Question 1

As a standard practice Mental Status Exam, one might see AOx3 or AOx4. What do these mean?

Accepted Answer

AO3 or AO4 is an indicator that the client is aware of person, place, historical events, and some basic geography. Sometimes, precipitating factors are an issue, but not always significant in how the client remembers. While it's a good idea for the client to be oriented to all, it's not always possible.

Question 2

When Hyper Harrison came into your office, you weren't sure what to think. During the third session, you are confident in an ADHD diagnosis. When you announce this, the family looks and sounds relieved. What is happening here?

Accepted Answer

There is a reaction to a diagnosis that is forming in the room. The calm could be a response to knowledge of what has been coming for a long time, but that they had no details to back up claims. With assessments complete, treatment can proceed as planned and hopefully return Harrison to his baseline of attention and activity.

Question 3

Evan is a thirty-year-old father of two. When his second son was born, Evan became overwhelmed with work and emotionally at home. When he considered everything going on, he couldn't quite put it all in perspective. Where might you begin to assess Evan's needs?

Accepted Answer

Was Evan involved in the birthing process at the hospital? Has the couple called on their in-laws for support via babysitting and other jobs? You can examine all of these things to find out how committed someone is to participating in the change that must happen over time.

Question 4

You notice that Max, a veteran salesman, is coming to therapy so that he can improve his relationship with his wife and children. Really, when it comes down to it, Max's personality and past professional experiences may be:

Accepted Answer

As humans, we are not necessarily on the lookout for how we can escape responsibility, nor are we waiting to be taken advantage of. Instead, our experiences can shape how we view our responsibilities and whether or not we are willing to engage those responsibilities completely. He is in search of an important relationship and is working hard, but is influenced overall by relationships.

Question 5

Gary and Gail had their only child at 45, a bit later than most. Their son is now fifteen and there is a large gap between what Gary and Gail had expected for themselves and where their son needs attention. Overall, the communication problem here results from:

Accepted Answer

Gary and Gail are now nearing 60, needing to look back on their life thus far with a sense of achievement and accomplishment, while their son looks forward to a lot of his life, looking to learn, build, make mistakes, and move forward. While not impossible, the life stages can prove to be a challenge for all involved.

Question 6

The Allen family presents in your office in order to ask your help in resolving sibling conflict in the house. Brian and Vicky are brother and sister, 8 and 10 respectively. Where might you begin when assessing the family system?

Accepted Answer

While it is helpful to look at all of these pieces of information, it is perhaps most helpful to look for details as to where certain behaviors come from. Finding out what gets the children upset will solve one problem, but they may be able to restart the upset themselves, even as their parents continue with current patterns of reinforcement.

Question 7

Tara is a teenager who appears to have many demands on her time. She is a ballet student, plays soccer, and performs in school musicals. She presents as very quiet, but also reveals quite a bit about herself when she attempts to maintain control of the conversation. Tara looks very thin. Which of the indicators most likely speaks to an eating disorder?

Accepted Answer

Individuals of all ages can be very active at different points in their lives. These can include soccer, ballet, and weight loss. And while all of these might cause physical concerns, it is the reservation that comes from understanding her issues of control that are most likely to lead to exploration of a potential eating disorder. Remember that eating disorders are almost never about the food.

Question 8

When Doug begins to tell you about the things he has attempted in order to reconcile his marriage, you begin to understand that he has involved many people, including family friends, in-laws, cousins, and others. You begin to understand:

Accepted Answer

Doug very clearly believes in his marriage. Keep in mind that it won't be your work that rebuilds his marriage, as much as it will be his work. With so many contributing to the overall wellness and supporting the couple, it is impractical to consult the entire system. Time is less of an object when working with something of importance for many couples and for the therapist, there is less concern about time.

Question 9

An individual is in your office and threatening to do harm to himself or another. Your first step is to assess for:

Accepted Answer

If a client is presenting as a danger to himself, the degree of seriousness is irrelevant. Whether or not a plan is in place will determine whether or not you need to assess for a means to carry it out. Mental status does not enter the assessment until a more appropriate time and usually occurs closer to assessment.

Question 10

Once you have ascertained that the client has a plan and is in fact serious, your next step is to:

Accepted Answer

While you may be able to de-escalate the client, you should not make any attempts that would put you in danger. Running or locking the door would have the potential to escalate the client even further, which would place you in even more immediate danger.

Question 11

For Matt, the origin of his social isolation came in high school, when he received the message both at home and at school that he wasn't good enough. As a result, Matt still lives at home, does not have many friends, and continues to isolate. As a structural therapist, you might be interested more in:

Accepted Answer

Something is keeping Matt from realizing that he is, in fact, good enough. Finding a way out and figuring out where he can turn for help is important, but on the other hand, he may be less inclined to do that if he feels comfortable in the current situation and it would force him to change position or status in the family system.

Question 12

Maria reports that every time she attempts to break away from her relationship, she manages to get pulled back in by hopes of change, memories of years past, and the appeal being together. What is one of the underlying beliefs that is prompting Maria right now?

Accepted Answer

So often, women are presented with a picture of things that lead them to believe that they must depend on men for a lot, when in reality, they are quite capable of providing for themselves in light of their abilities. All of the underlying feelings and ideas contribute to (A) that life as a single woman is too difficult. Therapy will help her to see that things will get better when she realizes her own capabilities.

Question 13

Every week, Hugo comes to therapy and is appreciative of the time his therapist gives him to talk about his own issues, in his own space. However, Hugo's parents always make a big scene about how much it costs and "When is he going to be fixed?" Inside the family system, one issue to explore might be:

Accepted Answer

Given Hugo's maturity and his willingness to take time with therapy, it might be important to examine how much Hugo feels like the parent. This would be especially important since he needs his own space, is willing to explore his feelings, and is showing some signs that he is not in a hurry, and understands therapy as a process.

Question 14

When a family comes to therapy reporting that they are unable to enter into emotional connections, you observe them for three sessions. When speaking to one another, they seem to fear reaction or retribution. One place to begin work might be:

Accepted Answer

If the family is so afraid of one another that they are unable to experience or express deeper emotions, it is important to examine what might be keeping them from talking with one another. All of the other options would achieve some type of equilibrium, but may not be possible without understanding why communication is at a standstill. Boundaries play a large role in how communication is interpreted or not.

Question 15

The O'Connors have a seven-year-old son, Sean. When he is unable to participate in family activities, they tend to leave him with others his age, even if he doesn't know them too well. They've begun noticing some issues. As their therapist you point out:

Accepted Answer

At such a young age, being included is essential. It sends the message that "you are important." Any attempts that Sean has made thus far are not misguided and it is true that Sean needs someone to look after him, but not to the extent that he doesn't feel independent. Being included in groups of adults and authority figures can be a large boost for them.

Question 16

Hilda is a sixty-four-year old Jewish Caucasian woman who attends temple regularly and who has three supportive children. Recently, just as her retirement benefits were about to kick in, Hilda received notice that her pension fund was nearing bankruptcy. She also reports that when her husband died last year, it was a really difficult transition for her. Which of the following types of environmental or contextual issues should be documented?

Accepted Answer

Clearly, Hilda has support from her family and maintains social and spiritual support through her temple. However, when it comes to financial stressors, Hilda certainly has quite a few. For example, her living arrangements, medication, or transportation could all be affected by her financial situation.

Question 17

One of the sometimes invisible, but important factors to note when gathering information regarding elder abuse is:

Accepted Answer

Access to safety, weapons, and history is all fairly detailed information that comes to the forefront of a conversation. However, if someone is timid or afraid and is unable to express themselves properly, they may be willing to place themselves at more risk if it means keeping things safe for the present moment. Fear in reporting is one of the top reasons things do not get investigated; create a calm and safe environment.

Question 18

When Carly presents for therapy, she identifies that she would like to get her children returned from social services and so is attending treatment. She refuses to acknowledge why, or for how long, but sees this as the way to her children. You will need to explore with her:

Accepted Answer

While therapy can be useful for many things, unless a client is personally engaged in the process, it will mean less to them. And while you appreciate her motives, she will need to engage a bit more in order to fully benefit from treatment. Even with mandated clients, it benefits them to review how they can benefit from treatment.

Question 19

When a husband and wife present for therapy, it becomes clear that they are dedicated to maintaining homeostasis by identifying each other and their difficulties in relation to the other individual. She is clearly the higher functioning of the two. Try as he might, the husband cannot present as higher functioning. Both are dedicated to:

Accepted Answer

When families and couples have been in certain patterns for long periods of time, it has sometimes helped them to repeat those patterns, even when they prove not to be helpful or to have destructive consequences. In this case, both husband and wife have defined roles and may be having trouble understanding what the other is like.

Question 20

When considering how to address spirituality in therapy, you must first evaluate:

Accepted Answer

For most individuals, there will always be a spiritual dimension. Regardless of the individual's spiritual beliefs or how often the subject comes up, things hinge on how much it can add to the client's therapy. If it cannot add to the client's therapy, one must ask why it is being pursued from the therapist point of view. Spirituality will be largely client driven over time.

Quiz 1: Assessment