements only
To document the client's progress, clinical reasoning, and treatment response over time (Correct answer)
To provide a verbatim transcript of each session
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 31: When reporting elder abuse in California, the initial report must be made to:

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

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

Beyond a reasonable doubt
Clear and convincing evidence
Reasonable suspicion (Correct answer)
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 33: How many hours of supervised experience are required for MFT licensure in California?

3,000 hours (Correct answer)
1,500 hours
2,000 hours
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 34: A minor aged 12 or older in California may consent to outpatient mental health treatment without parental consent under:

Welfare and Institutions Code §5150
Business and Professions Code §4980
Evidence Code §1014
Family Code §6924 (Correct answer)

Correct answer: Family Code §6924

California Family Code §6924 allows minors 12 and older to consent to outpatient mental health treatment on their own in certain circumstances.

Question 35: When treating a minor with parental consent, the therapist should also:

Require the parent to co-sign every treatment note
Exclude the minor from all discussions about their own treatment
Ignore the minor's preferences as the parent is the legal decision-maker
Obtain the minor's assent when developmentally appropriate (Correct answer)

Correct answer: Obtain the minor's assent when developmentally appropriate

While parents provide legal consent for minors, best practice and ethical standards call for obtaining the minor's assent (agreement) when age and development allow.

Question 36: Under California Tarasoff law (Civil Code §43.92), a therapist's duty to warn is triggered by a patient's threat toward:

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

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

A teenager admits to recreational marijuana use
A child says they got a bruise falling off their bike
A child expresses sadness about their parents divorcing
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 38: Under BBS regulations, an MFT trainee may provide psychotherapy services only when:

They have completed at least 500 hours of training
They have malpractice insurance in place
They are enrolled in an approved program and working under qualified supervision (Correct answer)
They have passed the California Law and Ethics Exam

Correct answer: They are enrolled in an approved program and working under qualified supervision

MFT trainees must be enrolled in an approved graduate program and work under the supervision of a qualified supervisor to provide therapy services legally.

Question 39: When conducting a suicide risk assessment, which of the following is considered a static (historical) risk factor?

A specific plan with available means
Current substance intoxication
Previous suicide attempts (Correct answer)
Recent significant loss or bereavement

Correct answer: Previous suicide attempts

Previous suicide attempts are static/historical factors—they have already occurred and cannot change—and are among the strongest predictors of future attempts.

Question 40: An MFT associate in California must complete the supervised experience requirement within how many years of receiving associate registration?

5 years
10 years
7 years (Correct answer)
3 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 41: In California, the written follow-up report for child abuse must be submitted within how many hours of the initial phone report?

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

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 42: When may a therapist share patient information with an insurance company without explicit patient authorization?

Only if the patient is unable to provide consent
Never — insurance companies must obtain records independently
For treatment, payment, and healthcare operations (TPO) under HIPAA (Correct answer)
Only with a court order

Correct answer: For treatment, payment, and healthcare operations (TPO) under HIPAA

HIPAA permits disclosure of PHI for treatment, payment, and healthcare operations (TPO) without a separate written authorization.

Question 43: A client changes their mind about consenting to a specific treatment component mid-therapy. The therapist should:

Continue the treatment component until the current treatment episode ends
Terminate the therapeutic relationship for non-compliance
Honor the withdrawal, document it, and explore alternatives with the client (Correct answer)
Explain that consent cannot be revoked once given

Correct answer: Honor the withdrawal, document it, and explore alternatives with the client

Clients have the right to withdraw consent at any time; therapists must honor this, document it, and work with the client to identify alternative approaches.

Question 44: When must a California MFT disclose their license status to clients?

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

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 45: Under HIPAA, what is the minimum necessary standard for disclosing protected health information?

Disclose whatever the patient requests regardless of purpose
Disclose only the minimum amount of information needed to accomplish the purpose (Correct answer)
Disclose all records whenever requested
Disclose full records to any licensed health provider

Correct answer: Disclose only the minimum amount of information needed to accomplish the purpose

HIPAA's minimum necessary standard requires that only the minimum PHI needed to accomplish the intended purpose be disclosed.

Question 46: Under California law, how long must a licensed therapist retain adult client records after the last date of service?

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

Correct answer: 7 years

California law requires adult mental health records to be retained for at least 7 years from the date of last service.

Question 47: In California, which board licenses Marriage and Family Therapists (MFTs)?

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

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

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
you need to call the family and notify them at once that restraints are being used
you need to avoid the patient so as not to escalate his or her agitation

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 49: 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.

True (Correct answer)
False

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.

Question 50: Under California law, when is a therapist legally REQUIRED (not merely permitted) to break confidentiality for a suicidal client?

Whenever the client expresses any level of suicidal ideation
When the client's family requests disclosure of the client's risk level
When the client has a specific plan, means, and a stated timeline
There is no absolute legal requirement—breaching confidentiality for suicidality is a matter of clinical judgment (Correct answer)

Correct answer: There is no absolute legal requirement—breaching confidentiality for suicidality is a matter of clinical judgment

California law permits therapists to breach confidentiality for suicidal clients but does not universally mandate it; therapists must exercise clinical judgment based on imminence and severity.

Question 51: For minor clients in California, mental health records must be retained until the minor reaches age 18 or for how long, whichever is longer?

5 years after last service
7 years after last service (Correct answer)
10 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 52: When does the Tarasoff duty to warn or protect NOT apply?

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)
When the client verbally denies any intent to harm another person
When the client is themselves a licensed mandated reporter

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 53: Under California law, a client who disagrees with information in their mental health record may:

Submit a written addendum or statement of disagreement to be included in the record (Correct answer)
Only dispute records through the BBS complaint process
Demand the therapist delete the disputed entry
File a lawsuit to compel correction without other remedies

Correct answer: Submit a written addendum or statement of disagreement to be included in the record

California Health and Safety Code §123111 gives patients the right to submit a written addendum stating their disagreement with record content, which must be included in the file.

Question 54: Which of the following does NOT constitute child abuse under CANRA?

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

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 55: A therapist has a patient who is a 'dependent adult' under California law. This means the patient:

Has a substance use disorder
Is between ages 18–64 with a physical or mental limitation that restricts their activities (Correct answer)
Is financially dependent on their therapist
Is under a court-ordered conservatorship

Correct answer: Is between ages 18–64 with a physical or mental limitation that restricts their activities

California Welfare and Institutions Code §15610.23 defines a dependent adult as a person aged 18–64 whose physical or mental limitation restricts their ability to carry out normal activities.

Question 56: Which of the following are indicators that you may be having boundary troubles?

Having a hard time saying “no” to a client.
All of the above (Correct answer)
Sharing unnecessarily personal stories with a client.
Wanting to punish or control a client.
Wanting to save or rescue 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 57: For informed consent to be valid in a therapeutic context, the client must have:

Prior therapy experience to understand the consent fully
At least 48 hours to review consent documents
Capacity to understand the information, be given adequate information, and consent voluntarily (Correct answer)
A third party present to witness the signing

Correct answer: Capacity to understand the information, be given adequate information, and consent voluntarily

Valid informed consent requires three elements: decisional capacity, adequate disclosure of information, and voluntariness (free from coercion).

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

Discharge the client immediately to a higher level of care
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

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

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

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

Storing records indefinitely to avoid any risk of improper disposal
Recycling paper records in standard recycling bins
Shredding paper records and using certified data destruction for electronic records (Correct answer)
Returning records to the client for their own 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 61: A client requests to discontinue therapy. The therapist's ethical obligation regarding informed consent is to:

Document the refusal and charge a termination fee
Contact the client's family to discuss the decision
Inform the client of potential risks of discontinuing and provide referrals as appropriate (Correct answer)
Require the client to continue for at least 30 days before terminating

Correct answer: Inform the client of potential risks of discontinuing and provide referrals as appropriate

Clients have the right to withdraw from treatment; therapists must inform them of relevant risks and provide referrals or resources as needed.

Question 62: Under California law, practicing psychotherapy without a license or registration is a:

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

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 63: 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 expresses general anger toward people
The patient refuses to take prescribed medication
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 64: Under the Elder Abuse and Dependent Adult Civil Protection Act (EADACPA), which professionals are mandated reporters for elder abuse in California?

All California adults over age 18
Only Adult Protective Services workers
Licensed mental health professionals, care custodians, and other specified persons (Correct answer)
Only physicians and hospital staff

Correct answer: Licensed mental health professionals, care custodians, and other specified persons

California Welfare and Institutions Code §15630 designates mental health professionals and other specified custodians as mandated reporters for elder and dependent adult abuse.

Question 65: Under California law and professional ethics standards, when determining whether to hospitalize a high-risk suicidal client, therapists should primarily follow which guiding principle?

Use the least restrictive intervention that adequately addresses the client's safety needs (Correct answer)
'When in doubt, hospitalize'—to avoid any risk of malpractice liability
Consult with the client's insurance company before authorizing any hospitalization
Always defer entirely to the client's stated preference regarding hospitalization

Correct answer: Use the least restrictive intervention that adequately addresses the client's safety needs

California law and professional ethics require therapists to use the least restrictive effective intervention, balancing client autonomy and therapeutic alliance with safety needs.

Question 66: When a mandated reporter suspects that a child is being abused by someone outside the family, who should receive the report?

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

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

Obtain supervisor approval only — client consent is optional
Obtain specific written informed consent for recording, separate from general therapy consent (Correct answer)
Obtain consent only if the recording will be shown outside the agency
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 68: A mandated reporter who fails to report known or suspected child abuse in California may face:

A fine of up to $10,000
License suspension only
Criminal misdemeanor charges and/or civil liability (Correct answer)
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 69: 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
Only therapists who work in hospitals or large organizations
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

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 70: Which California exam must an MFT associate pass before obtaining full licensure?

Only the National Counselor Examination (NCE)
The USMLE Step 1
The EPPP (Examination for Professional Practice in Psychology)
The California Law and Ethics Exam and the MFT Clinical Exam (Correct answer)

Correct answer: The California Law and Ethics Exam and the MFT Clinical Exam

MFT associates in California must pass two exams for licensure: the California Law and Ethics Exam and the MFT Clinical Exam administered by the BBS.

Question 71: 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)
They obtain a separate telehealth license from the BBS
All telehealth platforms must be approved by the BBS
Telehealth sessions do not count toward supervised hours

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 72: Which of the following must be documented in a client's treatment record according to California ethical and legal standards?

Only billing and insurance information
Progress notes, treatment plans, informed consent, and significant clinical decisions (Correct answer)
Only formal psychological test results
Only session dates and fees charged

Correct answer: Progress notes, treatment plans, informed consent, and significant clinical decisions

Comprehensive clinical records must include progress notes, treatment plans, informed consent, assessments, and documentation of significant clinical decisions.

Question 73: When may a therapist use client records for training or case consultation without client authorization?

Only within the same agency or practice setting
When the consultation is conducted in writing, not verbally
Never — authorization is always required for any disclosure
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 74: Which of the following are true about boundaries?

Only A and B
All of the above (Correct answer)
Boundaries are 100% the responsibility of the staff person to maintain in the relationship between staff and client.
Boundaries can be legal, ethical, moral or professional.
A boundary is a behavioral framework within which you must function in order to perform your role.

Correct answer: All of the above

Boundaries are essential in professional relationships, acting as a framework for appropriate behavior that encompasses legal, ethical, moral, and professional standards. Maintaining these boundaries is entirely the staff person's responsibility to ensure the client's safety and the integrity of the professional relationship. Therefore, all listed statements accurately describe the nature and importance of boundaries.

Question 75: A therapist may withhold a client's records if:

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

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.

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

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