Questions And Answers 1 Flashcards

A client with major depressive disorder reports that their antidepressant medication prescribed by their psychiatrist is causing significant side effects and asks the counselor to recommend a dosage reduction. What is the MOST ethically appropriate response?

Answer: Consult with the prescribing psychiatrist with the client's consent and encourage the client to communicate their concerns directly

Counselors operate within their scope of practice and do not prescribe or adjust medications. The ethical response involves encouraging interdisciplinary collaboration by facilitating communication between the client and the prescribing psychiatrist, ideally with the client's written consent for any direct consultation.

During an initial intake session, a client discloses that three years ago they experienced a single episode of elevated mood, decreased need for sleep, and impulsive spending that lasted approximately one week and required no hospitalization. Their current presentation includes a depressive episode. Which diagnosis BEST fits this clinical picture?

Answer: Bipolar II Disorder

Bipolar II Disorder is characterized by at least one hypomanic episode (lasting at least 4 days but not meeting full manic criteria or requiring hospitalization) and at least one major depressive episode. The described week-long episode without hospitalization aligns with hypomania, distinguishing it from Bipolar I.

A counselor in private practice uses a telehealth platform to see clients across multiple states. A prospective client in a neighboring state where the counselor is not licensed requests services. What is the counselor's FIRST ethical obligation?

Answer: Research interstate licensure compacts and applicable laws before accepting the client

Counselors must comply with the laws and regulations of the jurisdictions in which their clients reside when providing telehealth services. Before accepting an out-of-state client, the counselor must verify licensure requirements, review interstate compact eligibility, and ensure legal compliance.

A school counselor learns through a student's journal entry (submitted voluntarily for class) that the student is being emotionally abused at home. The student has not disclosed this to the counselor directly. What is the counselor's MOST appropriate next step?

Answer: Meet privately with the student to assess safety and gather more information before determining whether a report is required

Mandated reporting obligations are triggered by reasonable suspicion of abuse, not only direct disclosures. However, meeting with the student first allows the counselor to conduct a safety assessment, clarify the situation, and fulfill the duty to report with more complete information while maintaining the therapeutic relationship.

A client undergoing Exposure and Response Prevention (ERP) therapy for OCD repeatedly asks the counselor to provide reassurance that their intrusive thoughts will not come true. Which response is MOST consistent with ERP principles?

Answer: Acknowledge the client's distress while explaining that providing reassurance is itself a compulsion that maintains OCD

In ERP, reassurance-seeking is conceptualized as a compulsive behavior that reinforces the OCD cycle by temporarily reducing anxiety without allowing habituation or inhibitory learning. The therapist withholding reassurance is a core intervention, and explaining this rationale therapeutically preserves the alliance without undermining treatment.

A counselor conducting a suicide risk assessment uses the Columbia Suicide Severity Rating Scale (C-SSRS). A client endorses passive suicidal ideation with no plan, intent, or prior attempts, and has strong family support and future orientation. Which level of care is MOST clinically indicated?

Answer: Continued outpatient counseling with a documented safety plan and scheduled follow-up

Risk stratification in suicide assessment weighs ideation severity, plan, intent, means access, protective factors, and history. Passive ideation without plan or intent, combined with robust protective factors like family support and future orientation, typically indicates a low-to-moderate risk level that can be managed safely in outpatient settings with a safety plan.