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

Question 1: In a group therapy setting, what is the therapist's ethical obligation regarding confidentiality?

Confidentiality applies only between the therapist and the group as a whole
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

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

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

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

48 hours
24 hours
12 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 4: When may a therapist use client records for training or case consultation without client authorization?

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

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 5: 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)
Wanting to punish or control a client.
Sharing unnecessarily personal stories with 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 6: 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
Has been diagnosed with a serious mental illness by two independent physicians
Is a danger to themselves, others, or is gravely disabled due to a mental disorder (Correct answer)
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 7: A therapist wishes to video record sessions for training purposes. The therapist must:

Notify the client in the initial disclosure but no separate consent is needed
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

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

Demand the therapist delete the disputed entry
Submit a written addendum or statement of disagreement to be included in the record (Correct answer)
Only dispute records through the BBS complaint process
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 9: Under California law and professional ethics standards, when determining whether to hospitalize a high-risk suicidal client, therapists should primarily follow which guiding principle?

'When in doubt, hospitalize'—to avoid any risk of malpractice liability
Use the least restrictive intervention that adequately addresses the client's safety needs (Correct answer)
Always defer entirely to the client's stated preference regarding hospitalization
Consult with the client's insurance company before authorizing any 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 10: Which of the following is an essential element of valid informed consent for psychotherapy in California?

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

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

The therapist
The patient's estate or personal representative (Correct answer)
The patient's spouse
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 12: Under BBS regulations, an MFT trainee may provide psychotherapy services only when:

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

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

Voluntary industry standards only, as no specific laws govern EHRs
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

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 14: When providing teletherapy services, informed consent must additionally address:

The client's internet speed and device capabilities
Technology platform risks, emergency procedures, and jurisdiction-specific considerations (Correct answer)
Only technical aspects like software requirements
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 15: 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?

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

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 16: A therapist may withhold a client's records if:

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

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

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 18: 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 19: A therapist discovers an error in a client's medical record. The correct way to make a correction is to:

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
White out or delete the error and rewrite the entry
Destroy the original record and create a new one

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 20: Informed consent for therapy in California must be documented by:

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

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 21: 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 immediately regardless of timing
Must consult with a supervisor before deciding
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)

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 22: A patient waives the psychotherapist-patient privilege when they:

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

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 23: 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 24: Under California law, a BBS licensee convicted of a crime must report the conviction to the BBS within:

6 months
30 days
1 year
90 days (Correct answer)

Correct answer: 90 days

BBS regulations require licensees to report criminal convictions to the Board within 90 days of the conviction date.

Question 25: It is appropriate for the nursing assistant to share personal client information with ____.

the client's children
the client's wife
the client's roommate
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 26: Which of the following is NOT required in the written disclosure statement under California Business and Professions Code §4980.54?

The right to ask questions about treatment
The therapist's theoretical orientation and approach
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 27: Mandated reporters of elder abuse in California who report in good faith are protected by:

Confidentiality agreements with the receiving agency
No legal protection exists for reporters
Immunity from civil and criminal liability (Correct answer)
Protection only if the report is substantiated

Correct answer: Immunity from civil and criminal liability

California Welfare and Institutions Code §15634 grants good-faith reporters immunity from civil and criminal liability, regardless of whether the report is substantiated.

Question 28: Under California law, what must a therapist's initial disclosure statement include?

Only the therapist's fee schedule and cancellation policy
Insurance panel participation and billing procedures only
License type and number, educational background, therapeutic approach, and limits of confidentiality (Correct answer)
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 29: A therapist plans to use an evidence-based treatment the client is unfamiliar with. Informed consent requires the therapist to:

Obtain written consent only after the first session
Have the client research the treatment independently before consenting
Explain the treatment, its rationale, expected benefits, and any known risks (Correct answer)
Proceed without extensive explanation since it is evidence-based

Correct answer: Explain the treatment, its rationale, expected benefits, and any known risks

Regardless of whether a treatment is evidence-based, informed consent requires explaining the treatment rationale, expected benefits, risks, and alternatives.

Question 30: Under California law, how long must a licensed therapist retain adult client records after the last date of service?

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

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

They obtain a separate telehealth license from the BBS
All telehealth platforms must be approved by the BBS
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

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

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

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

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

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 34: Under the Lanterman-Petris-Short (LPS) Act, 'gravely disabled' refers to a person who:

Is unable to provide for their basic personal needs—food, clothing, or shelter—due to a mental disorder (Correct answer)
Has a permanent physical disability requiring round-the-clock medical care
Has been formally declared incompetent by a court of law
Requires assistance with all activities of daily living regardless of cause

Correct answer: Is unable to provide for their basic personal needs—food, clothing, or shelter—due to a mental disorder

Under the LPS Act, 'gravely disabled' means inability to provide for one's own basic survival needs (food, clothing, shelter) as a direct result of a mental disorder.

Question 35: 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 36: Under HIPAA, what is the minimum necessary standard for disclosing protected health information?

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

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 37: 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
Turn all records over to the California BBS for storage
Notify clients verbally but no written transfer plan is needed

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 38: 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.

Question 39: 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:

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

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 40: 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
File a report only if the child asks them to
Report if they have reasonable suspicion, as the threshold is low (Correct answer)
Wait until they are certain before making any report

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 41: Which of the following is required for a California BBS licensee to renew their license?

Passing a written renewal exam every two years
Submitting a new background check at every renewal
Completing continuing education (CE) hours as required by the BBS (Correct answer)
Completing 500 additional supervised hours

Correct answer: Completing continuing education (CE) hours as required by the BBS

California BBS licensees must complete required continuing education hours — typically 36 hours per renewal period for MFTs — to renew their license.

Question 42: What is the primary purpose of progress notes in a clinical record?

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

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

Only immediate family members
Only the therapist themselves
Any member of the general public
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 44: Under the Elder Abuse and Dependent Adult Civil Protection Act (EADACPA), which professionals are mandated reporters for elder abuse in California?

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

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 45: 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
Only after consulting with a supervisor
Immediately or as soon as practically possible by phone (Correct answer)

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

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

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 47: A therapist begins treatment with a new client. During the first session, the therapist explains the therapeutic process, including the potential risks and benefits, and provides the client with paperwork outlining these details. The client signs the paperwork without asking any questions. What should the therapist do next?

Ask the client if they have any questions about the informed consent process. (Correct answer)
Proceed with therapy since the client signed the informed consent form.
Reiterate that the client can withdraw consent at any time during therapy.
Skip further discussion and move on to therapeutic techniques.

Correct answer: Ask the client if they have any questions about the informed consent process.

Informed consent is an ongoing process, not merely a signed document. Even if a client signs the paperwork, a therapist has an ethical responsibility to ensure the client genuinely understands the information presented. Asking if they have any questions allows the client to clarify concerns, demonstrates the therapist's commitment to truly informed and voluntary participation, and reinforces the collaborative nature of therapy.

Question 48: A California therapist is required to inform clients of the limits of confidentiality:

Only when confidentiality must actually be broken
Once per calendar year in writing
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 49: A therapist has been seeing a client for six months. The client invites the therapist to their wedding, stating that the therapist has been a significant part of their healing journey. What should the therapist do?

Discuss it in the next session to determine the impact on the therapeutic process.
Politely decline and explain that attending the wedding could interfere with the therapeutic relationship. (Correct answer)
Refer the client to another therapist to avoid the dual relationship.
Accept the invitation as a gesture of support.

Correct answer: Politely decline and explain that attending the wedding could interfere with the therapeutic relationship.

Accepting a client's wedding invitation would create a dual relationship, blurring professional boundaries and potentially compromising the objectivity and effectiveness of therapy. Ethically, therapists must maintain a professional distance to ensure the therapeutic space remains focused on the client's needs, free from personal entanglements. Politely declining while explaining the rationale upholds ethical standards and protects the therapeutic relationship.

Question 50: What is a 'covered entity' under HIPAA as it applies to a California therapist in solo private practice?

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

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 51: 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 52: A California therapist receives a request from a coroner investigating a client's death. The therapist should:

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

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 53: Under California law, which privilege protects communications between a licensed psychotherapist and their patient from disclosure in legal proceedings?

Attorney-client privilege
Spousal privilege
Work product privilege
Psychotherapist-patient privilege (Correct answer)

Correct answer: Psychotherapist-patient privilege

The psychotherapist-patient privilege under Evidence Code §1014 protects confidential communications between a therapist and patient from compelled disclosure.

Question 54: What is the standard of proof required for a mandated reporter to file an elder abuse report?

Clear and convincing evidence
Reasonable suspicion (Correct answer)
Beyond a reasonable doubt
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 55: An MFT associate in California must complete the supervised experience requirement within how many years of receiving associate registration?

7 years (Correct answer)
3 years
5 years
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 56: 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
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)
Share all treatment information with the parent to coordinate care and protect the client
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 57: Which action does NOT fulfill a therapist's 'duty to protect' obligation under California law?

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

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

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

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

Board of Behavioral Sciences (BBS) (Correct answer)
California Medical Board
Department of Consumer Affairs only
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 60: How many hours of supervised experience are required for MFT licensure in California?

4,000 hours
3,000 hours (Correct answer)
1,500 hours
2,000 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 61: Which California exam must an MFT associate pass before obtaining full licensure?

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

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 62: 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)
3 years after last service
10 years after last service
5 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 63: 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:

Contact the DOJ to initiate firearms confiscation proceedings immediately
Avoid discussing firearms entirely due to Second Amendment considerations
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 64: 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 make decisions regarding their own care
the resident's right to be present when their care is discussed
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 65: A California therapist receives a subpoena for a patient's records. The correct first step is to:

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

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

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

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

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

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 68: 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?

Accept the payment but only share non-specific information.
Share the information anonymously to avoid direct involvement.
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 69: Which of the following is a reportable form of elder abuse under California law?

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

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 70: A client requests to discontinue therapy. The therapist's ethical obligation regarding informed consent is to:

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

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

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

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 72: 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
5 supervisees per supervisor
The supervisor may have no more than 3 supervisees at any time
No specific limit is set (Correct answer)

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 73: Residents have a right to telephone privileges. Which of these correctly describes these rights?

Residents may use phones, but they must provide their own.
Privacy and phone access are provided to each resident. (Correct answer)
Telephones can be used only under a caregiver's supervision.
Residents have the right to use phones during certain scheduled times.

Correct answer: Privacy and phone access are provided to each resident.

Residents in healthcare facilities have the right to privacy and access to communication, including telephone privileges. This means they should have reasonable access to a phone and the ability to make and receive calls privately, without undue restrictions or supervision. This right respects their autonomy and their ability to maintain connections with the outside world.

Question 74: What is the scope of practice for a Licensed Professional Clinical Counselor (LPCC) in California compared to an MFT?

LPCCs may only treat adults with individual therapy
LPCCs may work with couples and families without restriction
LPCCs have restricted scope for couples and family therapy unless they have additional training endorsed by the BBS (Correct answer)
LPCCs and MFTs have identical scopes of practice

Correct answer: LPCCs have restricted scope for couples and family therapy unless they have additional training endorsed by the BBS

California LPCCs require an additional BBS endorsement to provide couples and family therapy, distinguishing their scope from MFTs.

Question 75: Which of the following would not be considered a boundary violation?

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

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.

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

35 min

Time Limit

70%

To Pass

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