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Caught in the Middle: Ethical Challenges in Working with Couples and Families - Test
by Gerald P. Koocher, Ph.D., ABPP and Patricia Keith‑Spiegel, Ph.D.

Course content © copyright 2016 by Gerald P. Koocher, Ph.D. and Patricia Keith-Spiegel, Ph.D.. All rights reserved.

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1. In marital relationship therapy, it is important for the therapist to point out to the couple at the onset that: Help
It is likely that one or both of the parties are having an affair.
The in-laws will be required to participate, at least on occasion.
In the course of exploring the relationship, one result may be the dissolution of the relationship.
They will be charged full fee for every appointment, even if only one party shows up.
2. The case of former Olympic gymnast Dominique Moceanu illustrates the principle that: Help
Minors can seek court declarations to become emancipated or independent of parental authority in some situations.
Even accomplished youth require parental oversight.
Parenting by immigrant families qualifies as legally different from parenting laws applied to non-immigrant families.
Olympic medals awarded to child athletes belong to their parents.
3. U. S. Supreme Court cases involving parental authority over their children have established parents' rights to choose all but one of the following: Help
The nature of their children's education
Most decisions regarding their children's health care
Their children's participation in religious activities.
Making martyrs of their children.
4. Which professional association(s) established core competencies expected of their members in treating couples and families? Help
American Association for Marriage and Family Therapy
American Psychological Association
National Association of Social Workers
All of the above
5. With respect to cultural, ethnic, religious, and other differences, which of the following statements about couple and family therapists is true? Help
No family therapist will have the knowledge or cultural competence to serve every family they may encounter.
Recognizing and treating cultural differences is easy for most therapists.
Consultation on addressing cultural or ethnic differences among one's clients is rarely necessary.
Concerns about cultural or ethnic differences are largely matters of political correctness unrelated to psychotherapeutic care.
6. When treating couples and families complications usually include: Help
Angry people.
People with diagnosable psychopathology.
Duties of care to several individuals with conflicting preferences and needs.
A primary obligation to one person who has agreed to pay the cost of treatment.
7. More than four decades ago, the American Psychological Association Task Force on Sex Bias and Sex Role Stereotyping found that family therapists are vulnerable to particular biases. Which of the following statements represents such a bias? Help
Remaining in a marriage represents the better adjustment for a woman.
There is a tendency to hold a double standard in response to the extramarital affairs of a wife versus those of a husband.
There is less sensitivity to a wife's career as compared to the husband's career.
All of the above reveal biases.
8. When a therapist strongly believes that an entire family must be seen for treatment to succeed, but is faced with a very resistant family member who refuses, the therapist should: Help
Coerce the reluctant family member into treatment for the sake of the rest of the family.
Permit the reluctant family member to deny treatment to the other family members in hopes that the other family members will persuade the reluctant family member into participating.
Provide names of other therapists who may be willing to treat only part of the family.
Ask the family to put considerable pressure on the reluctant family member.
9. Family members often keep secrets from each other. How can a family therapist best respect confidentiality in this context? Help
Only keep secrets if necessary to avoid conflict in the family.
Formulate a policy based on therapeutic goals and defining that policy to all concerned at the outset of treatment.
Never agree to keep a secret from other members of the family.
Only keep secrets offered by family members over 18 years of age.
10. At times therapists may find it useful to bring collateral participants into a session. For example, inviting a nuclear family member into an individual session or inviting an extended family member into a couple's session. When attempting such collateral involvement therapists should: Help
Carefully clarify their role and establish the boundaries of a professional contract and purpose of the collateral person's participation at the start of the interaction.
Assure everyone that they will be treated equally as client.
Adjust the charges for the session based on the number of participants.
Remember that the most important person in the room is the collateral visitor and assure them of full confidentiality.
11. Which of the following is not a key element of a therapeutic contract? Help
A clear statement of who the client is and what duties are owed to him/her/them
An agreement about therapeutic goals
A review of the therapist's background and experience
A description of fees and payment practices.
12. When it becomes clear that the best interests of the couple in therapy diverge and may not be resolvable the therapist should: Help
Terminate treatment.
Identify the potential incongruity as a topic for discussion in treatment.
Ignore the incongruity and press the couple to cooperate more effectively.
Identify which member of the dyad is behaving most unreasonably and call them out.
13. If one parent brings a child for treatment and tells the therapist that he or she has "full legal custody," and claims that the other parent is not involved in the family's life the therapist should: Help
Proceed with treatment.
Refuse to accept the case without full participation of the other parent.
Ask the child for his/her preferences and act accordingly.
Seek official documentation regarding the legal authority of the presenting parent and preferences of the other parent before proceeding.
14. A couple's therapist has kept a single set of clinical records for all sessions. Every session was attended by both parties. After treatment ends, one of the parties asks for a copy of the records. Which of the following statements is correct? Help
The client has the right to the records under the provisions of HIPAA, because the requesting client was present in treatment at every session reported in the file.
The therapist should mark the records "confidential."
The therapist should follow the records release policy that was carefully explained at the start of the therapeutic relationship.
All of the above.
15. The case of Donna Rhea involves a sexually active 14 year old. What reporting obligations does her therapist (Dr. Childs) have to the parents or child protective service authorities? Help
Donna is under 18, so mandatory reporting clearly applies.
The range of reporting responsibilities can vary widely across jurisdictions, so practitioners must remain aware of applicable laws.
The therapist should protect Donna's confidentiality no matter what.
Most states recognize 14 year olds as mature minors, capable of making decisions regarding their sexuality independent of parental authority.
16. Basic considerations regarding sharing details of child therapy with their parents include: Help
Therapy has to be safe for all participants and parents need to know information about their children that allows them to fulfill parental responsibilities.
Children have the same fundamental rights to confidentiality as adults.
Children have no confidentiality rights, and therapists can ethically share information freely with parents without informing the child of their plan to do so.
Parents of adult children in therapy have an automatic right of access to their children's records without their child's consent.
17. Under the legal principle of parens patriae states have enacted legislation that may: Help
Lead to imprisonment of psychotherapists who assault their clients.
Require a psychotherapist to release otherwise confidential information in order to protect a vulnerable party.
Allow a psychotherapist to keep a firearm in their office for self-defense.
Testify in court even if a client refuses to waive their legal privilege.
18. Mandated reporting laws have been enacted in some states to: Help
Protect children.
Protect elders.
Prevent dangerous people from obtaining firearms.
All of the above.
19. When treating family members in joint sessions and separate individual sessions, an effective way to protect confidentiality in subsequent record release requests would involve: Help
Keeping no records.
Keeping separate clinical records and psychotherapy notes.
Keeping files distinct in a manner that reflects who was present at the documented session.
All of the above.
20. Which of the following elements is NOT required in a release form under HIPAA regulations? Help
A description of the information to be used/disclosed in a specific and meaningful form
The signature of a notary public
A description of the purpose or requested use of the information
An expiration date
21. When billing for couple or family therapy it is ethically important to: Help
Describe the services rendered accurately.
Use the most benign DSM diagnosis possible.
Bill as individual sessions for each member serially.
Set a billing rate based on the number of clients present in each session.
22. In psychotherapy fee situations, a "third-party" relationship exists whenever: Help
A parent is paying for the minor child's therapy.
An organization or agency other than the client is involved in the payment to the therapist.
There is a duty to warn a third party about a client's condition.
The client brings a family member along to the therapy session.
23. You have been treating a client who has immigrated from outside the United States. The client reports a harsh regimen of disciplining his or her child that you believe amounts to child abuse. Which of the following statements applies? Help
You are not responsible for acting as a mandated reporter of child abuse because of the family's cultural differences.
Your child abuse-reporting obligations are not altered because of the client's cultural differences.
There is no need to act immediately, as you will need time to explore the cultural nuances of the situation.
You should contact a colleague who is culturally similar to the client and delay reporting.
24. Involvement in child custody disputes: Help
Is a common trigger for licensing board complaints.
Should be avoided, unless the clinician has appropriate forensic training.
Requires special consent procedures at the outset of accepting the case.
All of the above.



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