Your FREE ASWB Masters (MSW) Exam Practice Test 2026 – 250+ Q&A

Correct answer: Countertransference linked to her own history

Her pull toward this client comes from her own history with her sister, which is countertransference, and it is bending her judgment. Transference runs the other way: it is the client's feelings toward the worker. Empathic resonance means accurately sensing what the client feels, and it would not lead her to make exceptions she makes for no one else. Parallel process is a dynamic carried between therapy and supervision, and no supervisory relationship is involved here.

Correct answer: Transference rooted in his early attachment

The client is reliving his relationship with a critical, controlling mother and placing those feelings on the worker, which is transference. Countertransference would be the worker's reaction to him, not his reaction to her. Resistance is opposition to the work of change, and it does not explain why he casts her as his mother. Projection attributes one's own disowned impulses to someone else, while here he is repeating a pattern from a real past relationship.

Correct answer: Take the reaction to supervision and assess its effect on the work

Countertransference that is affecting objectivity belongs in supervision or consultation, where the worker can understand it and protect the client. Disclosing it to the client shifts the focus onto the worker's feelings and can burden or confuse the client. An abrupt transfer without discussion can harm the client and skips the step of trying to manage the reaction. Keeping it private and waiting lets the bias keep shaping the work.

Correct answer: Purposeful use of self through limited disclosure

A brief, intentional disclosure made to normalize the client's grief and strengthen the alliance is a purposeful use of self. It is not acted-out countertransference, because it was chosen for the client's benefit rather than driven by the worker's own needs. It is not a boundary violation, since limited disclosure that serves the client is permitted. A shared experience does not create a second role, so no dual relationship exists.

Correct answer: Whether the disclosure serves the client's interests over her own

The governing test for self-disclosure is whether it serves the client's therapeutic interests rather than the worker's needs. Accuracy matters, but a correct detail can still be a disclosure that does nothing for the client. Wanting the client to find her relatable is about the worker's image and wish for connection, which is exactly the self-focus the test screens out. Agency policy can set outer limits, but it cannot answer whether this particular disclosure serves this client.

Correct answer: Secondary traumatic stress among helpers

Intrusive images from clients' stories, numbing and dread after repeated indirect exposure to trauma are the signature of secondary traumatic stress. Burnout grows from workload and organizational strain and shows as exhaustion and cynicism, without trauma-specific intrusions. Moral distress arises when constraints keep a worker from doing what she believes is right. Countertransference is an emotional reaction to particular clients, not a cluster of trauma symptoms tied to the content of the work.

Correct answer: Blunted empathy and judgment that undermine care for clients

The greatest ethical risk of unaddressed compassion fatigue is that blunted empathy and impaired judgment undermine the care clients receive, which is why self-care is treated as an ethical duty. Compassion fatigue erodes empathy rather than heightening it, so it does not make her overly indulgent. It does not typically drive over-documentation, and billing or charting liability is unrelated to the worker's emotional depletion.

Correct answer: Collegial consultation

Seeking advice from an experienced colleague who has no authority over one's work is consultation. Clinical supervision would involve a supervisor who oversees and is accountable for her practice, which the stem rules out. Peer review is a formal evaluation of practice or records, not informal advice on a case. Administrative oversight concerns agency policy and performance management, which is also a line of authority.

Correct answer: Supervision carries oversight of the work, while consultation is strictly advisory

Supervision includes oversight, evaluation and shared accountability for the supervisee's work, while a consultant only advises and holds no authority over it. Licensing laws commonly require supervision for newer workers, and they do not mandate consultation while leaving supervision voluntary. Supervision is not limited to the period before licensure; many agencies require it throughout employment. Supervision is not therapy for the worker's personal issues; it focuses on practice and client care.

Correct answer: Address the mistake with the supervisee and act to protect client welfare

A supervisor shares responsibility for a supervisee's work, so she should address the mistake, make sure the client is protected, and give corrective guidance. Leaving it to the supervisee ignores that shared accountability. Going to the licensing board before even meeting with her skips correcting the problem and protecting the client, and a single clinical error is normally handled in supervision first. Keeping the error out of the record is concealment and falsifies documentation.

Correct answer: Decline, since romance with a former client poses long-term risk of harm

The NASW Code warns against romantic and sexual relationships with former clients because the potential for harm and exploitation outlasts the professional relationship, and a worker who proceeds bears the full burden of showing there was no exploitation. The end of services and a two-year gap do not remove that risk. A supervisor's approval cannot make the relationship ethical. Unlike some other professions' codes, the NASW Code sets no waiting period, such as five years, after which dating becomes acceptable.

Correct answer: Disclose the conflict and have another colleague take over the file

A close personal friendship with a client is a dual relationship that compromises objectivity, so the worker should disclose the conflict and have a colleague take over the case. Recording the friendship in the notes documents the conflict without resolving it. Pausing the friendship does not undo the existing bond that clouds her judgment. A signed waiver cannot remove a role conflict the Code asks her to avoid.

Correct answer: It risks a dual relationship and conflict that may exploit a client

Bartering creates a second, business role with the client, and that dual relationship and conflict of interest can lead to exploitation. The NASW Code does not ban bartering outright; it allows it only in limited circumstances, such as when it is accepted local practice, negotiated without coercion, and entered at the client's initiative with informed consent. No rule requires disclosing and reporting a barter arrangement to the licensing board. Painting an office does not in itself expose other clients' files, so privacy is not the core concern.

Correct answer: They can cloud judgment and invite exploitation of the client's trust

A second role alongside the professional one can cloud the worker's judgment and give her a way to exploit the trust and power the helping relationship creates. Tax or legal consequences from money changing hands are not the ethical issue, and many dual relationships involve no money at all. Being seen in public with a client does not by itself disclose anything. A dual relationship does not make the worker legally responsible for crimes the client commits.

Correct answer: Decline the evaluator role and keep acting as the treating therapist

Treating a client and evaluating that same client for the court are incompatible roles, so the worker should decline the forensic role and remain the treating therapist. Client consent cannot cure the conflict between therapeutic support and neutral evaluation. Ending therapy to take the evaluation still draws on knowledge gained as the therapist and abandons the client. Basing the report only on counseling records is still serving as evaluator in a dual role.

Correct answer: Accurate, timely, and relevant to the services the client received

Ethical records are accurate, timely and relevant to the services the client received, which protects clients and supports continuity of care. Notes so general that they omit the specifics needed for care are not adequate documentation. The worker's personal opinions go beyond what is relevant to services and can harm the client if the record is released. Writing notes only once a month fails the requirement that documentation be timely.

Correct answer: Allow reasonable access, with a narrow exception for risks of harm

Clients generally have a right to reasonable access to their records, with a narrow exception when access could cause serious harm, and even then the worker helps interpret the record or limits only the harmful part. The agency owns the physical record, but that does not cancel the client's right to see it. A summary can be offered if the client agrees, but clients are not limited to one as a rule. No court order is needed for a client to see his own file.

Correct answer: Shred or otherwise securely destroy them so no one can reconstruct them

Records with protected health information must be securely destroyed, such as by shredding, so they cannot be read or reconstructed. Crossing out names leaves other identifiers like dates, addresses and diagnoses exposed in the recycling stream. Storing them indefinitely is not disposal and keeps the risk of a breach alive. Handing records back to clients can expose information about others and gives up the worker's duty to ensure secure destruction.

Correct answer: Limit what is shared to the least amount the request reasonably needs

The minimum necessary standard means sharing only the protected information reasonably needed to accomplish the request. Sending the entire record leaves the trimming to the recipient, which is the opposite of the standard. Written authorization is a separate requirement that does not apply to every permitted disclosure, such as many made for treatment or payment. A fixed rule of diagnosis and dates only may share too much for one purpose and too little for another.

Correct answer: Volunteering some skills with no expectation of financial returns

The value of service asks social workers to place helping people above self-interest, and the Code specifically encourages volunteering some professional skill with no expectation of significant financial return. Advocating for policy change to fight injustice expresses the value of social justice. Honoring each client's inherent worth is the value of dignity and worth of the person. Acting in a trustworthy way consistent with the profession's mission is the value of integrity.

Correct answer: Raise the conduct through proper channels rather than letting it pass

The Code bars social workers from condoning discrimination and expects them to respond to colleagues' unethical conduct through appropriate channels, often starting with the colleague or a supervisor. Staying silent because the clients belong to someone else is the kind of condoning the Code forbids. Treating it only as her own self-care topic leaves the coworker's conduct unaddressed. Alerting clients spreads the problem without stopping the behavior.

Correct answer: To identify core values and standards that guide social work

One central purpose of the NASW Code is to identify the profession's core values and set ethical standards that guide practice. The Code is not law and imposes no state legal penalties, although boards and courts may refer to it. It explicitly declines to rank its values and duties in a fixed order, recognizing that reasonable workers can disagree when obligations conflict. It sets ethical standards, not tests or treatments for particular diagnoses.

Correct answer: What the gift means culturally and how it may affect the relationship

A small, culturally meaningful gift calls for judgment about what it means in the family's culture and how accepting or refusing it will affect the professional relationship. Dollar value is one factor, but the idea that small gifts never raise a concern is false. Feeling obliged to return the favor is not the ethical test. How often staff and managers accept such gifts says nothing about this family's intent or this relationship.

Correct answer: Read the results with care, weighing cultural factors that limit validity

When a tool was normed mostly on another group, cultural humility calls for reading the results cautiously and weighing how cultural factors may limit their validity. Reporting the raw scores as recorded assumes the norms fit everyone. Raising scores by an arbitrary amount invents a correction with no empirical basis. Discarding the instrument for impressions alone throws away useful information and swaps one source of bias for another.

Correct answer: Seek training and consultation while letting the client guide her learning

Cultural humility means taking responsibility for learning through training and consultation while treating the client as the expert on their own experience. Referring out solely because of unfamiliarity denies service when competence can be built. Making the client do the teaching in place of her own training shifts the worker's job onto the client. Standard skills and empathy alone ignore the specific knowledge she needs to serve this client well.

Correct answer: Sharing power and reducing the harm of the worker-client power imbalance

Anti-oppressive practice asks the worker to recognize the power imbalance inside the helping relationship and to share power so its harms are reduced. Holding on to clear power and authority over clients reinforces that imbalance. Treating power as neutral denies the very dynamic she is reflecting on, and it does not keep her biases out. Anti-oppressive work examines structural oppression too, but it does not exclude the relationship itself from that analysis.

Correct answer: Taking reasonable steps to protect the intended victim, including warning

Once a serious, imminent threat against an identifiable person is assessed, the duty to warn or protect calls for reasonable protective steps, which may include warning the neighbor or notifying police. Seeing the client more often while keeping the threat secret leaves the neighbor unprotected. Ending therapy and transferring the client does nothing for the person at risk and abandons the client. The duty does not depend on the client's release, which he may never give.

Correct answer: A credible threat of grave violence toward an identifiable third party

In most jurisdictions the duty to warn or protect is triggered by a serious threat of violence against a reasonably identifiable victim. A past history of violence may inform risk assessment but does not trigger the duty without a current threat. No diagnosis is required, and most people with serious mental illness pose no threat to others. Refusing a referral is a treatment choice, not a threat to anyone.

Correct answer: Clinicians may owe a duty to protect identifiable people a client threatens

Tarasoff held that when a client poses a serious danger of violence to an identifiable person, the clinician may have a duty to take reasonable steps to protect that person. It did not create a duty to report every client with a violent history. Its holding concerned liability for failing to protect a victim, not liability for warning one. It made protective disclosure possible without the client's consent.

Correct answer: That taking part is voluntary and declining will not affect services

Valid research consent requires that clients know participation is voluntary and that declining or withdrawing will not affect their services. Promising faster access is an undue inducement that undermines voluntariness. Participants may withdraw at any time, so telling them they must continue is false. Research records and results are not sent to insurers for reimbursement, and implying so would mislead and deter them.

Correct answer: The client's specific informed consent to the recording and its usage

Recording a session requires the client's specific informed consent to the recording and to how it will be used. A supervisor's approval cannot substitute for the client's decision, whatever her training and review duties. An agency head may need to sign off internally, but agency ownership of the recording does not replace the client's consent. A blanket intake form is not specific enough to cover recording a session for training.

Correct answer: The risks, limits, and viable alternatives to the proposed services

Informed consent requires that the client understand the risks, limits and reasonable alternatives to the proposed services, not just the benefits. The worker's past success rates speak only to benefits and can mislead. Her education and job history are not what makes a decision about these services informed. No outcome can be guaranteed, and implying one misrepresents the choice.

Correct answer: The laws on minors' consent and privacy, which vary in each jurisdiction

Whether a minor can consent to counseling, and how much the parents may learn, depends on laws that vary by jurisdiction and type of service, so the worker must follow those laws. Parental consent is not required for every therapy, because many states let older minors consent to outpatient mental health care. A 17-year-old does not have full adult legal rights. An agency rule cannot override state law.

Correct answer: State reporting laws, which cover suspected neglect of an older adult

Untreated pressure sores and severe underfeeding in a dependent older adult are signs of neglect that trigger state reporting laws for suspected abuse or neglect of a vulnerable adult. Self-determination does not apply when a dependent adult is being harmed by a caregiver, whether or not help was requested. Privacy rules give way to the legal reporting duty, so the client's consent is not required. Calling in the suspected caregiver first can endanger the client and delay the required report.

Correct answer: File the report now and let investigators confirm what really occurred

Mandated reporters must report when they have reasonable suspicion, not proof, so she should file now and leave the investigation to child protective services. Gathering evidence herself oversteps her role and delays the report. Questioning the parents first can endanger the child and compromise the investigation. Consulting a supervisor is fine, but waiting for agreement does not relieve her personal duty to report promptly.

Correct answer: Good-faith immunity from civil and criminal liability for the reports

Mandated reporting laws generally give reporters immunity from civil and criminal liability for reports made in good faith, whether or not the abuse is later confirmed. Protection does not wait until a report is substantiated, which would discourage reporting. It covers all mandated reporters, including social workers, not only physicians and nurses. It applies to identified reporters and is not limited to anonymous referrals.

Correct answer: Tactfully stop the discussion and suggest moving it to a private space

Client information should be discussed only in private, so the best response is to tactfully stop the conversation right away and move it to a private setting. Waiting for a departmental meeting lets the breach continue in front of strangers. Joining in, even to soften it, keeps confidential material in a public space. Writing the names into a report may follow later, but it does nothing to stop the disclosure as it happens.

Correct answer: Remove identifying details or else get the client's consent for it

Case material may be presented only if it is disguised so the client cannot be identified or the client has consented. Changing the name alone leaves other facts that can identify the client. Attendees are not bound to this client's confidentiality simply by being professionals at a conference. A supervisor cannot authorize sharing identifiable client information in place of the client.

Correct answer: Follow the policy on secrets she laid out when the therapy started

In conjoint therapy the prudent course is to set a clear policy on secrets at the outset and then follow it, so both partners know what to expect. Promising to keep any secret can trap the worker in an alliance with one partner against the other. Revealing it at the next joint session without regard to the policy violates the expectations she set. Ending couples work over a single email abandons the treatment both partners sought.

Correct answer: Keep what each client says private unless the client permits its release

Each spouse is a separate client owed full confidentiality, so neither one's information goes to the other without that client's authorization. Being married does not merge two clients into one shared case. A combined record would expose each client's notes to the other. Information that concerns both of them is still confidential to the client who disclosed it.

Correct answer: Assert the privilege on the client's behalf and refuse all disclosure

When the client has invoked privilege and no exception applies, the worker asserts the privilege on the client's behalf and declines to disclose the protected communications. A deposition does not override a valid privilege. Answering the questions the client considers less sensitive still discloses privileged content, because privilege covers the communications regardless of how sensitive they feel. Sealing the transcript afterward does not undo an improper disclosure.

Correct answer: The court orders disclosure under a defined exception like abuse

Privilege yields when a court finds that a recognized legal exception applies, such as certain abuse or danger cases. A subpoena from an attorney is not a court order and does not by itself defeat privilege; the worker should assert the privilege and seek guidance. Ending treatment does not end privilege. The worker's belief that testimony would help the client's claims does not override the client's control of the privilege.

Correct answer: Relevant records may become open to discovery in this lawsuit alone

Placing his mental health at issue waives privilege for relevant communications, so they may become discoverable in this lawsuit. The waiver is limited to that matter and to relevant material, so confidentiality is not lost for every other purpose. It does not entitle anyone connected with the case to the complete file. The waiver is real, so privilege does not stay fully intact once he made his condition part of the claim.

Correct answer: Treat ethical duties as paramount and strive to resolve the conflict

When agency policy conflicts with the Code, the worker's ethical obligations remain primary and she should work to resolve the conflict through appropriate channels. Employers do not override the profession's ethical standards. Documenting an objection while still carrying out the unethical action does not meet her duty. Resigning at once skips the effort to resolve the conflict and may leave clients without help.

Correct answer: Weigh the probable consequences of each option for all involved

After identifying the values involved and the possible courses of action, the model calls for weighing the likely consequences of each option for everyone affected. Recording the decision and its reasoning comes after a decision is made. Monitoring and evaluating outcomes comes after the action. Restating the problem and identifying the parties with competing duties are earlier steps already completed.

Correct answer: Reach a reasoned and defensible choice that best weighs the values

In a true dilemma the realistic aim is a reasoned, defensible choice that best weighs the competing values, accepting that some value goes unmet. An option that satisfies every value with no trade-off does not exist in a genuine dilemma. Handing the choice to a supervisor does not divide away the worker's own responsibility. The NASW Code does not rank its values, so there is no top-ranked value to apply.

Correct answer: Ethics can require more than the minimum, so legality is not conclusive

Ethical standards can require more than the legal minimum, so an action being legal does not by itself make it ethical. Law does not fully embody professional ethics, so legality is not the same as ethics. The Code expects workers to act ethically even when the law points elsewhere, so law does not automatically win a conflict. Ethics also applies where the law speaks, not only where it is silent.

Correct answer: Respect her choice while offering information on services to cut risk

A competent adult has the right to choose to live independently, so the worker respects that choice while offering information on services and supports that reduce the risk. Adult protective services addresses abuse, neglect or self-neglect a person cannot manage, not a competent person's lawful choice. A guardianship evaluation is unwarranted when capacity is not in question, however serious the risks. Making services conditional on a safety plan coerces the client.

Correct answer: Go back to the client's own goals and support the client's choices

Self-determination requires the worker to return to the goals the client chose and support the client's own decisions. Explaining her reasons more fully is still steering toward her preferred goal. Combining her goal into the plan keeps imposing her preference in a softer form. Calling the client resistant for having different goals mislabels a legitimate choice.

Correct answer: The person's right to decide, limited by serious, imminent risk of harm

Self-determination is a person's right to make their own choices, limited when those choices pose a serious, foreseeable and imminent risk to themselves or others. It is not an unrestricted freedom regardless of danger. It does not give the worker authority to choose for the client. Adults are presumed competent and do not need a court declaration to exercise it.

Correct answer: Refer to or collaborate with a professional qualified in that area

Social workers practice only within their areas of competence, so she should refer to or collaborate with a professional qualified to diagnose and treat childhood neurodevelopmental disorders. A license does not make a worker competent in every specialty. Supervision by someone who also lacks training adds no competence. A brief online class is not the education, training and supervised experience needed to practice in a new specialty.

Correct answer: Perform those tasks herself only when overseen by a qualified clinician

Her license limits her to the services it authorizes, so clinical work she cannot yet do alone must be done under the supervision her state requires. Approval from agency leaders cannot expand what a license permits. A short training course adds knowledge but does not change her legal scope, and a client's signed waiver cannot authorize practice the license does not allow.

Correct answer: Seek out therapy or supervision and lighten her caseload if necessary

When personal distress begins to cloud her judgment, she should get help such as her own therapy or supervision and adjust her caseload so clients are protected. Grief may be ordinary, but grief that is already impairing sessions does call for a response. Telling clients about the bereavement shifts her needs onto them, and permanently closing the practice is an extreme step the situation does not require.

Correct answer: Refuse the offer, because a fee for referral alone is prohibited

The NASW Code bars accepting anything of value for making a referral when the referring social worker provides no professional service, so she should turn the offer down. Telling each person referred about the payment does not remove the conflict. Strong program results do not make a per-referral bonus acceptable, and donating the proceeds still means accepting a payment the Code prohibits.

Correct answer: Refuse to lend her credentials to claims she cannot verify

Lending her professional credentials to a treatment she has not evaluated would be a misleading professional claim, so integrity requires her to decline. Calling herself a satisfied consumer does not help while the ad still trades on her standing, and the company's own survey data is not an independent evaluation. Moving the endorsement from a radio ad to leaflets keeps the same unsupported claim in print.

Correct answer: Integrity

Listing a license she does not hold is dishonesty, and integrity is the NASW value that requires social workers to act honestly and in a trustworthy way. Competence concerns practicing within the skills she actually has, which is a separate issue from lying about a credential. Service and social justice concern helping people in need and challenging injustice, not truthfulness about qualifications.

Correct answer: Say she cannot discuss whether someone is or is not her client

The fact that someone is a client is itself confidential, so the worker should neither confirm nor deny it. Confirming the relationship and then refusing details still discloses protected information. Lying that the person is not a client is dishonest, and her refusals in real cases would then become a signal. A friend's promise to keep it secret does not authorize any disclosure.

Correct answer: Follow the sharing limits discussed at intake and applicable state laws

With a minor, the limits of confidentiality should be explained to the teen and parents at intake and applied consistently with state law, which separates routine disclosures from safety risks. Adolescents often do have legal confidentiality protections, so telling the parents automatically is not justified. Promising secrecy even if a serious threat emerges is a promise she could not keep, and requiring the teen to tell his parents ignores the agreed limits.

Correct answer: Keep it confidential and keep assessing for suicide risk over time

Hopelessness without intent, plan, or threat does not meet any threshold for breaking confidentiality, so the worker keeps the information private while continuing to assess suicide risk. Calling an emergency contact is a disclosure with no legal basis here. Involuntary admission requires imminent danger, which has not been shown. Stopping screening is also wrong, because hopelessness is a risk factor that needs ongoing monitoring.

Correct answer: Explain the risks today, before any formal decision to go ahead

Informed consent means the client hears the known risks before deciding, so the worker must disclose them now. Choosing which risks a client can handle is paternalistic and leaves the consent incomplete. Waiting until trust is built means the client has already agreed without the facts, and a brief signed form saying all treatment carries risk does not disclose the specific risks she knows about.

Correct answer: Explaining what the service involves and the client's right to refuse

Consent rests on the client understanding what the service involves, including its risks and limits, and the right to refuse, and free services do not change that. Fee waiver eligibility and donor policy are administrative details, not the substance of consent. A funding agency cannot consent on the client's behalf, and a bare signature with no explanation is not informed consent even when no fee is involved.

Correct answer: Adapt her approach and check her own assumptions about those norms

Cultural humility means treating the client as the expert on his own norms, adjusting her approach, and checking her assumptions. Reading reduced eye contact as depression imposes her own norms as the standard. Keeping one style for everyone treats sameness as fairness and ignores the difference she noticed, and predicting his preferences from a survey of his birth cohort swaps one stereotype for another.

Correct answer: Include relatives as he requests while he retains the final say

A culturally humble worker brings relatives into decisions in the way the client wants, while the client keeps the final say over his own care. Coaching him to decide alone imposes an individualistic value he does not hold. Letting family members choose for him overcorrects and removes his self-determination, and labeling his reliance on kin as enmeshment pathologizes a cultural norm.

Correct answer: Examine the reaction with her supervisor or a trusted consultant

The first step with suspected countertransference is to understand the reaction, and supervision or consultation is where that work happens. Transferring the client before the next meeting skips that step and may abandon him over a reaction that could be managed. Disclosing the resentment burdens the client with her feelings, and spacing out appointments reduces his care to ease her discomfort.

Correct answer: Notice when feelings from earlier bonds are redirected onto her

Transference is the client redirecting feelings from earlier relationships onto the worker, and recognizing it lets her use that pattern in treatment. Her own history shaping her reactions to clients is countertransference, not transference. Keeping anxiety at bay through unconscious defenses describes defense mechanisms in general, and taking on the attributes of an idealized figure is identification.

Correct answer: Whether telling her story would further his goals in treatment

Self-disclosure is justified only when it serves the client's therapeutic goals and stays within professional boundaries, so that is the primary test. How long her sobriety has lasted concerns her credibility, not his benefit. A client's direct question does not by itself make disclosure helpful, and agency policy may permit a disclosure that is still wrong for this client.

Correct answer: Shifting the focus toward her own needs and blurring roles

Too much self-disclosure pulls the focus of sessions toward the worker's own needs and blurs the line between professional and personal roles. It tends to make the worker seem overly familiar, not cold or distant. Privilege belongs to the client and is not waived by anything the worker says about herself, and self-disclosure does not trigger new consent forms before each visit.

Correct answer: Discuss the concern with the supervisor, then escalate if unresolved

A supervisee who believes a directive could harm a client should first raise it respectfully with the supervisor, then use agency or other channels if it is not resolved. The supervisor's liability does not relieve her of her own duty to the client. Filing a board complaint before any conversation skips the direct step, and asking the client to arbitrate shifts a professional disagreement onto him.

Correct answer: A dual relationship arises within an unequal power dynamic

The supervisor evaluates the supervisee, so a romantic relationship creates a dual relationship and a conflict of interest inside a power imbalance. Coworkers seeing favoritism is a side effect, not the central ethical problem. Dating a supervisee does not inherently breach the confidentiality of the supervisee's clients, and adult consent does not remove the exploitation risk that the power gap creates.

Correct answer: Impaired workers can deliver less safe and effective support

Burnout matters ethically because an exhausted, cynical worker can deliver care that is less safe and less effective for clients. Reduced agency output is a business concern, not the reason it matters to clients. Workers are not required to tell clients about burnout, and burnout is not a diagnosis that automatically costs a license; the duty is to address it before it harms care.

Correct answer: Pair regular supervision with ample rest and support from peers

Compassion fatigue is prevented by ongoing supports such as regular supervision, adequate rest, peer support, and work-life balance. Holding back empathy protects the worker at the cost of the relationship clients need. Waiting for serious symptoms before taking a sabbatical is a reaction, not prevention, and accepting more trauma cases increases the exposure that causes compassion fatigue.

Correct answer: Keep records private unless there is consent or board approval

Identifiable client records may be used in research only with the clients' consent or proper authorization such as an ethics review board waiver, so she should keep them private. A study's promised benefit does not replace consent. Removing names while leaving birth dates keeps records identifiable, and approval from her supervisor and director is not the authorization that research on client data requires.

Correct answer: Private details sent insecurely could be seen by an outsider

The concern is that clinical details sent through an unsecured channel can be read by people who should not see them, so the content and the channel need safeguards. HIPAA does not ban text reminders outright, especially ones that carry minimal information. A phone carrier that only transmits messages does not have to sign a business associate agreement, and text messages can be documented in a client's chart.

Correct answer: Contain the damage and notify affected clients as law requires

Under HIPAA's breach notification rule, the organization must contain the harm and notify affected individuals without unreasonable delay and no later than 60 days after discovering the breach. Notification does not depend on whether clients threaten lawsuits. Waiting for a yearlong audit to finish would far exceed the required timeline, and telling only the tech vendor leaves the people whose data was exposed uninformed.

Correct answer: Comment on nothing and neither confirm nor deny any services

Media attention does not waive confidentiality, so the worker should not even confirm that she provides services to the person. Commenting on facts already published in print and online media still confirms the relationship. Family members cannot authorize disclosure of an adult client's information, and discussing the diagnosis without a name still identifies the client when the reporter already knows who it is.

Correct answer: Boundary maintenance

Extra time, gifts, and special favors for one client are classic signs of boundary blurring, so the concern is maintaining appropriate professional boundaries. Duty to warn applies when a client threatens an identifiable person. Informed consent covers what clients are told before services begin, and record retention concerns how long files are kept, so neither fits this pattern.

Correct answer: A dual role could exploit him and compromise therapeutic gains

Employing a current client creates a dual relationship in which the power imbalance can be exploited and the therapeutic work compromised. No federal labor law bars hiring someone because they receive services. Paying fair wages and benefits does not remove the dual relationship, and a signed waiver cannot cure a conflict the client may feel unable to refuse.

Correct answer: Coordinate with the agency so clients are told and choose freely

A departing worker should work with the agency so clients are properly notified, continuity of care is planned, and each client can choose where to continue. Secretly calling clients before quitting to recruit them is improper solicitation. Copying agency charts on the way out breaches confidentiality and the agency's ownership of records, and telling clients they must stay denies them a choice they are entitled to make.

Correct answer: Decline it, because a personal online tie could blur roles

A personal social media connection with a former client risks a dual relationship and blurred boundaries, so the protective choice is to decline. The end of treatment does not remove that concern. Restricting which updates the person sees still creates a personal online relationship, and no waiting period makes such a connection appropriate later.

Correct answer: That posting it would disclose that sessions had taken place

A public review naming the worker as the reviewer's therapist reveals that the person attended sessions with her, which raises confidentiality and boundary concerns that come first. Whether the review portrays her skills accurately is secondary to that exposure. Thanking the reviewer openly would itself confirm the client relationship, and the platform's editing features have nothing to do with the ethical issue.

Correct answer: Take steps through formal channels to stop the misconduct

When a colleague has clearly exploited a client, the worker should act through appropriate channels, such as discussing it with the colleague when feasible and reporting to the agency or licensing board. Waiting for the client to file a complaint leaves the burden on the person being harmed. The violation is already clear, so gathering more evidence only delays action, and quietly steering the client to another worker leaves the colleague free to exploit others.

Correct answer: Discuss ending ahead of time and arrange any needed follow-up

Ethical termination is planned: the worker discusses ending in advance, reviews progress, and arranges any follow-up the client needs. Announcing in the final session that services are over gives the client no time to prepare, even when goals are met. Meeting indefinitely to spare the client a sense of loss continues services without need, and closing the file after two missed sessions is abandonment.

Correct answer: Give notice after weighing clinical needs and any risks of harm

The NASW Code allows ending services for nonpayment when the financial terms were clear, the client is not a danger, and the clinical consequences have been discussed, so she should give notice after weighing those factors. Ending over unpaid fees is therefore not barred. Stopping the same day skips notice and risk review, and withholding records until invoices are paid is improper.

Correct answer: Initiate emergency measures allowed by law to protect his life

Serious, imminent suicide risk is a recognized limit on self-determination, so the worker may take legally permitted protective steps such as arranging an emergency evaluation. Autonomy does not outweigh the duty to protect life when danger is imminent. A no-harm agreement has no proven protective value, and a later visit with daily calls does not address danger that is immediate.

Correct answer: Address it as a breach and advocate for stronger safeguards

An unauthorized disclosure by staff is a confidentiality breach, so the worker should treat it as one, address it through the agency, and push for safeguards against a repeat. Office staff are bound by the same confidentiality obligations as clinicians. Asking the relative to keep quiet does nothing about the agency's failure, and apologizing while saying nothing can be fixed is wrong because the agency can still respond and prevent further breaches.

Correct answer: Share only what is authorized and essential for his schoolwork

In schools, the worker shares only information that is authorized and that the teacher needs to support the student, keeping session content confidential. Being part of the school team does not entitle a teacher to session themes. What the parents and principal were told does not authorize disclosure to a teacher, and a promise of discretion does not make an unauthorized summary acceptable.

Correct answer: Keep learning emerging research relevant to her field of work

Competence over a career depends on continually learning the emerging knowledge and evidence in one's field. Experience is valuable but becomes outdated without new learning. Narrowing practice does not stop methods from aging, and completing only the hours a license requires meets the rule without actively keeping her practice current.

Correct answer: Refuse to sign records that overstate her role in casework

Signing documentation for services she did not supervise or provide overstates her role, so integrity requires declining. Even if the agency confirms the services happened, her signature would still claim involvement she did not have. A cosignature is not a mere formality, and notes added later by the treating clinician do not make her signature an accurate record of supervision she never gave.

Correct answer: Pursue his claim through proper avenues until it is resolved

Social justice and the commitment to clients support actively advocating so the client receives what he is entitled to. Accepting an unfair outcome to preserve agency goodwill puts the agency's comfort ahead of his rights. Holding off while he exhausts every appeal alone leaves him without help when it matters most, and advocacy is part of every social worker's role, including clinicians.

Correct answer: Reflect on the pattern and seek consultation to counter it

The responsible response to possible implicit bias is self-reflection and consultation so its influence on her judgments can be reduced. Implicit bias operates outside awareness, so training does not automatically correct for it. Telling each affected client about her bias burdens them without fixing her judgment, and transferring or referring out clients she may judge unfairly avoids the bias rather than addressing it.

Correct answer: A biopsychosocial evaluation

A biopsychosocial evaluation gathers biological, psychological, and social information, including health, functioning, family, work, and community supports. A mental status examination is a snapshot of current cognition, mood, and thinking. A functional behavioral analysis looks at what triggers and maintains a specific behavior, and a genogram maps family relationships across generations, so each covers only part of this picture.

Correct answer: Her diabetes diagnosis and the insulin she now takes

The biological dimension covers physical health, so a chronic illness such as diabetes and the medication used to treat it belong there. Ties to a church and a food pantry are social and community supports. Using jokes to deflect painful emotions is a coping style that belongs in the psychological dimension, and strained family relationships are part of the social dimension.

Correct answer: Thought process

Thought process describes how thoughts are organized and linked, so rapid topic shifts with loose connections are a thought process finding. Thought content is what the person thinks about, such as delusions or obsessions. Abstract thought is the ability to reason beyond the literal, such as interpreting a proverb, and affect is the observed emotional expression, so neither describes how ideas connect.

Correct answer: A firm belief that neighbors are poisoning her water supply

Thought content is what a person believes or thinks about, so a fixed false belief that neighbors are poisoning her water is a delusion and a thought content finding. Answers that meander and never return to the point describe thought process. Uncertainty about the year and her location is a problem of orientation, and a flat expression with a very narrow emotional range describes affect.

Correct answer: The DSM-5-TR

The DSM-5-TR sets out the diagnostic criteria used to decide whether symptoms meet a specific mental disorder. The PHQ-9 is a depression screening questionnaire that flags symptoms but does not establish a diagnosis. The NASW Code of Ethics governs professional conduct, and the ASAM criteria guide level-of-care placement for substance use treatment, not diagnosis.

Correct answer: Two weeks

DSM-5-TR requires the symptoms of a major depressive episode to last at least two weeks. Four consecutive days is the minimum duration for a hypomanic episode. Two months is the symptom-free period DSM-5-TR uses to define full remission, not the duration needed for diagnosis, and two years is the minimum for persistent depressive disorder in adults.

Correct answer: Displacement

Displacement is redirecting a feeling from a threatening target to a safer one, as when anger at the boss is taken out on the children. Projection attributes one's own feelings to someone else. Rationalization offers a reasonable-sounding excuse for behavior, and regression is a return to earlier developmental behavior, so none of them describes shifting anger onto a safer target.

Correct answer: Denial

Denial is refusing to accept a painful reality despite clear evidence, which is what the client does when she insists her drinking is not a problem. Rationalization would admit the drinking but offer excuses for it. Repression keeps painful memories out of awareness, and undoing is an act meant to cancel out an earlier unacceptable thought or behavior.

Correct answer: Projection

Projection is attributing one's own unacceptable feelings to someone else, so the client's hostility is experienced as the coworker's hatred. Displacement would redirect his hostility onto a safer target instead of recasting it as the coworker's feeling. Reaction formation would show exaggerated friendliness toward the coworker, and splitting sees people as all good or all bad.

Correct answer: Identity versus role confusion

Erikson placed identity versus role confusion in adolescence, when young people explore values, beliefs, and future roles. Intimacy versus isolation is the task of young adulthood, after identity has formed. Industry versus inferiority belongs to the school-age years, and initiative versus guilt to the preschool years.

Correct answer: Integrity versus despair

Integrity versus despair is Erikson's final stage, when older adults review their lives and come to accept or regret them. Generativity versus stagnation is the midlife task of contributing to the next generation. Intimacy versus isolation belongs to young adulthood, and identity versus role confusion to adolescence.

Correct answer: Trust versus mistrust

Trust versus mistrust is Erikson's first stage, in infancy, when consistent and responsive caregiving builds basic trust. Autonomy versus shame and doubt follows in toddlerhood. Initiative versus guilt belongs to the preschool years, and industry versus inferiority to the school-age years.

Correct answer: Concrete operational

Conservation, the grasp that an amount stays the same when only its shape changes, is the hallmark achievement of Piaget's concrete operational stage, which begins around age 7. A pre-operational child judges by appearance and says the taller glass holds more, which is why conservation marks the exit from that stage. Formal operations bring abstract and hypothetical reasoning in adolescence, and the sensorimotor period of infancy centers on object permanence, not conservation.

Correct answer: Sensorimotor stage

Piaget placed object permanence in the sensorimotor stage, roughly birth to age 2, when infants learn that a hidden toy still exists. The pre-operational stage that follows is defined by symbolic play and egocentric thought, which presuppose object permanence rather than create it. Concrete operations bring conservation and logic about real objects, and formal operations bring abstract reasoning, both far later than this infant milestone.

Correct answer: Getting food and safe shelter right away

Maslow's hierarchy places physiological and safety needs at the base, so a homeless client's food and safe shelter generally come first. Joining a club for friends and belonging serves love and belonging, which sits above safety and is hard to pursue while the client has nowhere to sleep. Therapy for shaky esteem and goal-setting for a more purposeful life target the esteem and self-actualization levels, the highest tiers of the model.

Correct answer: Self-actualization needs

Self-actualization, realizing one's full potential, sits at the top of Maslow's pyramid. Esteem needs are the tier just beneath it, which makes them the closest wrong answer but still not the peak. Love and belonging needs fall in the middle of the pyramid, and safety needs sit just above physiological needs near the base.

Correct answer: Ambivalent attachment

Ainsworth's ambivalent (also called anxious-resistant) pattern shows intense distress at separation and a reunion in which the infant both seeks and angrily resists contact and is hard to settle. Avoidant infants show little distress and ignore the caregiver on return rather than clinging. Disorganized infants lack any coherent strategy and may freeze or look fearful, and securely attached infants are comforted quickly at reunion.

Correct answer: The quality of early bonds shaping later ties

Bowlby and Ainsworth's attachment theory explains how the quality of early caregiver bonds forms internal working models that shape later relationships, so it is a relational assessment lens. Moral reasoning stages come from Kohlberg, not attachment research. Unmet physical and safety needs are the territory of Maslow's hierarchy, and readiness to change a behavior is assessed with the transtheoretical stages of change.

Correct answer: Dependency, nail biting and overindulgence

Freud linked oral-stage fixation to dependency and oral habits such as nail biting, smoking and overindulgence in food or drink. Strict orderliness, hoarding and obstinacy describe the anal-retentive personality, while sloppiness and defiance describe the anal-expulsive one, so both belong to the anal stage. Vanity, brashness and exhibitionism are traits Freud tied to phallic-stage fixation.

Correct answer: Ego

In Freud's structural model the ego follows the reality principle, finding realistic ways to satisfy drives while weighing outside demands and the conscience. The id runs on the pleasure principle and seeks immediate gratification, and the superego holds internalized moral standards rather than mediating. The preconscious is part of Freud's earlier topographic model of awareness, not one of the three structures of personality.

Correct answer: The denial stage

Denial is the first Kubler-Ross stage, in which the person refuses to accept that the loss is real, exactly as when a client insists the spouse will come home. Anger involves protest and blame directed at others, which still admits the loss happened. Bargaining tries to negotiate the loss away with "if only" deals, and depression is deep sadness that follows recognition of the loss.

Correct answer: Stages can recur, overlap or be skipped, and seldom follow one order

Kubler-Ross herself said the stages are not a fixed sequence; people may move back and forth, revisit stages or skip some, so the model is a loose guide rather than a rule. Insisting that each stage must finish before the next begins is the rigid reading the model does not support. A missed stage is not a sign of abnormal grief, and the model came from interviews with dying patients, not studies of widows.

Correct answer: Acute lethality and the immediacy of any attempt

A specific plan, access to a firearm and a chosen time point to acute risk: how deadly an attempt could be and how soon it may happen. Chronic background risk reflects long-standing history and does not capture this sudden escalation. Protective factors lower risk rather than raise it, and static demographic traits such as age and gender stay the same regardless of what the client discloses.

Correct answer: Have you thought about how you would end your life?

Asking how the client would end their life goes directly to method, the core of a current plan, and opens follow-up about means and timing. Asking about past self-harm measures history, a strong risk factor but not evidence of a present plan. Asking about suicide in the family measures another background risk factor, and asking whether living feels not worth it screens for passive ideation, which can exist with no plan at all.

Correct answer: Family ties and repeated events across generations

A genogram is a multigenerational family diagram, so it shows relationships, major life events and repeating patterns across at least three generations. Mapping ties to outside systems such as work or church is the job of an ecomap. Cognition, mood and orientation are assessed in a mental status exam, and readiness to change is framed by the transtheoretical stages of change.

Correct answer: Ecomap

An ecomap places the client or family in a center circle and draws lines to outside systems such as work, school, church and agencies, with line styles showing the strength and stress of each tie. A genogram maps relationships inside the family across generations rather than links to outside systems. A sociogram charts relationships among members of a group, and a culturagram summarizes a family's cultural background such as immigration history and values.

Correct answer: Contemplation stage

Contemplation combines awareness of a problem with ambivalence about acting, which fits a client who admits drinking too much but is not ready to change. Precontemplation would mean the client does not yet see the drinking as a problem, which this client plainly does. Preparation involves intending to act soon and making small plans, and action involves actively changing the behavior, neither of which this client describes.

Correct answer: The precontemplation stage

In precontemplation the person has no intention of changing in the foreseeable future and often does not see the behavior as a problem. Contemplation requires at least recognizing the problem while weighing change. Preparation means planning to act soon, and maintenance means sustaining a change already made, so both assume a recognized problem this client denies.

Correct answer: Reciprocal exchanges linking people and their settings

The person-in-environment perspective, the signature lens of social work, looks at the ongoing two-way exchange between a person and the social and physical environment. Focusing on inner conflicts from childhood is the psychodynamic lens. Inherited and biological factors reflect a medical model, and distorted thought patterns are the focus of cognitive theory, each of which looks at the person without the environment.

Correct answer: The behavior both shapes and mirrors family and school life

Systems theory treats a person as part of interacting systems, so the child's behavior both affects and is affected by family and school dynamics. Saying the behavior is learned and kept going by others' attention is a behavioral account that runs in one direction only. An old conflict rooted in childhood is a psychodynamic explanation, and a normal stage the child will outgrow is a developmental account, so neither describes reciprocal influence among systems.

Correct answer: Face-to-face settings, such as the family, class and friends

Bronfenbrenner's microsystem is the set of immediate settings where the person interacts face to face, such as family, classroom and friends. Linkages between those settings, such as parent conferences that connect home and school, form the mesosystem. Systems that affect the person indirectly, like a parent's job, form the exosystem, and overarching values, laws and policy make up the macrosystem.

Correct answer: Skills, resources and supports the client already has

The strengths perspective starts from the skills, resources and supports a client already has and builds the plan on them. Cataloguing symptoms to support a diagnosis reflects the medical model the strengths perspective was developed to balance. Tracing root causes to childhood is a psychodynamic emphasis, and leading with gaps and deficits in current functioning is the deficit-focused stance strengths practice sets aside.

Correct answer: Depression alongside a diagnosable substance use disorder

A co-occurring disorder, often called a dual diagnosis, means the client personally meets criteria for both a mental disorder and a substance use disorder at the same time. Casual substance use below the diagnostic threshold is use, not a disorder. A chronic physical illness such as asthma is a medical comorbidity rather than a co-occurring substance problem, and a spouse's substance use is a family stressor, not a diagnosis the client holds.

Correct answer: Needing larger amounts to achieve the effect once felt

Tolerance means a person needs markedly more of a substance to get the effect a smaller amount once produced. Feeling ill and shaky as the substance wears off is withdrawal, a separate criterion. Powerful urges set off by old triggers describe craving, and repeated failed attempts to cut down describe impaired control, both real criteria but not tolerance.

Correct answer: Validate the concerns and urge a talk with their prescriber

Nausea and sexual side effects are common with SSRIs, so the social worker should take the concern seriously and encourage the client to raise it with the prescriber, who can adjust the plan. Skipping doses and tapering off alone are medication changes outside a social worker's scope, and stopping an SSRI without guidance can cause discontinuation symptoms and relapse. Side effects do not prove that the drug is working, so that reassurance would be inaccurate.

Correct answer: It needs regular blood levels because its window is narrow

Lithium has a narrow therapeutic window, so blood levels are checked regularly to catch toxicity, along with kidney and thyroid function. Ibuprofen and many diuretics raise lithium levels and can push a client into toxicity, so they are not safe to combine. Lithium takes one to several weeks to reach full effect, and routine liver enzyme panels are the key safety test for valproate, not lithium.

Correct answer: The client will attend every session over eight weeks

A measurable goal names an observable behavior that can be counted, and attending every session over eight weeks can be checked against attendance records. Gaining greater insight has a time frame but no observable marker of when insight has been gained. Feeling more optimistic and growing more self-aware are internal states with the same problem, so none of them can be measured as written.

Correct answer: A specific, measurable step toward a broader end

An objective is a specific, measurable step that moves the client toward a broader goal. A broad, long-range outcome is the definition of a goal, the very thing objectives break down. A technique the worker uses in sessions is an intervention, and a summary of the presenting problems and history belongs in the assessment, not in the planning hierarchy.

Correct answer: Orientation

Asking the date, the place and the client's own identity checks orientation to time, place and person. Recent memory is tested by asking the client to recall words or events after a delay, not to state where they are. Concentration is tested with tasks such as serial sevens, and abstract thinking with proverbs or similarities, neither of which these questions require.

Correct answer: Secure attachment

Secure attachment shows a child exploring freely while using the caregiver as a safe base, checking back now and then and settling quickly when upset. Ambivalent children stay clingy, explore little and are hard to soothe. Avoidant children seem indifferent to the caregiver and do not seek comfort, and disorganized children show contradictory or frightened behavior with no consistent strategy.

Correct answer: Arrange a medical evaluation to rule out physical causes

Conditions such as thyroid disease and anemia can mimic depression, so the right step is a medical evaluation to rule out physical causes. Starting therapy and leaving somatic concerns for later risks missing a treatable illness. A depression screening tool measures symptom severity but cannot reveal a medical cause, and having the client monitor mood before any referral postpones the very question the worker is concerned about.

Correct answer: Incongruent affect

Affect is the emotion the clinician observes, and when it clashes with the client's stated mood, such as laughing while reporting sadness, it is called incongruent affect. Labile affect shifts rapidly and unpredictably between emotions. Constricted and blunted affect describe a reduced range or intensity of expression, which is the opposite of broad smiling and laughter.

Correct answer: Generativity vs. stagnation

Erikson's middle-adulthood crisis is generativity versus stagnation, resolved by guiding and contributing to the next generation through mentoring, parenting or productive work. Intimacy versus isolation is the young-adult task of forming close relationships. Integrity versus despair is the late-life review of one's life, and identity versus role confusion is the adolescent search for a sense of self.

Correct answer: Sublimation

Sublimation turns unacceptable impulses into socially valued activity, such as channeling aggression into sport and creative work. Displacement shifts the feeling onto a safer target, like yelling at a sibling instead of a boss, without making it constructive. Reaction formation replaces an impulse with its opposite, and rationalization offers a plausible excuse for behavior, so neither converts the drive into achievement.

Correct answer: Prochaska's transtheoretical model

Prochaska and DiClemente's transtheoretical model, the stages of change, was built to gauge a client's readiness to change a behavior and to match interventions to that stage. Maslow's hierarchy ranks which needs to address first, not motivation to change a habit. Erikson's psychosocial stages describe life-span developmental crises, and Kubler-Ross's stages describe responses to loss.

Correct answer: The social dimension, covering stressors and hardships

Job loss, eviction and the end of a relationship are environmental and relational stressors, which belong to the social dimension of a biopsychosocial assessment. The biological dimension covers health, medications and heredity rather than life events. The psychological dimension covers the client's moods and coping in response to stress, and the spiritual dimension covers meaning and beliefs, so neither is where these events themselves are recorded.

Correct answer: Culture can shape how distress is expressed and should inform diagnosis

DSM-5-TR stresses that culture shapes how people experience and express distress, and it offers the Cultural Formulation Interview so clinicians weigh that context before diagnosing. Culture matters for every client, not only for recent immigrants. DSM-5-TR treats cultural concepts of distress, including those rooted in faith, as part of diagnostic assessment rather than barring them, and applying criteria the same way regardless of culture risks misdiagnosis.

Correct answer: Prolonged grief disorder

DSM-5-TR prolonged grief disorder covers grief that persists at least 12 months after a death in adults, causes clinically significant impairment and clearly exceeds cultural and religious norms. A normal grief reaction stays within those norms and gradually eases, which this presentation does not. Major depressive disorder and persistent depressive disorder require a pervasive depressive syndrome rather than grief centered on the deceased.

Correct answer: Securing food and emergency shelter without delay

A client who has not eaten in two days and has nowhere safe to sleep has unmet physiological and safety needs, which Maslow placed at the base of the hierarchy. Building friendships through a peer group addresses love and belonging, a higher tier. Boosting confidence by praising small gains serves esteem needs, and clarifying long-term goals tied to deeper meaning serves self-actualization, both of which depend on the basics being met first.

Correct answer: A multigenerational pattern

Depression and early divorce recurring in three consecutive generations is a multigenerational pattern, which is exactly what a genogram is designed to reveal. Triangulation describes a two-person conflict that pulls in a third person, not repetition across generations. Emotional cutoff is distancing from family to manage unresolved ties, and sibling position concerns birth-order traits, so neither names a recurring cross-generational pattern.

Correct answer: A strained or conflicted tie

On a standard ecomap, a line crossed with hatch marks shows a stressful or conflicted connection between the client and a system. A strong, supportive link is drawn as a solid or thickened line. Arrows on the line show the direction of energy or resources, so a one-way flow uses a single arrowhead and a mutual exchange uses arrowheads at both ends, not hatch marks. (A broken or dashed line, by contrast, shows a weak or tenuous connection.)

Correct answer: What has helped you cope and remain sober until now?

A strengths-based question looks for what has already worked, so asking what has helped the client cope and remain sober draws out skills and resilience to build on. Asking how often and how much the client uses gathers a quantity-frequency history, which is useful data but not a strength. Asking which people or places tempt a relapse maps risk, and asking what problems use causes focuses on consequences, both of which center deficits rather than resources.

Correct answer: Treating both conditions together in one shared plan

Current best practice for co-occurring disorders is integrated treatment, in which one team addresses both conditions together in a single coordinated plan. Treating substance use first and anxiety second is the older sequential model, and treating anxiety first assumes one condition simply underlies the other, so both leave a disorder untreated in the meantime. Separate programs running at once is parallel treatment, which tends to give conflicting messages and fragmented care.

Correct answer: Warning signs that call for a prompt, fuller evaluation

Giving away prized possessions, withdrawing and saying goodbye are classic suicide warning signs, so they call for an immediate, fuller risk evaluation. A sudden calm after such behavior can mean the person has settled on a plan, so it is not evidence that the crisis has passed. Treating the behaviors as routine sadness to revisit next session delays action on an urgent risk, and calling them normal events in life dismisses them entirely.

Correct answer: Engagement and the right to self-determination

Writing goals together with the client honors the client's right to self-determination and builds engagement, because people work harder toward goals they helped choose. Collaboration does not make clinical judgments more objective or accurate. Documentation rules can be met with or without the client's input, and collaborative planning often takes more time, so moving clients through referrals efficiently is not what it most directly serves.

Correct answer: Egocentrism

Believing the moon follows her shows preoperational egocentrism, the difficulty separating one's own viewpoint from how the world actually works. Centration is a preoperational trait too, but it means fixing on one feature of a problem, as in conservation tasks, not seeing events from one's own perspective. Reversibility develops in the concrete operational stage, and object permanence is an infant achievement of the sensorimotor stage.

Correct answer: Linked systems that both shape and reflect the client

The ecological perspective sees the client, workplace and family as linked systems with reciprocal influence, so change in one affects the others. Treating them as separate stressors to handle one at a time ignores those connections. Describing them as outside forces acting in one direction misses that the client also shapes the systems, and treating them as background to the inner psyche reverses the ecological emphasis.

Correct answer: Likely extrapyramidal effects to report to the prescriber

Muscle stiffness, tremor and restlessness (akathisia) are classic extrapyramidal side effects of antipsychotics, and the social worker should make sure the prescriber hears about them. Calling them anxiety and offering relaxation training mislabels a medication effect. Reading them as worsening psychosis that needs a higher dose could make the effects worse and is outside a social worker's scope, and calling them harmless reactions ignores symptoms that need medical review.

Correct answer: Distress or impairment that is clinically significant

Most DSM-5-TR diagnoses include a clinical significance criterion: the symptoms must cause clinically significant distress or impairment in social, occupational or other areas of functioning. Required duration varies by disorder, from days to years, so six months is not a universal rule. DSM-5-TR diagnoses rest on clinical criteria rather than laboratory or imaging confirmation, and a family history of the same condition can raise risk but is never required.

Correct answer: Supporting new habits and plans to prevent relapse

In the action stage the client is actively changing, so the work is to support the new behavior and build relapse-prevention plans. Raising awareness of health hazards fits precontemplation, when the person does not yet see a problem. Weighing pros and cons fits contemplation, and choosing a quit date fits preparation, both of which this client has already moved past.

Correct answer: Genogram

A genogram maps family structure across at least three generations, including marriages, births, deaths and the quality of relationships. An ecomap shows the family's links to outside systems rather than its generational structure. A culturagram summarizes a family's cultural background, and a sociogram charts relationships among members of a group, so neither is built to record births, deaths and marriages across generations.

Correct answer: Normal grief reaction

Intense sadness, tears and withdrawal that fit the size of the loss and are easing over time describe a normal grief reaction. Prolonged grief disorder requires grief that persists at least a year in adults and exceeds cultural norms, which a recent and easing reaction does not meet. A major depressive episode involves pervasive symptoms such as worthlessness that are not tied to the loss, and adjustment disorder implies distress out of proportion to the stressor.

Correct answer: Pursue higher aims like esteem and fulfillment

Maslow held that lower physiological and safety needs generally must be met before a person can turn energy toward higher needs such as esteem and self-actualization. Noticing distress about missing meals or shelter is the experience of an unmet lower need, not something that waits for those needs to be met. Accepting caseworker help with shelter and dinner and using crisis services for safety are ways of meeting lower needs, so they come first rather than depending on them.

Correct answer: Build on the existing ties while addressing the work strain

An ecomap guides planning by showing which connections can be strengthened and which ones drain the client, so the plan should build on the supportive ties while working on the stress from the employer. A finished diagram does not end assessment, and one stressful bond does not cancel the client's other assets. Centering the plan on the disorder and its symptoms throws away the environmental picture the ecomap was drawn to provide.

Correct answer: Her unsafe housing and violent block are feeding her distress

The person-in-environment perspective explains a client's difficulties through the interaction between the person and her circumstances, so linking her distress to unsafe housing and a violent neighborhood fits it. Blaming a personal flaw of character, or brain chemistry and genes alone, looks only at the individual. Saying her surroundings play no part denies the environmental side that defines this perspective.

Correct answer: Measurable objectives with fixed dates for a review

Progress can only be tracked against something observable, so objectives stated in measurable terms and tied to review dates let the worker and client see whether the plan is working. A background narrative describes the past rather than setting a benchmark. A vague promise of feeling better and a list of the worker's favored theories give no criterion to measure change against.

Correct answer: Orderliness, stubbornness, and a strong need for control

Freud linked fixation at the anal stage, where toilet training is the central conflict, to an anal-retentive pattern of orderliness, stubbornness, and a need for control. Dependence, gullibility, and overeating are the traits he tied to oral fixation. Vanity and recklessness belong to phallic fixation, and mature intimacy with productive work describes healthy arrival at the genital stage rather than any fixation.

Correct answer: Use can mimic, hide, or intensify the mood problems seen

Alcohol and drugs can produce depressive symptoms, mask them, or make them worse, so screening is needed to understand the presentation and plan treatment. The clinical reason has nothing to do with payers denying claims. Finding substance use does not rule out depression, since the two often co-occur, and a screen cannot show whether someone is truthful; it is a structured way to gather information.

Correct answer: A powerful predictor that raises the chance of a later attempt

A prior suicide attempt is one of the strongest predictors of a future attempt, so it raises the client's assessed risk. Surviving an attempt is not a protective factor. It is never a detail to set aside, and its weight does not vanish because the attempt was months or years ago.

Correct answer: Internal working models of self and others

Bowlby proposed that early attachment experiences form internal working models, mental templates of the self and others that shape expectations in later relationships. The pleasure principle is part of Freud's account of the id. Conservation is a Piagetian cognitive milestone, and the zone of proximal development is Vygotsky's idea about guided learning; none of these explains how infant bonds carry into adult relationships.

Correct answer: Tied closely to the needs and problems that were revealed

Goals should come straight out of what the assessment revealed, so they address the client's actual needs and problems. A standard template ignores the individual findings. Building goals from the diagnosis instead of the client's wishes undermines collaboration, and goals picked before the first interview cannot reflect an assessment that had not yet happened.

Correct answer: A survivor with resilience and skills ready to be mobilized

The strengths perspective sees the client as someone who has already survived hardship and brings resilience and skills that can be used to address unemployment. Defining the person by deficits, treating past setbacks as proof that change will fail, or leading with pathology are all deficit-based views that this perspective rejects.

Correct answer: A system's pull toward stability and away from change

In systems theory, homeostasis is a system's tendency to keep its balance and resist change, which is why families often slide back into familiar patterns. It does not mean a household without stable rules or roles, and it is no promise that relatives avoid open disputes. Regulating body heat is the biological meaning of the word, not the family systems concept.

Correct answer: Physiological dependence on the drug

Sweating, agitation, and muscle aches that appear when opioid use stops are withdrawal signs, and withdrawal shows the body has adapted to the drug, which is physiological dependence. Intoxication is the effect of taking the drug, not of stopping it. These symptoms are not psychotic features, and a withdrawal syndrome rules out casual use with no established pattern.

Correct answer: A routine, safe inquiry that does not raise danger

Asking directly about suicidal thoughts is a standard part of risk assessment, and research shows it does not raise risk; it often brings relief and more honest disclosure. It does not plant ideas of suicide. Safety assessment is a legitimate reason to ask, so it is not an improper intrusion on privacy, and a client who does not look upset can still be having suicidal thoughts.

Correct answer: Cultural values, laws, and public norms

In Bronfenbrenner's ecological model, the macrosystem is the outer layer of culture, laws, and societal norms that shapes every other level. Household members are part of the microsystem. Links between home and classroom form the mesosystem, and policies set by a parent's employer belong to the exosystem, a setting that affects the client without the client being in it.

Correct answer: Record difficulties and current capacities

Pairing the strengths perspective with assessment means recording the presenting difficulties and also the client's current capacities, so both can inform the plan. Documenting deficits to justify reimbursement leaves out strengths. Sidestepping hardships leaves the problems unassessed, and favoring the worker's impressions over self-report ignores the client as the expert on their own life.

Correct answer: Sedation, dependence, and dangers if mixed with alcohol

Benzodiazepines cause sedation, carry a real risk of physical dependence, and can depress breathing dangerously when combined with alcohol. Weight gain with raised lipids and blood sugar is the metabolic profile of second-generation antipsychotics. Tremor, thirst, and blood-level monitoring describe lithium, and sexual side effects with a delayed onset are typical of SSRIs, while benzodiazepines act quickly.

Correct answer: Piaget's theory of cognitive development

Piaget's concrete operational stage, roughly ages 7 to 11, is when children begin to reason logically about concrete objects, for example mastering conservation. Erikson describes psychosocial crises such as industry versus inferiority, not reasoning ability. Kohlberg traces how moral judgments develop, and Freud's psychosexual stages concern the focus of libido, so neither explains logical operations.

Correct answer: Family patterns over time and ties to outside systems

A genogram maps family structure and patterns across generations, and an ecomap shows the client's ties to outside systems, so together they give an internal and an external view. Neither tool produces a diagnostic score or predicts future conduct. They do not summarize lab results or medications, and they supplement the interview and informed consent rather than standing in for them.

Correct answer: A person-in-environment practice model

Explaining the veteran's sleep problems and irritability through both his combat history and his crowded, unstable housing joins individual and environmental factors, which is the person-in-environment model of social work practice. A biomedical disease approach leaves out the housing context. A trait framework looks only at stable internal characteristics, and psychoanalytic drive theory focuses on unconscious conflict rather than current living conditions.

Correct answer: Abstract thinking and everyday judgment

Interpreting a proverb tests abstract thinking, and asking what the client would do on smelling smoke in a theater tests everyday judgment; both are standard mental status items. Attention and concentration are usually checked with serial sevens or spelling a word backward. Mood and affect are reported and observed feelings, and orientation and memory are checked by asking about time and place and having the client recall words.

Correct answer: Whether a medical condition or substance use better explains them

DSM-5-TR asks the clinician to rule out that symptoms are better explained by another medical condition, such as a recent head injury, or by a substance before diagnosing a primary mental disorder. Whether the client agrees with the diagnosis and which diagnosis pays more are not diagnostic criteria. How annoying the family finds the symptoms is not the test either; the question is what actually causes them.

Correct answer: A time-limited imbalance that overwhelms her own defenses

Crisis theory describes a crisis as a temporary state of disequilibrium in which an event overwhelms a person's usual coping, which is why her normal strategies are failing hours after the accident. A personality disorder is a long-standing pattern, not a sudden reaction. Nothing suggests she is exaggerating to get assistance, and an acute emotional reaction is not evidence of a permanent neurological deficit.

Correct answer: Identify the major problem the person faces right now

Once safety is secured and rapport is built, structured crisis models such as Roberts' seven stages move to identifying the major problem so the work stays focused on the present. Closing the case with check-ins months away abandons the client mid-crisis. A personality test battery and an exploration of childhood roots are slow, long-term activities that do not fit the immediate, problem-focused pace of crisis intervention.

Correct answer: Activate reachable friends, peer groups, and local aid

A client who feels alone after a sudden loss needs connection, so crisis work actively mobilizes whatever friends, peer groups, and community resources are available. Avoiding any reference to relationships and limiting visits would deepen the isolation. Waiting for mourning to resolve before offering practical help leaves the client without support during the acute period when it matters most.

Correct answer: Dichotomous thinking

Treating one mistake as proof of being a total failure sorts the self into only two categories, which is dichotomous, or all-or-nothing, thinking. Emotional reasoning treats a feeling as evidence of fact. Mind reading assumes what others are thinking without evidence, and personalization blames the self for events outside one's control; none of these is the black-and-white judgment in the statement.

Correct answer: Socratic questioning

Guiding a client through a series of questions to test how accurate and useful a belief is defines Socratic questioning, the main tool of cognitive restructuring in CBT. Free association is a psychoanalytic method of saying whatever comes to mind. Thought stopping interrupts unwanted thoughts rather than examining them, and systematic desensitization pairs relaxation with graded exposure, not questioning.

Correct answer: Holding acceptance and change together

DBT rests on the dialectic of accepting the client as they are while pushing for change at the same time, which is exactly what validating pain and insisting on new skills combines. Remaining neutral and quiet is the opposite of the worker's active stance. Interpreting transference belongs to psychodynamic therapy, and shaping behavior with no validation drops the acceptance half of the dialectic.

Correct answer: Core mindfulness

Observing the present moment without judgment and participating one-mindfully are the what and how skills of the core mindfulness module, which underpins the rest of DBT. Distress tolerance teaches crisis survival and radical acceptance. Emotion regulation targets understanding and changing emotions, and interpersonal effectiveness covers asking for what one needs in relationships, not present-moment awareness.

Correct answer: Distress tolerance

TIPP, which stands for temperature, intense exercise, paced breathing, and paired muscle relaxation, is one of the crisis survival skills taught in the distress tolerance module. Emotion regulation builds longer-term skills for changing emotions. Core mindfulness teaches nonjudgmental awareness, and interpersonal effectiveness teaches assertive requests, so neither is where TIPP is taught.

Correct answer: Emotion regulation

Lowering vulnerability to negative emotions by treating illness and attending to eating, sleep, exercise, and substance avoidance is the PLEASE skill set in the emotion regulation module. Distress tolerance covers getting through a crisis without making it worse. Core mindfulness covers present-moment awareness, and interpersonal effectiveness covers relationships, not these self-care routines.

Correct answer: Chronic mood swings with repeated self-harm acts

DBT was developed for people with chronic emotion dysregulation, repeated self-harm, and unstable relationships, the classic profile of borderline personality disorder. A mild adjustment problem after one setback calls for brief support. Help limited to career planning decisions and a single parenting skills class are educational needs that do not require a year-long, skills-intensive program.

Correct answer: Highlight and build on progress made recently

The pre-session change question draws attention to progress the client has made since booking, so those gains can be noticed and expanded. Recording a symptom inventory and tracing the difficulty to its historical causes keep the conversation centered on the problem, which solution-focused work avoids. Confronting avoidance is not the purpose of this question, which is meant to build hope and momentum.

Correct answer: Explore in detail how the person made it happen

In solution-focused brief therapy an exception is valuable information, so the worker asks in detail what the client did differently so it can be repeated. Writing it off as chance wastes it. Reading it as a sign of an unconscious motive belongs to psychodynamic work, and warning that the change will not endure undercuts the hope the approach tries to build.

Correct answer: Righting reflex

Motivational interviewing calls the helper's urge to fix the problem by directing and persuading the righting reflex, and workers are taught to resist it because it tends to provoke resistance. Rolling with resistance is the MI response to pushback, not the urge that causes it, and developing discrepancy helps clients see the gap between their values and behavior. Positive regard is a Rogerian condition of acceptance, not a fix-it impulse.

Correct answer: Affirm and consolidate the person's change talk

Ending a summary with the client's own reasons for change, then asking for their reaction, is a deliberate way to affirm and consolidate that change talk. It is not a way to maneuver the client into a commitment they did not want. Asserting the worker's expertise and authority runs against MI's collaborative spirit, and the summary invites more discussion rather than announcing that the session is ending.

Correct answer: Removing harsh cues that could trigger distress

Calming the waiting room, ending sudden loud announcements, and training staff to greet clients gently all remove harsh environmental cues that can trigger distress or retraumatize people, which is central to trauma-informed safety. Requiring full trauma disclosure at intake violates client choice. Limiting care to people holding formal diagnoses and speeding up visits at the cost of comfort work against the safe, welcoming setting trauma-informed care requires.

Correct answer: Trustworthiness and transparency

Explaining what to expect, keeping commitments, and acting consistently are the behaviors SAMHSA lists under trustworthiness and transparency. Collaboration and mutuality is about sharing power and decisions between staff and clients. Empowerment, voice, and choice is about building client control and options, and the cultural, historical, and gender principle addresses bias and identity rather than reliability.

Correct answer: Peer support and mutual self-help

Hiring people with lived experience of trauma and recovery to support current clients is the SAMHSA principle of peer support and mutual self-help, which builds trust, hope, and collaboration. Safety concerns the physical and emotional security of the setting. The cultural, historical, and gender principle concerns bias and identity, and empowerment, voice, and choice concerns client control, so none of these names the use of peers.

Correct answer: Let her set the pace of disclosure and prioritize safety

Trauma-informed practice gives the client control over what she shares and when, and starts by building safety and engagement. Requiring a full trauma story or pressing for specifics at intake can retraumatize her and takes that control away. Transferring her elsewhere until she can discuss it in depth withholds services and treats disclosure as the price of care.

Correct answer: Meeting clients where they are, to lessen risks of use

Giving a client who keeps drinking practical ways to reduce harm, such as safer limits, hydration, and not driving impaired, shows the harm reduction principle of meeting people where they are and lessening the risks of continued use. Insisting that abstinence is the one true goal and refusing help until the client quits are abstinence-only stances. Treating any drink as failure is the judgmental framing harm reduction rejects.

Correct answer: Greater family understanding and support that avert new episodes

Family psychoeducation teaches relatives about the illness, warning signs, and calmer communication so they can support the client and lower expressed emotion, which reduces the risk of relapse. It does not place responsibility for the illness on relatives. It supports antipsychotic medication rather than eliminating the need for it, and uncovering repressed secrets is an insight-oriented goal, not the aim of psychoeducation.

Correct answer: A clear service contract

The task-centered model formalizes the target problem, goals, and time limit in an explicit contract between worker and client. A release of information authorizes sharing records with others. A closing summary documents the end of services, and a genogram legend explains the symbols on a family diagram, so none of them is the working agreement.

Correct answer: Examine the obstacles and redesign or divide the work

When a task is not completed, the task-centered model reviews what got in the way and then redesigns the task or breaks it into smaller steps. Labeling the client resistant and closing the case ignores the obstacles. Swapping in a problem the worker prefers breaks the agreed contract, and disregarding the unfinished task loses the chance to learn from it.

Correct answer: Summarizing

Pulling together the main themes of a session and checking that they were understood correctly is summarizing. Reframing offers a new way of seeing a problem, and probing asks questions to dig deeper into one point. Disclosing shares something from the worker's own life, so none of these is the act of drawing the themes together and confirming them.

Correct answer: Reflecting emotion

Naming an emotion the client is showing but has not said, such as the anger behind clenched fists, is reflecting emotion, the skill usually called reflection of feeling. Paraphrasing restates the facts of what was said, not the emotion. Closed questioning asks for short answers, and reassurance tries to comfort, so neither puts the unspoken feeling into words.

Correct answer: A minimal encourager

A short prompt such as "tell me more" that invites the client to keep talking is a minimal encourager. A scaling question asks for a rating, such as zero to ten. A closed-ended question invites a yes or no answer rather than more of the story, and an interpretation offers the worker's view of the meaning.

Correct answer: The strength of the working alliance

Common-factors research finds that elements shared by all effective treatments, above all the therapeutic alliance, account for much of client improvement. The particular model used and the program where the worker trained are exactly what differ between the two treatments, so they cannot explain the shared result. The sequence of skills taught is also treatment-specific rather than common.

Correct answer: Validation of what the person feels

The statement shows the worker understands how the situation feels from the client's side, which is empathic validation. Sympathy feels sorry for the client from outside their experience. Validation does not mean agreeing that the client's view is accurate, and analyzing hidden motives goes beyond what the client has expressed.

Correct answer: A normal reaction to closure that is worth processing

Symptoms often flare as termination approaches, especially for clients who have relied heavily on the worker, and this reaction to closure should be named and worked through. It does not mean discharge should be put off forever. It is not a new, unrelated disorder, and extending services with no review of progress avoids the ending rather than processing it.

Correct answer: Give ample notice and arrange a referral or transfer

When a worker leaves an agency, the NASW Code of Ethics expects reasonable notice and help arranging a referral or transfer so the client's care continues. An unexplained letter, leaving the client to arrange further care unaided, or quietly ceasing to book sessions would each amount to abandoning the client.

Correct answer: Service coordination

Bringing the physician, housing specialist, and vocational counselor together to align their plans is service coordination, a core case management function. Individual therapy is direct one-to-one treatment. A diagnostic intake assesses the client, and clinical oversight of the worker's practice is supervision, so neither describes coordinating several providers.

Correct answer: Closer, hands-on help that keeps clients engaged longer

Small caseloads and frequent community contact let intensive case managers give close, hands-on help, which keeps clients with serious mental illness engaged and improves outcomes. The aim is not more documentation per session. The model increases contact instead of cutting it to let caseloads grow, and it works alongside psychiatric and therapeutic care rather than replacing it.

Correct answer: Blocking the dominant member and asking quiet ones to speak

Blocking, also called cutting off, tactfully limits the dominant member and redirects the floor to quieter members, which directly rebalances participation. Praising the dominant member rewards the very behavior that is crowding others out. Pressing quiet members to justify their silence puts them on the spot and usually deepens withdrawal. Side pairings move talk out of the full group and leave the dominance pattern in place there.

Correct answer: Altruism

Altruism is the curative factor in which helping another member is itself therapeutic, raising the helper's sense of worth and capability. Cohesion is the sense of belonging and attraction to the group, not the benefit of giving help. Catharsis is the release of strong emotion. Universality is the relief of learning that others share one's problems, which describes the member receiving the strategy rather than the one offering it.

Correct answer: Treating the conflict as rich material for members to explore

The worker is using the disagreement as material, recasting it as a sign of safety so members can explore it in the here and now. Halting it early would shut the exchange down and lose that opportunity. Mediating a truce treats the conflict as a problem to settle and end, not as material to use. Tracing it to family history shifts to individual interpretation of the past instead of the group's present process.

Correct answer: Systemic family therapy

Circular questioning, in which one member is asked about the relationship between two others, comes from the Milan school of systemic family therapy and is used to surface interactional patterns. Cognitive behavioral therapy targets one person's thoughts and behaviors. Psychodynamic insight therapy explores an individual's unconscious conflicts. Person-centered therapy relies on empathic reflection, not questions that map relationships among other people.

Correct answer: Setting shared rules and clear limits among new subsystems

A remarried family needs shared rules and clear boundaries between its new subsystems, such as the couple, the siblings, and each parent-child pair. Handing the stepparent full control of discipline early tends to provoke resistance; the biological parent usually leads discipline at first. Restoring the first family's norms ignores the members who joined. Letting each child pick whose rules to follow undermines the parental subsystem.

Correct answer: Organizing the community

Helping residents build a coalition, set shared goals, and negotiate with officials is community organizing, which mobilizes people for collective action on a larger system. A needs assessment only documents what a community lacks; it does not mobilize anyone. Case management coordinates services for one client. Policy analysis studies the effects of a policy rather than organizing residents to act.

Correct answer: Class advocacy aimed at a statewide policy

Testifying for a bill that affects an entire population is cause or class advocacy, which seeks policy change for a group. Case advocacy works on one client's situation, such as access to a single service. Self-advocacy is a client speaking up for themselves, not the worker testifying. Advocacy aimed at an agency's internal procedures targets that organization, not a state legislature.

Correct answer: Universal prevention

A campaign aimed at the whole population before problems appear is universal, or primary, prevention. Selective prevention targets subgroups known to be at elevated risk. Indicated prevention targets individuals who already show early signs. Tertiary prevention limits disability from a condition that is already established.

Correct answer: Indicated prevention

Serving only students who already show early warning signs, to keep problems from escalating, is indicated prevention, which corresponds to secondary prevention in the public health model. Universal prevention reaches every student regardless of risk. Selective prevention targets groups at elevated risk who do not yet show signs. Tertiary prevention addresses a disorder that is already established.

Correct answer: Cultural humility

Lifelong self-reflection about one's own biases, combined with treating the client as the expert on his culture, is the definition of cultural humility. Cultural competence stresses acquiring knowledge and skill about groups, which can imply a finished mastery that humility rejects. Cultural relativism is the view that practices should be judged within their own culture. Cultural pluralism describes a society in which many cultures coexist.

Correct answer: Adapt the delivery while keeping the core components intact

Competent cultural adaptation changes how the intervention is delivered to fit the community while keeping the core components that make it effective. Delivering it unchanged ignores the cultural mismatch that can reduce engagement. Replacing it with a locally designed program gives up the evidence base. Translating materials alone is a surface fix that leaves values, examples, and format unexamined.

Correct answer: Measurement-based care

Giving a validated symptom measure every session and reviewing the trend with the client to guide treatment is measurement-based care. Goal attainment scaling rates progress on individualized goals rather than a standard symptom scale. Process recording is a written account of a session used in supervision. Formative program evaluation assesses a program while it is being developed, not one client's ongoing care.

Correct answer: Set a baseline that later phases can be compared against

In a single-system design, the measurements taken before the intervention form the baseline, and change during the intervention phase is judged against it. They are not a diagnostic step. They do not gauge motivation to begin. Although repeated measures should be stable, the purpose of this phase is comparison, not testing the instrument's reliability.

Correct answer: Secure her immediate safety and limit access to the means

A specific plan for tonight plus access to means signals imminent risk, so the first priority is her immediate safety, including reducing access to the lethal means. Exploring the story behind the crisis can follow once she is safe. A verbal no-harm contract does not protect a client at imminent risk and is no substitute for safety measures. An intake tomorrow is too late for a plan she intends to carry out tonight.

Correct answer: A psychoeducational group debriefing

A structured meeting held right after a critical incident, where staff share reactions and learn about normal stress responses, is a psychoeducational debriefing within crisis response. A multi-week trauma-processing group is longer-term treatment, not an immediate one-time meeting. An individual symptom assessment evaluates one person and teaches nothing about normal reactions. A bereavement support group is an ongoing service rather than an early crisis response.

Correct answer: Interoceptive exposure

Deliberately bringing on feared bodily sensations, such as a racing heart, so the client learns they are harmless is interoceptive exposure. In-vivo exposure confronts feared situations or places in real life. Imaginal exposure has the client confront a feared scene in imagination. Systematic desensitization pairs relaxation with an imagined fear hierarchy rather than inducing physical sensations.

Correct answer: Catastrophizing

Leaping to the worst possible outcome from an uncertain event, such as reading a missed call as a sign of injury, is catastrophizing. Personalization is taking responsibility for events that have nothing to do with oneself. Overgeneralization draws a sweeping rule from a single incident. Mislabeling attaches a harsh global label to oneself or others based on one behavior.

Correct answer: Interpersonal effectiveness skills

DEAR MAN, a script for asking for what you need while protecting the relationship, belongs to the interpersonal effectiveness module. Core mindfulness teaches present-moment awareness. Distress tolerance teaches getting through a crisis without making it worse. Emotion regulation teaches understanding and changing emotional responses.

Correct answer: Teaching and rehearsing skills in a structured class format

The DBT skills group is run like a class: it teaches the skill modules and has members practice them. Crises are deliberately handled in individual therapy, not processed in the skills group. The group adds to individual therapy rather than replacing it. Phone coaching is a separate mode of comprehensive DBT, not the purpose of the skills group.

Correct answer: Small changes tend to ripple outward into larger change

Solution-focused therapy assumes change is constant and that a small change can set off larger ones, which is why it builds on the preferred future and small next steps. It holds that insight into causes is not required. It does not require a full problem history before goals are set. It treats the client, not the worker, as the expert who sets the direction.

Correct answer: Open questions, Affirmations, Reflections, Summaries

OARS stands for open questions, affirmations, reflections (reflective listening), and summaries. Assessments are not one of the core skills and are not the A in the acronym. Support and reframing are useful moves but are not letters of OARS. Observations is not one of the core skills either.

Correct answer: Reflect her wish to cut down and invite her to elaborate

Reflecting the change talk, her wish to cut down, and inviting her to elaborate strengthens it without pushing. Pointing to her doubt as proof she is not ready reinforces the sustain talk. Reassuring her it will work out is the righting reflex and tends to draw out more doubt. Pressing for a firm quit date jumps ahead of her stated readiness and invites resistance.

Correct answer: Empowerment, voice, and choice

Offering real choices about timing, seating, and topics restores a sense of control, which is the SAMHSA principle of empowerment, voice, and choice. Trustworthiness and transparency concern clear, consistent communication about how services work. Collaboration and mutuality concern sharing power in the relationship, but the act here is giving the client choices. Peer support refers to help from people with lived experience of trauma.

Correct answer: View it as an adaptation that previously helped them cope

A trauma-informed reframe sees the behavior as an adaptation that once helped the person survive, which changes the question from what is wrong with them to what happened to them. Treating it as defiance to be met with consequences repeats the control dynamics trauma-informed care avoids. Behavior charts treat it as a simple skills gap and ignore its origin. Jumping to a personality disorder pathologizes a response that trauma can explain.

Correct answer: Retraumatization can stem from policies and from sessions

Reviewing policies for dynamics of control and powerlessness reflects the idea that an organization can retraumatize clients through its systems, not just through what happens in sessions. Trauma-informed care is an organization-wide approach, not a task for direct staff alone. Policies shape clients' daily experience, so treating them as only an accreditation or legal matter misses that. Limiting trauma's relevance to the therapy room ignores every other contact a client has with the agency.

Correct answer: Staying alive matters more than any demand for abstinence

Handing out test strips and overdose-reversal training puts keeping people alive ahead of any requirement to stop using, a core harm reduction value. Harm reduction does not treat abstinence as the real goal with safety tools as a temporary stopgap. It does not make help conditional on progress toward abstinence. It also does not reserve help for people who agree to detox; it meets people where they are.

Correct answer: Support the switch as a legitimate drop in the overall harm

Switching from injecting to a less risky route is a real reduction in harm, so harm reduction supports it as legitimate in its own right. Making support conditional on a promise to taper adds a demand the client did not choose. Framing it as a step toward required abstinence keeps an abstinence goal the client has not set. Moving off injection does reduce harm, since it removes needle-related risks such as HIV, hepatitis C, and abscesses.

Correct answer: Shared decisions and steadier adherence to the medication

Knowing how the medication works, when to expect benefit, and which side effects to watch for lets the client take part in decisions and makes adherence more likely. It does not shift dosing decisions away from the prescriber. It gives the social worker no grounds to override the prescriber on dosage. It supplements the prescriber's informed consent discussion rather than replacing it.

Correct answer: Easing caregiver strain and building coping skill

Caregiver psychoeducation is meant to reduce caregiver stress and build the knowledge and skills needed to cope. Teaching caregivers does not slow the disease itself. Attending a class has nothing to do with eligibility for long-term care placement. It complements respite and other formal supports rather than replacing them.

Correct answer: Few agreed-upon target problems within a set timeframe

The task-centered model focuses on a small number of target problems that the client acknowledges, worked on through tasks within a set, brief time frame. It avoids an open-ended look back at early history. Goals are agreed with the client, not set by the worker after an assessment. It is time-limited by design, not continued until every problem is resolved.

Correct answer: Pin down the concrete meaning behind a vague statement

Asking what exactly has been hardest is a clarifying question that turns a vague statement into a concrete, precise account. A summary pulls together themes already discussed rather than asking for detail. A reflection of feeling names the emotion back to the client and does not ask a question. Confrontation points out a discrepancy, and none has been noted here.

Correct answer: The nonverbal message layer

Tone, facial expression, and body language are nonverbal communication, which adds meaning to what the client says. Verbal content is the words themselves, which the worker is attending to in addition. Latent symbolic meaning is a psychoanalytic idea about hidden content, not the observable cues described. Cognitive appraisal concerns how the client interprets events, not how the client conveys them.

Correct answer: Goals, tasks, and bond

Bordin described the working alliance as agreement on goals, agreement on tasks, and the emotional bond between worker and client. Empathy, warmth, and genuineness are Rogers' facilitative conditions. Engaging, focusing, and evoking are processes of motivational interviewing. Transference is a psychodynamic concept and is not one of Bordin's three components.

Correct answer: Unconditional positive regard

Keeping warmth and regard for the client as a person, whatever the behavior, is unconditional positive regard. Accurate empathy is understanding the client's experience from the inside. Congruence is the worker being genuine and transparent about their own reactions. Therapeutic neutrality is a stance of not taking sides and does not involve active warmth.

Correct answer: Planning relapse prevention

Identifying situations that could trigger a setback and rehearsing how to cope with them is relapse prevention planning. Consolidating gains reviews what has already been achieved rather than preparing for future risks. Processing feelings about ending addresses the emotions of termination. Booster sessions are follow-up contacts, not the rehearsal of coping with triggers.

Correct answer: Connecting the client with outside services that fit

As a broker, the social worker links the client to community resources and services that match the client's needs. Doing all the counseling personally is the clinician role, not brokering. Pressing agencies to change their policies is the advocate role. Teaching daily living skills is the educator or enabler role.

Correct answer: Convene the agencies to align one shared service plan

Coordinating communication among the agencies so they work from one shared plan is the core case management response to duplicated and conflicting services. Having the client quit an agency without review may cut off a needed service. Deferring to whichever agency opened the case first does not resolve the conflict. Complaints may sour the working relationships and still leave the plans unaligned.

Correct answer: Norms

Shared expectations that guide how all members behave, such as confidentiality, respect, and attendance, are group norms. Cohesion is the members' sense of belonging and attraction to the group. Roles are expected behaviors attached to particular positions, not rules for everyone. Group process refers to the interactions and dynamics among members as the group works.

Correct answer: Composing the group

Selecting members so they are alike enough to relate yet different enough to learn from each other is group composition. Contracting sets the agreement about goals and expectations with members already chosen. Setting norms shapes behavior once the group meets. Defining the purpose decides what the group is for, not who belongs in it.

Correct answer: Triangulation

When two people in conflict lower their tension by drawing in a third, such as parents focusing on a child, the pattern is triangulation. Enmeshment is overly close boundaries with little individual autonomy. Parentification puts a child in a caretaking role for a parent. Disengagement is overly rigid boundaries with little connection.

Correct answer: Lower defensiveness so that needs are voiced more clearly

Speaking from one's own feelings with I statements lowers defensiveness and helps each person voice needs clearly. The goal is not to decide whose account of events is accurate. The intervention works on how partners talk in the present, not on uncovering past hurts. Venting anger fully tends to escalate conflict rather than calm it, which is why the therapist slows the exchange down.

Correct answer: Organizer uniting tenants for joint action

Helping tenants document conditions, build a coalition, and press the landlord together is the organizer role, uniting a group for collective action. A broker would only refer tenants to legal services, while here the worker builds a coalition with them. A mediator stays neutral between the parties, but this worker sides with the tenants. An educator teaches tenants about the law but does not organize them to act.

Correct answer: Tertiary prevention

Relapse prevention and supported employment for people who already have a serious substance use disorder limit long-term disability, which is tertiary prevention. Secondary prevention catches a problem early, before it is established. Indicated prevention targets people showing early signs, not an established disorder. Primary prevention acts before any problem develops.

Correct answer: Build the family's shared way of deciding into the plan

Culturally competent practice builds the family's collective way of deciding into the plan, since that is how this client prefers to make health choices. Coaching the client to decide alone imposes an individualist value. Excluding the client from discussions ignores the client's own voice within the family process. Holding the plan until the client decides alone delays care and still imposes individual autonomy.

Correct answer: Best research, clinical expertise, and client preferences

Evidence-based practice integrates the best available research, the practitioner's clinical expertise, and the client's values and preferences. Swapping client preferences for an agency mandate drops the client's voice. Consumer wishes, colleague norms, and funder requirements leave out both research and expertise. Manuals, outcome data, and supervisor direction can inform practice but omit the client's values.

Correct answer: Critically appraising each study's quality

Weighing interventions by how well the supporting studies were conducted for this age group and problem is the critical appraisal step of evidence-based practice. Framing the question comes first and decides what to look for. Searching databases finds studies but does not judge their quality. Evaluating outcomes happens after the intervention has been delivered.

Correct answer: Crisis intervention

Assessing the client's perception of the precipitating event, available supports, and usual coping is the early appraisal step of crisis intervention, drawn from Aguilera's balancing factors. Task-centered casework organizes work around agreed target problems and tasks rather than appraising a crisis. Solution-focused therapy looks for exceptions and a preferred future rather than appraising the precipitating event. Motivational interviewing works with ambivalence about change.

Correct answer: A life experienced as worth living

DBT states its overarching goal as building a life worth living, in the client's own terms. It does not aim to empty life of painful emotions, which skills such as distress tolerance teach clients to bear. Strict self-control is not the goal; DBT balances acceptance with change. Understanding the past is not its focus, since DBT is a skills-based behavioral treatment.

Correct answer: A focus on present goals and preferred futures

Asking what the client wants to be different, rather than why the problem started, reflects the model's present- and future-oriented, goal-directed focus. Insight into origins is exactly what the worker sets aside here. Cataloguing deficits and symptoms is a problem-focused stance the model avoids. The worker's expert causal analysis conflicts with the model's view of the client as the expert.

Correct answer: A strengths-based recovery stance

Building on resilience and the capacity to heal reflects the strengths-based, recovery-oriented stance of trauma-informed care. Safety is a trauma-informed principle, but a stabilization focus does not describe emphasizing resilience. A symptom-focused medical stance centers on pathology, the very thing the worker moves away from. Exposure-based trauma processing is a specific treatment, not this orientation.