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

Question 1: Which of the following is required for a California BBS licensee to renew their license?

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

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

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

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 3: A therapist plans to use an evidence-based treatment the client is unfamiliar with. Informed consent requires the therapist to:

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

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

Receive a confession from the alleged perpetrator
Know or reasonably suspect that abuse or neglect has occurred (Correct answer)
Observe physical injuries firsthand
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 5: Which of the following are indicators that you may be having boundary troubles?

All of the above (Correct answer)
Having a hard time saying “no” to a client.
Sharing unnecessarily personal stories with a client.
Wanting to save or rescue a client.
Wanting to punish or control 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: A therapist has a long-term client who runs a business offering services that the therapist could benefit from. The client offers a discount on their services to the therapist. How should the therapist respond?

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

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

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

Question 7: Which of the following does NOT constitute child abuse under CANRA?

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

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

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

Correct answer: Child Protective Services and/or law enforcement

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

Question 9: A California MFT who wants to add telehealth services must ensure that:

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)
They obtain a separate telehealth license from 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 10: Under HIPAA, psychotherapy notes stored separately from the general medical record:

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

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

5 years
7 years (Correct answer)
3 years
10 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 12: A therapist discovers an error in a client's medical record. The correct way to make a correction is to:

Destroy the original record and create a new one
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

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

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
Insurance panel participation and billing procedures only

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

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

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

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

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

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

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

Work product privilege
Spousal privilege
Attorney-client 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 18: A client asks to see their signed informed consent form. The therapist should:

Provide access only after the therapeutic relationship ends
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)
Require the client to submit a written request and wait 90 days

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

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

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

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

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

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)
When the client's family requests disclosure of the client's risk level
Whenever the client expresses any level of suicidal ideation

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

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

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

Only within the same agency or practice setting
When information is de-identified so the client cannot be identified (Correct answer)
Never — authorization is always required for any disclosure
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 24: An MFT associate must use which designation when identifying themselves to clients?

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

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 25: 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)
Therapists who use EHR systems but not those using paper records
Only therapists who accept Medicare or Medicaid
Only therapists who work in hospitals or large organizations

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

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

Question 26: What is the standard of proof required for a mandated reporter to file an elder abuse report?

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

Correct answer: Reasonable suspicion

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

Question 27: If a patient requests access to their own mental health records in California, the therapist must generally respond within:

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

Correct answer: 30 calendar days

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

Question 28: A patient waives the psychotherapist-patient privilege when they:

Miss multiple scheduled appointments
Request a change in treatment modality
Place their mental condition at issue in a legal proceeding (Correct answer)
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 29: Under California law, practicing psychotherapy without a license or registration is a:

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

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 30: Which California Welfare and Institutions Code section authorizes a 14-day involuntary psychiatric hold for intensive treatment after an initial 5150 hold?

WIC 5270
WIC 5300
WIC 5250 (Correct answer)
WIC 5150

Correct answer: WIC 5250

WIC 5250 authorizes a 14-day involuntary hold for intensive treatment when a person continues to meet criteria after the initial 72-hour 5150 hold.

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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